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WASP (Write a Scientific Paper): Interpretative phenomenological analysis: Its attraction and relevance to the medical field
Early Human Development 133 (2019) 52–56
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Early Human Development journal homepage: www.elsevier.com/locate/earlhumdev
Best practice guidelines
WASP (Write a Scientific Paper): Interpretative phenomenological analysis: Its attraction and relevance to the medical field
T
A R T I C LE I N FO
A B S T R A C T
Keywords: Interpretative phenomenological analysis Qualitative research Illness Medical Methodological design Reflexivity
This paper describes the use of Interpretative Phenomenological Analysis (IPA) in qualitative research and its adaptability to medical research. Whilst presenting the main tenets of the approach, it also highlights its' strengths in helping medical professionals gain rich information about their service users' needs, symptoms and experiences, via research. It discusses the application of IPA on various levels such as by contextualising quantitative data or gaining insight into patients' understanding of clinical guidelines. The paper also describes methodological choices of the approach and the reasoning behind them. It outlines the sample, data collection tools and method of analysis utilised in IPA. To help researchers locate the particular use of this approach on the qualitative research landscape, this paper also compares its' use to that of other qualitative approaches. Finally, it discusses ways of evaluating IPA studies and hence, to ensure that such studies respect the philosophical roots of qualitative research in general, and those of IPA in particular.
1. Introduction This paper describes the use of Interpretative Phenomenological Analysis (IPA) in qualitative research. IPA was developed by Jonathan A. Smith in the 1990s. The aim of this approach is essentially to gain a phenomenological understanding of individuals' experiences and perception of events. In comparison with other approaches, IPA manages to incorporate individual participants' idiosyncratic understanding and the cognitions behind their views [1,2]. It is based on the assumption that human beings are constantly engaged in the process of interpreting their experiences and that such interpretations are necessary for them to reach an understanding of the events or experiences that mark their life. To the world of medicine, this particular focus may have various implications, such as, for the type of communication between the practitioner and the patient, the extent of patient treatment adherence and for improved multi-disciplinary engagement, to name a few. From a philosophical point of view, IPA is grounded in phenomenology, hermeneutics and symbolic interactionism. These fields see human beings as co-creators of their own narratives and they assume that individuals' understanding of life events is heavily based on their interpretations of these events [1] and on their emotional reaction to them [3]. In IPA the idea of objective truth is openly dismissed. On the contrary, a lot of attention is given to one's subjective reality and how he or she interacts cognitively with it. Therefore, IPA lends itself most straightforwardly to studies designed to thoroughly investigate the lived experience of participants. In Smith's [3] own words, ‘IPA believes in a chain of connection between embodied experience, talk about that experience and a participant's making sense of, and emotional reaction to, that experience’ (p. 10). The aim of IPA is therefore to describe participants' understanding of various phenomena and how they make sense of their experiences [4,5]. https://doi.org/10.1016/j.earlhumdev.2019.03.012
0378-3782/ © 2019 Elsevier B.V. All rights reserved.
Many IPA studies explore and investigate issues related to health and well-being. For instance, a review of published studies using IPA, conducted by Smith [3] himself, indicates that ‘illness experience is, by far, the biggest individual category’ (p. 14). He explains that between 1996 and 2008, out of 293 published IPA journal articles, this category accounted for 24% of the topics under investigation. Besides covering topics which are more traditionally associated with psychology, such as living with depression (e.g., [6–8]), IPA studies have also explored topics more evidently associated with the medical field, amongst others chronic pain (e.g., [9,10]), genetic testing (e.g., [11,12]) and HIV riskrelated behaviour (e.g., [2]). 1.1. Analysing the ‘chemistry’ between IPA and the medical field Qualitative studies have been less popular amongst medical publications. Yet, it is apparent that the conclusions derived from qualitative investigations have a lot to offer to the medical professional interested in offering a good quality of service. A recent letter signed by academics sent to the British Medical Journal, [13] encourage the editors of the journal to reconsider this practice on the grounds that: Qualitative studies help us understand why promising clinical interventions do not always work in the real world, how patients experience care, and how practitioners think. They also explore and explain the complex relations between the healthcare system and the outside world, such as the sociopolitical context in which healthcare is regulated, funded, and provided, and the ways in which clinicians and regulators interact with industry’ (p. 2). In view of medical and health journals, Smith [14] acknowledges that one of the obstacles that IPA face in view of publication is the apparent parsimonious word limit assigned by these journals. This, is often quite limiting as qualitative research, including IPA studies, need
Early Human Development 133 (2019) 52–56
Best practice guidelines
‘sufficient space’ to rigorously represent the data, especially since ‘evidence’ supporting the analysis requires a number of participant quotations. This presents a true challenge for IPA as it tries to become visible to the medical profession. However, it's applications are undoubtedly extremely valuable to professionals within the field. One possible application of IPA studies in the medical field is to help professionals understand and contextualise quantitative findings and conclusions. This is mostly helpful to those opting to look at the ‘lived’ version of what is captured in numerical forms in other studies. An example of such application is the study by Mitchie, et al. [11] where the researchers attempted to understand the puzzling findings that suggest that a significant number of individuals continue to engage in seemingly unnecessary medical screenings, even after receiving a reassuring negative result provided by genetic testing. The authors discovered that these individuals' cognitions may have had a say in this: they had intrinsically very different beliefs about genes and their mutations and therefore could not truly engage with the definite result of the genetic testing (Mitchie et al., 2003). Such findings can be very helpful to medical professionals. Indeed, ‘the findings suggest that health professional communication may be an important influence in illness and test [cognitive] representations’ (p.346). These findings also help explain that essentially, the information passed on to patients in these instances may be distorted by the latter's own belief system and hence why they may not be reassured by the genetic test. Another possible application of IPA studies, is to assess the patients' perception of guidelines for service provision and their ability to understand their symptoms. For instance, a study by Osborne and Smith [31] explored the experience of women living with chronic lower back pain. Their findings suggested that the participants were clearly unhappy with the level of understanding of their symptoms. The actual lived experience of their pain deviated significantly from the medicalised version presented to them. In fact, the latter was described by the authors as ‘a major impediment to the participants’ ability to understand and accommodate to their pain’ ([31], p.75). In terms of guidelines, a more recent case study about the experience of chronic pain suggests that whereas ‘current treatment rhetoric is focused on acceptance, disengaging from the battle with pain and on developing resilience’ ([16]; p.169), the particular experience of the participant in their study indicated that resilience could be related to something more. They suggest that their participant's ‘positive trajectory’ in dealing with her condition was the result of having ‘recovered her sense of agency and control over her life’ (p.169). Whilst pointing out the need for medical personnel to engage in a deeper understanding of such experiences, such findings may also shed some light on why some medical ailments such as chronic pain, may be so financially taxing on western health systems [32]. It seems natural to conclude that the link between theoretical knowledge and practical application is not as straightforward as we imagine. IPA ‘in practice […] is most commonly used to examine experience which is of existential import to the participant’ ([3]; p. 9). Pain, disease, disorders and health in general are intrinsically laden with various levels of existential significance. This is another reason why IPA studies are possibly so relevant to the medical field.
[6,15,16]). Researchers adopting an IPA approach rely on a sample that can provide as much information as possible about the lived experience of those who face specific events or phenomena. Hence, they favour purposive sampling where the choice of participants basically depends on how closely they fit the ‘purpose’ of the study and its objectives. Furthermore, because IPA points towards unravelling the idiosyncratic understanding of experiences, the sample is predominantly homogenous. Smith and Osborne [33] explain that the level of ‘specificity’ in terms of homogeneity will depend on how rare the particular topic under investigation is. When the topic is quite unique, naturally less people may be experiencing the particular phenomena under investigation. For less unusual topics, researchers usually choose a sample that is more similar in terms of demographics, socio economic status and so on. In an attempt to ensure more homogeneity, sometimes the level of specificity is quite high. For example, in the study by Van Parys et al. [8] about the experience of growing up with a mother suffering from depression, the authors decided to define their sample as: European, White, middle class women living in the Flemish part of Belgium and aged between 39 and 47. In each case, the participant's mother was hospitalized for depression several times before the participant turned 18. All participants were married and had children between 12 and 27 years old. (p.4). Such research decisions will eventually dictate others. Considering how important it is to ensure that the participants recruited for an IPA study are able to provide the richest information in view of the research questions, it is very important that the researcher develops inclusion and exclusion criteria prior to sample recruitment. This would ensure that the sample is the best fit for the particular research question. 1.2.2. Data collection tools used in IPA In most IPA studies the data collection tool of choice is the in-depth, semi-structured interview which is believed to be the ‘exemplary method for IPA’ (Smith & Osborne, 2003; p.55). The semi-structured interview is described as a flexible tool where the researcher is guided, rather than constrained, to follow the set of questions that he or she develops, with the aim of answering the research question [5]. The questions chosen are predominantly open-ended and aimed at encouraging research participants to relate their experience in their own way. Biggerstaff & Thompson [17] refer to the interview schedule in IPA as a ‘prompt sheet’, clearly indicating that it is not meant to be prescriptive but instead, that it should be aimed at helping participants to ‘take the lead’ of the interview (p. 217). This, in turn, will enable their ‘phenomenology’ to come to the surface. Although most studies adhere to the traditional formula of conducting face-to-face semi-structured interviews, there have also been some adaptations. For instance a study by Turner and Coyle [18] used email as the communication medium between themselves, as researchers, and participants. Other studies have used focus groups in addition to one-to-one interviews (e.g., [19]). Readers seeking more information about semi-structured interviews or clearer guidelines on how to develop this type of interview schedule in IPA are encouraged to consult Smith and Osborn, [5]. Although semi-structured interviews are, as mentioned above, the most common data collection tools in IPA, some studies have also utilised other, perhaps less conventional tools in conjunction to semistructured interviews. These included the use of drawings (e.g., [16,20]), diary entries [21] or the participants' use of metaphors to describe their experiences (e.g., [22]).
1.2. Method: what does it involve? IPA studies have been quite flexible in terms of methodological design. This section provides an overview of the main elements of this methodology. 1.2.1. The sample Considering the level of detail explored in IPA studies, sample sizes are relatively small, that is, they rarely amount to more than 10 participants [4,14]. The size of the sample will also depend on the type of favoured data collection tool. For instance, a sample of one is also possible if the researcher is using a case study approach (e.g.,
1.2.3. The analytic method The following section will explore the IPA method related to face-toface semi-structured interviews as these are, by far, the most common means of data collection in IPA. For information about analysing other data collection tools as suggested above, the reader is invited to consult 53
Early Human Development 133 (2019) 52–56
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1.3. Difference between IPA and other qualitative methods
texts indicated by the citations next to the examples reported. The face-to-face interviews held with participants are usually recorded and, then transcribed verbatim for analysis. Each transcript is read thoroughly for the researcher to engage more intensely with the meanings and contextual experiences of each participant [23]. Although, reading of transcripts is often mentioned as the main step in starting to engage with the narrative of participants, Rodham et al. [24], suggest analysing the interviews by listening to them rather than simply reading them as ‘[t]he context of audio recording provides a cue to bring into awareness one's preconceptions and potential biases which should be acknowledged’ (p. 67). For instance, in their study about the health-seeking behaviours of medical trainees, one of the authors picked up a sense of passive-aggression whilst reading a transcript, whereas the other two authors, one of whom had conducted the interview and the other listened to the recording, experienced more empathy towards the participants. One's perceptions on this level are naturally quite important as they would influence how the researcher interprets the data. Hence, such elements as paralanguage and vocalics are also significant in IPA. In view of this, Smith [3] refers to a double hermeneutic, when referring to the process of the researcher trying to make sense of the research participant's own attempt at making sense of their experiences. For this reason, it becomes extremely important for researchers to keep track of their own ideas and the development of their own understanding of what has been experienced by the participant. A good analysis therefore would be able to capture both the participants' as well as the researchers' understanding of their experience and how these intertwine. As one engages with the data, themes are then identified for each participant independently. Smith et al. [4] suggest that by engaging in each participant's data, one is satisfying the ‘idiographic approach to analysis, beginning with particular examples and only slowly working up to more general categorizations or theory’ (p.220). Following this step, a second process of analysis involving the collection of inferences and reactions of the researcher to the text occurs [5]. Subsequently, over-arching themes are developed as resulting from the pool of interviews. For more information regarding data analysis, researchers embarking on their first IPA study are encouraged to consult Smith et al. [4] and Smith and Osborn [5]. Although the themes elicited from this analysis are usually discussed in the light of the findings of other literature and research studies, Smith [3] cautions researchers to ‘bracket’ or suspend any information and beliefs previously gained about the topic of investigation. Interpretation is principally sought in relation to the contexts and phenomenological understanding of the participants. Although acknowledging that this is indeed very difficult, Smith suggests that researchers should at least be aware of this and strive to be faithful to their participant's reality.
Distinguishing between IPA and other qualitative methods is not the main scope of this work. However, it may be beneficial to clarify a few of the distinguishing features between IPA and some other qualitative methods namely, content analysis, discourse analysis and grounded theory. Whilst it is true that these methods share the interest in qualitative analysis and that they also rely heavily on data collection tools which aim at delving in one's experience, they all have a different focus. In relation to content analysis, Brocki and Wearden [1] explain that ‘IPA starts with, but should go beyond, a thematic analysis’ (p.89). Whereas content analysis aims at extracting the themes from data gathered in research, in IPA the researcher is expected to engage in the understanding of people's meaning making, therefore diving into the complexity of the lived experience and unravel meaning that people develop. The individual participant and his or her idiosyncratic way of seeing life, not to mention their cognitive make up and other contextual elements are core features of IPA. Although content analysis is indeed a laborious process, it does not necessarily go in this amount of detail. Similarly, IPA and discourse analysis share the interest of language as a primary and illuminating way of delving into participants' experiences. However, even in this case the difference lies in the focus one ascribes to the use of language as a means of gaining intimate knowledge of our participants' lived experience. In IPA studies, the function of participants' ‘discourse’ is also believed to be pivotal in revealing the participants' cognitions, through a deep level of analysis [1]. Discourse analysis on the other hand is ‘skeptical’ of this position. It strives to shed light on the ‘interactive tasks being performed by verbal statements and the pre-existing discourses which speakers draw on in this process’ ([4]; p. 219). Grounded theory, as the name suggests, aims to develop theories about particular phenomena. This suggests that, whilst still being considered a qualitative method, it still attempts to discover or build a ‘theory’ which would be able to explain phenomena for a target population [1]. On the contrary, in IPA the onus lies on exploring the nuances, or shared and divergent experiences of a small group of participants. This variance has implications for the type of sampling method, for instance: whereas IPA studies favour homogenous purposive sampling, grounded theory approaches utilise theoretical sampling. The latter is a procedure whereby ‘the participants […] are selected purposefully as the analysis progresses for their ability to provide data that would confirm, challenge or expand an emerging theory’ ([26]; p. 104). Correspondingly, the size of the sample is also potentially quite different because, whereas grounded theory focuses on reaching saturation of data, that is, the recruitment of participants is expected to continue until it is felt that no new insights are being gained from additional participants [26,27], IPA is profoundly invested in the experiences of the participants one has already recruited.
1.2.4. The role of reflexivity Reflexivity takes central stage in IPA studies. This term refers to the researcher's constant awareness of the choices they make in the research process and how their own personhood, personality and cognitions interact with the topic and the analysis of the collected data. Since, as mentioned above, the researcher's own understanding of the participant's meaning making is so central in IPA, it naturally also reinforces the role of the researchers' reflexivity and essentially requires the researcher to interact closely and meaningfully with the data generated during the interviews [1,25]. Due to the double hermeneutic mentioned above, attention is given to the conjoint relationship between data generation and the researcher's self-awareness. Biggerstaff and Thompson [17] explain that ‘[t]he interviewer's thoughts and feelings are admitted as explicit and thus legitimate components of the enquiry, and their congruence or divergence from those of the participant are matters of proper enquiry’ (p. 221).
1.4. Evaluating IPA research Evaluating IPA research involves bringing together two types of review criteria: those specific to IPA and those applicable to qualitative research in general. Amongst the latter, researchers often cite those listed by Yardley [28] whilst those for IPA have been indicated by Smith [3]. The amalgamation of the two appears to be quite harmonious. The criteria mentioned by Yardley take into account the sensitivity to context; commitment and rigour; transparency and coherence; and, impact and importance of the research. The sensitivity to context refers to an awareness of the existing literature and the ‘understandings created by previous investigators’ ([28]; p. 219). In addition, the author highlights the importance of an ‘analysis that is sensitive to the data itself’ (p. 220). Jonathan A. Smith [3] seems to be elaborating on this with reference to IPA when he stresses the importance of providing enough ‘space’ to the elaboration of the different themes'. Furthermore, 54
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(1,2).
it is often stressed that one should ensure that each of the themes outlined in the final analysis is represented in the data collected during the interviews themselves [1]. This is where the concept of bracketing mentioned earlier is also quite fundamental. Yardley [29] explains that by ‘showing awareness of the participants' perspectives and setting, the sociocultural and linguistic context of the research, and how these may influence both what participants say and how this is interpreted by the researcher’ (p. 295) the researcher is able to demonstrate sensitivity to context. In view of IPA, the double hermeneutic mentioned earlier relies heavily on the researcher's self-reflexivity and the contextualising of the participants' contribution to data collection. This in turn, is believed to encourage an understanding of different contextual dimensions existing between researcher and participants [30]. In her article, Yardley groups together the elements of commitment, rigour, transparency and coherence of the data (2000; p. 221). The meaning of these elements is quite clear and ‘straightforward’. Most IPA studies report, in various levels of detail, the steps taken to ensure that they are all adhered to. In this regard, a parallel consideration of Jonathan Smith's suggestions about what makes a good IPA paper in conjunction with those presented by Yardley, leads us to recognise that the four elements presented by Yardley should assist in preserving not simply the narrative and cognitive understanding of participants' experience, but also those related to IPA and it's phenomenological routes. Commitment seems to be a principle which would undoubtedly guide Smith's guideline to provide sufficient ‘elaboration of themes’ as well as that to ensure that the paper ‘has strong data’ ([3]; p.24). In IPA, rigour in relation to the participant's own narrative, is also identified by the amount of extracts researchers should present as evidence for the relevance of the theme. Then there is also rigour intended towards IPA's methodology, as he suggests that good IPA studies ‘should be pointing to both convergence and divergence’ ([3]; p.24). Transparency and coherence are also quite central in the case of IPA. Rodham et al., (2015) suggest that although this is something which most IPA studies appear to dedicate some space discussing, there appears to be a lacuna about how, for instance, the researcher's own values and preconceptions about the topic under investigation, will impact the analytical process or how a final agreement is reached in the development of the final agreed overview of how themes and subthemes fit together. In fact, in their article they give focus significantly on this process and indicate that even something like listening to the interviews compared to simply reading the transcripts will have an impact on the interpretation one gives to the narrative. This provides food for thought for future IPA studies.
Conflict of interest statement There are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. References [1] J.M. Brocki, A.J. Wearden, A critical evaluation of the use of interpretative phenomenological analysis (IPA) in health psychology, Psychol. Health 21 (1) (2006) 87–108. [2] P. Flowers, J.A. Smith, P. Sheeran, N. Beail, ‘Coming out’ and sexual debut: understanding the social context of HIV risk-related behaviour, J. Community Appl. Soc. Psychol. 8 (1998) 409–421. [3] J.A. Smith, Evaluating the contribution of interpretative phenomenological analysis: a reply to the commentaries and further development of criteria, Health Psychol. Rev. 5 (1) (2011) 9–27. [4] J.A. Smith, M. Jarman, M. Osborn, Doing interpretative phenomenological analysis, in: M. Murray, K. Chamberlain (Eds.), Qualitative Health Psychology: Theories and Methods, Sage, London, 1999, pp. 218–240. [5] J.A. Smith, M. Osborn, Interpretative phenomenological analysis, in: J.A. Smith (Ed.), Qualitative Psychology: A Practical Guide to Research Methods, Sage, London, 2003, pp. 51–80. [6] J. Rhodes, J. Smith, “The top of my head came off”: an interpretative phenomenological analysis of the experience of depression, Couns. Psychol. Q. 23 (4) (2010) 399–409. [7] J.A. Smith, J. Rhodes, Being depleted and being shaken: an interpretative phenomenological analysis of the experiential features of a first episode of depression, Psychol. Psychother. Theory Res. Pract. 88 (2) (2015) 197–209. [8] H. Van Parys, J.A. Smith, P. Rober, Growing up with a mother with depression: an interpretative phenomenological analysis, Qual. Rep. 19 (15) (2014) 1–18. [9] M. Osborn, J. Smith, The fearfulness of chronic pain and the centrality of the therapeutic relationship in containing it: an interpretative phenomenological analysis, Qual. Res. Psychol. 5 (4) (2008) 276–288. [10] J. Smith, M. Osborn, Pain as an assault on the self: an interpretative phenomenological analysis of the psychological impact of chronic benign low back pain, Psychol. Health 22 (5) (2007) 517–534. [11] S. Michie, J. Smith, V. Senior, T. Marteau, Understanding why negative genetic test results sometimes fail to reassure, American Journal of Medical Genetics A 119 (3) (2003) 340–347. [12] J. Smith, S. Michie, M. Stephenson, O. Quarrell, Risk perception and decisionmaking processes in candidates for genetic testing for Huntington's disease: an interpretative phenomenological analysis, J. Health Psychol. 7 (2) (2002) 131–144. [13] Greenhalgh, T., Annandale, E., Ashcroft, R., Barlow, J., Black, N., Bleakley, A., … Ziebland, S. (2016). An open letter to the BMJ editors on qualitative research. British Medical Journal (Online), 352, 1–4. doi: https://doi.org/10.1136/bmj.i563 [14] J.A. Smith, Evaluating the contribution of interpretative phenomenological analysis, Health Psychol. Rev. 5 (1) (2011) 55–61. [15] V. Eatough, J. Smith, I was like a wild wild person': understanding feelings of anger using interpretative phenomenological analysis, Br. J. Psychol. 97 (4) (2006) 483–498. [16] I. Nizza, J. Smith, J. Kirkham, ‘Put the illness in a box’: a longitudinal interpretative phenomenological analysis of changes in a sufferer's pictorial representations of pain following participation in a pain management programme, Br. J. Pain 12 (3) (2018) 163–170. [17] D. Biggerstaff, A. Thompson, Interpretative phenomenological analysis (IPA): a qualitative methodology of choice in healthcare research, Qual. Res. Psychol. 5 (3) (2008) 214–224. [18] A. Turner, A. Coyle, What does it mean to be a donor offspring? The identity experiences of adults conceived by donor insemination and the implications for counselling and therapy, Hum. Reprod. 15 (9) (2000) 2041–2051. [19] P. Flowers, C. Knussen, B. Duncan, Re-appraising HIV testing among Scottish gay men: the impact of new HIV treatments, J. Health Psychol. 6 (6) (2001) 665–678. [20] P. Shinebourne, J.A. Smith, 'It is just habitual': an interpretative phenomenological analysis of the experience of long-term recovery from addiction, Int. J. Ment. Heal. Addict. 9 (3) (2011) 282–295. [21] J. Smith, Towards a relational self: social engagement during pregnancy and psychological preparation for motherhood, The British Journal of Social Psychology 38 (4) (1999) 409–426. [22] P. Shinebourne, J.A. Smith, The communicative power of metaphors: an analysis and interpretation of metaphors in accounts of the experience of addiction, Psychol. Psychother. Theory Res. Pract. 83 (1) (2010) 59–73. [23] R. Dallos, A. Vetere, Researching Psychotherapy and Counselling, Open University Press, Maidenhead, 2005. [24] K. Rodham, F. Fox, N. Doran, Exploring analytical trustworthiness and the process of reaching consensus in interpretative phenomenological analysis: lost in transcription, Int. J. Soc. Res. Methodol. 18 (1) (2013) 1–13. [25] J.A. Smith, Reflecting on the development of interpretative phenomenological analysis and its contribution to qualitative research in psychology, Qual. Res. Psychol. 1 (1) (2004) 39–54. [26] T.J.T. Kennedy, L.A. Lingard, Making sense of grounded theory in medical
2. Concluding comments This paper attempted to set the scene for IPA and its use in medical research. It analysed the meaningful relationship which IPA may have with medical literature, its method, its uniqueness compared to other qualitative designs and how to assess good IPA quality. Good qualitative research according to Yardley [28] considers the impact and importance of the study. As mentioned above, a number of IPA studies attempt to explain, in more realism and personal experience, what is being reported in quantitative studies or perhaps to look at the lived experience of some conditions. IPA studies in the medical field can, in time, help wider society and the medical profession update treatment provision and guidelines to consider the lived experience. In so doing, it may be that researchers will engage in the process of making medicine more comprehensible to the patient's eyes, increase communication efficacy and open the eyes of medical researcher to other horizons in terms of research. Acknowledgments The inspiration for this series of papers arises from the international Write a Scientific Paper course (WASP - http://www.ithams.com/wasp) 55
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[32] J. Smith, M. Osborn, Pain as an assault on the self: An interpretative phenomenological analysis of the psychological impact of chronic benign low back pain, Psychol. Health 22 (5) (2007) 517–534. [33] J.A. Smith, M. Osborn, Interpretative phenomenological analysis, in: J.A. Smith (Ed.), Qualitative psychology: A practical guide to research methods, Sage, London, 2003, pp. 51–80.
education, Med. Educ. 40 (2006) 101–108. [27] K. Charmaz, Grounded theory, in: J. Smith (Ed.), Qualitative Psychology: A Practical Guide to Research Methods, Sage, London, 2003, pp. 81–110. [28] L. Yardley, Dilemmas in qualitative health research, Psychol. Health 15 (2000) 215–228. [29] L. Yardley, Demonstrating the validity of qualitative research, J. Posit. Psychol. 12 (3) (2017) 295–296. [30] R. Elliott, C. Fischer, D. Rennie, Evolving guidelines for publication of qualitative research studies in psychology and related fields, The British Journal of Clinical Psychology 38 (1999) 215–229. [31] M. Osborn, J. Smith, The personal experience of chronic benign lower back pain: An interpretative phenomenological analysis, Br. J. Health Psychol. 31 (1) (1998) 65–83.
Miriam Geraldi Gauci, University of Malta, Msida, Malta E-mail address: [email protected].
56
Contents lists available at ScienceDirect
Early Human Development journal homepage: www.elsevier.com/locate/earlhumdev
Best practice guidelines
WASP (Write a Scientific Paper): Interpretative phenomenological analysis: Its attraction and relevance to the medical field
T
A R T I C LE I N FO
A B S T R A C T
Keywords: Interpretative phenomenological analysis Qualitative research Illness Medical Methodological design Reflexivity
This paper describes the use of Interpretative Phenomenological Analysis (IPA) in qualitative research and its adaptability to medical research. Whilst presenting the main tenets of the approach, it also highlights its' strengths in helping medical professionals gain rich information about their service users' needs, symptoms and experiences, via research. It discusses the application of IPA on various levels such as by contextualising quantitative data or gaining insight into patients' understanding of clinical guidelines. The paper also describes methodological choices of the approach and the reasoning behind them. It outlines the sample, data collection tools and method of analysis utilised in IPA. To help researchers locate the particular use of this approach on the qualitative research landscape, this paper also compares its' use to that of other qualitative approaches. Finally, it discusses ways of evaluating IPA studies and hence, to ensure that such studies respect the philosophical roots of qualitative research in general, and those of IPA in particular.
1. Introduction This paper describes the use of Interpretative Phenomenological Analysis (IPA) in qualitative research. IPA was developed by Jonathan A. Smith in the 1990s. The aim of this approach is essentially to gain a phenomenological understanding of individuals' experiences and perception of events. In comparison with other approaches, IPA manages to incorporate individual participants' idiosyncratic understanding and the cognitions behind their views [1,2]. It is based on the assumption that human beings are constantly engaged in the process of interpreting their experiences and that such interpretations are necessary for them to reach an understanding of the events or experiences that mark their life. To the world of medicine, this particular focus may have various implications, such as, for the type of communication between the practitioner and the patient, the extent of patient treatment adherence and for improved multi-disciplinary engagement, to name a few. From a philosophical point of view, IPA is grounded in phenomenology, hermeneutics and symbolic interactionism. These fields see human beings as co-creators of their own narratives and they assume that individuals' understanding of life events is heavily based on their interpretations of these events [1] and on their emotional reaction to them [3]. In IPA the idea of objective truth is openly dismissed. On the contrary, a lot of attention is given to one's subjective reality and how he or she interacts cognitively with it. Therefore, IPA lends itself most straightforwardly to studies designed to thoroughly investigate the lived experience of participants. In Smith's [3] own words, ‘IPA believes in a chain of connection between embodied experience, talk about that experience and a participant's making sense of, and emotional reaction to, that experience’ (p. 10). The aim of IPA is therefore to describe participants' understanding of various phenomena and how they make sense of their experiences [4,5]. https://doi.org/10.1016/j.earlhumdev.2019.03.012
0378-3782/ © 2019 Elsevier B.V. All rights reserved.
Many IPA studies explore and investigate issues related to health and well-being. For instance, a review of published studies using IPA, conducted by Smith [3] himself, indicates that ‘illness experience is, by far, the biggest individual category’ (p. 14). He explains that between 1996 and 2008, out of 293 published IPA journal articles, this category accounted for 24% of the topics under investigation. Besides covering topics which are more traditionally associated with psychology, such as living with depression (e.g., [6–8]), IPA studies have also explored topics more evidently associated with the medical field, amongst others chronic pain (e.g., [9,10]), genetic testing (e.g., [11,12]) and HIV riskrelated behaviour (e.g., [2]). 1.1. Analysing the ‘chemistry’ between IPA and the medical field Qualitative studies have been less popular amongst medical publications. Yet, it is apparent that the conclusions derived from qualitative investigations have a lot to offer to the medical professional interested in offering a good quality of service. A recent letter signed by academics sent to the British Medical Journal, [13] encourage the editors of the journal to reconsider this practice on the grounds that: Qualitative studies help us understand why promising clinical interventions do not always work in the real world, how patients experience care, and how practitioners think. They also explore and explain the complex relations between the healthcare system and the outside world, such as the sociopolitical context in which healthcare is regulated, funded, and provided, and the ways in which clinicians and regulators interact with industry’ (p. 2). In view of medical and health journals, Smith [14] acknowledges that one of the obstacles that IPA face in view of publication is the apparent parsimonious word limit assigned by these journals. This, is often quite limiting as qualitative research, including IPA studies, need
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‘sufficient space’ to rigorously represent the data, especially since ‘evidence’ supporting the analysis requires a number of participant quotations. This presents a true challenge for IPA as it tries to become visible to the medical profession. However, it's applications are undoubtedly extremely valuable to professionals within the field. One possible application of IPA studies in the medical field is to help professionals understand and contextualise quantitative findings and conclusions. This is mostly helpful to those opting to look at the ‘lived’ version of what is captured in numerical forms in other studies. An example of such application is the study by Mitchie, et al. [11] where the researchers attempted to understand the puzzling findings that suggest that a significant number of individuals continue to engage in seemingly unnecessary medical screenings, even after receiving a reassuring negative result provided by genetic testing. The authors discovered that these individuals' cognitions may have had a say in this: they had intrinsically very different beliefs about genes and their mutations and therefore could not truly engage with the definite result of the genetic testing (Mitchie et al., 2003). Such findings can be very helpful to medical professionals. Indeed, ‘the findings suggest that health professional communication may be an important influence in illness and test [cognitive] representations’ (p.346). These findings also help explain that essentially, the information passed on to patients in these instances may be distorted by the latter's own belief system and hence why they may not be reassured by the genetic test. Another possible application of IPA studies, is to assess the patients' perception of guidelines for service provision and their ability to understand their symptoms. For instance, a study by Osborne and Smith [31] explored the experience of women living with chronic lower back pain. Their findings suggested that the participants were clearly unhappy with the level of understanding of their symptoms. The actual lived experience of their pain deviated significantly from the medicalised version presented to them. In fact, the latter was described by the authors as ‘a major impediment to the participants’ ability to understand and accommodate to their pain’ ([31], p.75). In terms of guidelines, a more recent case study about the experience of chronic pain suggests that whereas ‘current treatment rhetoric is focused on acceptance, disengaging from the battle with pain and on developing resilience’ ([16]; p.169), the particular experience of the participant in their study indicated that resilience could be related to something more. They suggest that their participant's ‘positive trajectory’ in dealing with her condition was the result of having ‘recovered her sense of agency and control over her life’ (p.169). Whilst pointing out the need for medical personnel to engage in a deeper understanding of such experiences, such findings may also shed some light on why some medical ailments such as chronic pain, may be so financially taxing on western health systems [32]. It seems natural to conclude that the link between theoretical knowledge and practical application is not as straightforward as we imagine. IPA ‘in practice […] is most commonly used to examine experience which is of existential import to the participant’ ([3]; p. 9). Pain, disease, disorders and health in general are intrinsically laden with various levels of existential significance. This is another reason why IPA studies are possibly so relevant to the medical field.
[6,15,16]). Researchers adopting an IPA approach rely on a sample that can provide as much information as possible about the lived experience of those who face specific events or phenomena. Hence, they favour purposive sampling where the choice of participants basically depends on how closely they fit the ‘purpose’ of the study and its objectives. Furthermore, because IPA points towards unravelling the idiosyncratic understanding of experiences, the sample is predominantly homogenous. Smith and Osborne [33] explain that the level of ‘specificity’ in terms of homogeneity will depend on how rare the particular topic under investigation is. When the topic is quite unique, naturally less people may be experiencing the particular phenomena under investigation. For less unusual topics, researchers usually choose a sample that is more similar in terms of demographics, socio economic status and so on. In an attempt to ensure more homogeneity, sometimes the level of specificity is quite high. For example, in the study by Van Parys et al. [8] about the experience of growing up with a mother suffering from depression, the authors decided to define their sample as: European, White, middle class women living in the Flemish part of Belgium and aged between 39 and 47. In each case, the participant's mother was hospitalized for depression several times before the participant turned 18. All participants were married and had children between 12 and 27 years old. (p.4). Such research decisions will eventually dictate others. Considering how important it is to ensure that the participants recruited for an IPA study are able to provide the richest information in view of the research questions, it is very important that the researcher develops inclusion and exclusion criteria prior to sample recruitment. This would ensure that the sample is the best fit for the particular research question. 1.2.2. Data collection tools used in IPA In most IPA studies the data collection tool of choice is the in-depth, semi-structured interview which is believed to be the ‘exemplary method for IPA’ (Smith & Osborne, 2003; p.55). The semi-structured interview is described as a flexible tool where the researcher is guided, rather than constrained, to follow the set of questions that he or she develops, with the aim of answering the research question [5]. The questions chosen are predominantly open-ended and aimed at encouraging research participants to relate their experience in their own way. Biggerstaff & Thompson [17] refer to the interview schedule in IPA as a ‘prompt sheet’, clearly indicating that it is not meant to be prescriptive but instead, that it should be aimed at helping participants to ‘take the lead’ of the interview (p. 217). This, in turn, will enable their ‘phenomenology’ to come to the surface. Although most studies adhere to the traditional formula of conducting face-to-face semi-structured interviews, there have also been some adaptations. For instance a study by Turner and Coyle [18] used email as the communication medium between themselves, as researchers, and participants. Other studies have used focus groups in addition to one-to-one interviews (e.g., [19]). Readers seeking more information about semi-structured interviews or clearer guidelines on how to develop this type of interview schedule in IPA are encouraged to consult Smith and Osborn, [5]. Although semi-structured interviews are, as mentioned above, the most common data collection tools in IPA, some studies have also utilised other, perhaps less conventional tools in conjunction to semistructured interviews. These included the use of drawings (e.g., [16,20]), diary entries [21] or the participants' use of metaphors to describe their experiences (e.g., [22]).
1.2. Method: what does it involve? IPA studies have been quite flexible in terms of methodological design. This section provides an overview of the main elements of this methodology. 1.2.1. The sample Considering the level of detail explored in IPA studies, sample sizes are relatively small, that is, they rarely amount to more than 10 participants [4,14]. The size of the sample will also depend on the type of favoured data collection tool. For instance, a sample of one is also possible if the researcher is using a case study approach (e.g.,
1.2.3. The analytic method The following section will explore the IPA method related to face-toface semi-structured interviews as these are, by far, the most common means of data collection in IPA. For information about analysing other data collection tools as suggested above, the reader is invited to consult 53
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1.3. Difference between IPA and other qualitative methods
texts indicated by the citations next to the examples reported. The face-to-face interviews held with participants are usually recorded and, then transcribed verbatim for analysis. Each transcript is read thoroughly for the researcher to engage more intensely with the meanings and contextual experiences of each participant [23]. Although, reading of transcripts is often mentioned as the main step in starting to engage with the narrative of participants, Rodham et al. [24], suggest analysing the interviews by listening to them rather than simply reading them as ‘[t]he context of audio recording provides a cue to bring into awareness one's preconceptions and potential biases which should be acknowledged’ (p. 67). For instance, in their study about the health-seeking behaviours of medical trainees, one of the authors picked up a sense of passive-aggression whilst reading a transcript, whereas the other two authors, one of whom had conducted the interview and the other listened to the recording, experienced more empathy towards the participants. One's perceptions on this level are naturally quite important as they would influence how the researcher interprets the data. Hence, such elements as paralanguage and vocalics are also significant in IPA. In view of this, Smith [3] refers to a double hermeneutic, when referring to the process of the researcher trying to make sense of the research participant's own attempt at making sense of their experiences. For this reason, it becomes extremely important for researchers to keep track of their own ideas and the development of their own understanding of what has been experienced by the participant. A good analysis therefore would be able to capture both the participants' as well as the researchers' understanding of their experience and how these intertwine. As one engages with the data, themes are then identified for each participant independently. Smith et al. [4] suggest that by engaging in each participant's data, one is satisfying the ‘idiographic approach to analysis, beginning with particular examples and only slowly working up to more general categorizations or theory’ (p.220). Following this step, a second process of analysis involving the collection of inferences and reactions of the researcher to the text occurs [5]. Subsequently, over-arching themes are developed as resulting from the pool of interviews. For more information regarding data analysis, researchers embarking on their first IPA study are encouraged to consult Smith et al. [4] and Smith and Osborn [5]. Although the themes elicited from this analysis are usually discussed in the light of the findings of other literature and research studies, Smith [3] cautions researchers to ‘bracket’ or suspend any information and beliefs previously gained about the topic of investigation. Interpretation is principally sought in relation to the contexts and phenomenological understanding of the participants. Although acknowledging that this is indeed very difficult, Smith suggests that researchers should at least be aware of this and strive to be faithful to their participant's reality.
Distinguishing between IPA and other qualitative methods is not the main scope of this work. However, it may be beneficial to clarify a few of the distinguishing features between IPA and some other qualitative methods namely, content analysis, discourse analysis and grounded theory. Whilst it is true that these methods share the interest in qualitative analysis and that they also rely heavily on data collection tools which aim at delving in one's experience, they all have a different focus. In relation to content analysis, Brocki and Wearden [1] explain that ‘IPA starts with, but should go beyond, a thematic analysis’ (p.89). Whereas content analysis aims at extracting the themes from data gathered in research, in IPA the researcher is expected to engage in the understanding of people's meaning making, therefore diving into the complexity of the lived experience and unravel meaning that people develop. The individual participant and his or her idiosyncratic way of seeing life, not to mention their cognitive make up and other contextual elements are core features of IPA. Although content analysis is indeed a laborious process, it does not necessarily go in this amount of detail. Similarly, IPA and discourse analysis share the interest of language as a primary and illuminating way of delving into participants' experiences. However, even in this case the difference lies in the focus one ascribes to the use of language as a means of gaining intimate knowledge of our participants' lived experience. In IPA studies, the function of participants' ‘discourse’ is also believed to be pivotal in revealing the participants' cognitions, through a deep level of analysis [1]. Discourse analysis on the other hand is ‘skeptical’ of this position. It strives to shed light on the ‘interactive tasks being performed by verbal statements and the pre-existing discourses which speakers draw on in this process’ ([4]; p. 219). Grounded theory, as the name suggests, aims to develop theories about particular phenomena. This suggests that, whilst still being considered a qualitative method, it still attempts to discover or build a ‘theory’ which would be able to explain phenomena for a target population [1]. On the contrary, in IPA the onus lies on exploring the nuances, or shared and divergent experiences of a small group of participants. This variance has implications for the type of sampling method, for instance: whereas IPA studies favour homogenous purposive sampling, grounded theory approaches utilise theoretical sampling. The latter is a procedure whereby ‘the participants […] are selected purposefully as the analysis progresses for their ability to provide data that would confirm, challenge or expand an emerging theory’ ([26]; p. 104). Correspondingly, the size of the sample is also potentially quite different because, whereas grounded theory focuses on reaching saturation of data, that is, the recruitment of participants is expected to continue until it is felt that no new insights are being gained from additional participants [26,27], IPA is profoundly invested in the experiences of the participants one has already recruited.
1.2.4. The role of reflexivity Reflexivity takes central stage in IPA studies. This term refers to the researcher's constant awareness of the choices they make in the research process and how their own personhood, personality and cognitions interact with the topic and the analysis of the collected data. Since, as mentioned above, the researcher's own understanding of the participant's meaning making is so central in IPA, it naturally also reinforces the role of the researchers' reflexivity and essentially requires the researcher to interact closely and meaningfully with the data generated during the interviews [1,25]. Due to the double hermeneutic mentioned above, attention is given to the conjoint relationship between data generation and the researcher's self-awareness. Biggerstaff and Thompson [17] explain that ‘[t]he interviewer's thoughts and feelings are admitted as explicit and thus legitimate components of the enquiry, and their congruence or divergence from those of the participant are matters of proper enquiry’ (p. 221).
1.4. Evaluating IPA research Evaluating IPA research involves bringing together two types of review criteria: those specific to IPA and those applicable to qualitative research in general. Amongst the latter, researchers often cite those listed by Yardley [28] whilst those for IPA have been indicated by Smith [3]. The amalgamation of the two appears to be quite harmonious. The criteria mentioned by Yardley take into account the sensitivity to context; commitment and rigour; transparency and coherence; and, impact and importance of the research. The sensitivity to context refers to an awareness of the existing literature and the ‘understandings created by previous investigators’ ([28]; p. 219). In addition, the author highlights the importance of an ‘analysis that is sensitive to the data itself’ (p. 220). Jonathan A. Smith [3] seems to be elaborating on this with reference to IPA when he stresses the importance of providing enough ‘space’ to the elaboration of the different themes'. Furthermore, 54
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(1,2).
it is often stressed that one should ensure that each of the themes outlined in the final analysis is represented in the data collected during the interviews themselves [1]. This is where the concept of bracketing mentioned earlier is also quite fundamental. Yardley [29] explains that by ‘showing awareness of the participants' perspectives and setting, the sociocultural and linguistic context of the research, and how these may influence both what participants say and how this is interpreted by the researcher’ (p. 295) the researcher is able to demonstrate sensitivity to context. In view of IPA, the double hermeneutic mentioned earlier relies heavily on the researcher's self-reflexivity and the contextualising of the participants' contribution to data collection. This in turn, is believed to encourage an understanding of different contextual dimensions existing between researcher and participants [30]. In her article, Yardley groups together the elements of commitment, rigour, transparency and coherence of the data (2000; p. 221). The meaning of these elements is quite clear and ‘straightforward’. Most IPA studies report, in various levels of detail, the steps taken to ensure that they are all adhered to. In this regard, a parallel consideration of Jonathan Smith's suggestions about what makes a good IPA paper in conjunction with those presented by Yardley, leads us to recognise that the four elements presented by Yardley should assist in preserving not simply the narrative and cognitive understanding of participants' experience, but also those related to IPA and it's phenomenological routes. Commitment seems to be a principle which would undoubtedly guide Smith's guideline to provide sufficient ‘elaboration of themes’ as well as that to ensure that the paper ‘has strong data’ ([3]; p.24). In IPA, rigour in relation to the participant's own narrative, is also identified by the amount of extracts researchers should present as evidence for the relevance of the theme. Then there is also rigour intended towards IPA's methodology, as he suggests that good IPA studies ‘should be pointing to both convergence and divergence’ ([3]; p.24). Transparency and coherence are also quite central in the case of IPA. Rodham et al., (2015) suggest that although this is something which most IPA studies appear to dedicate some space discussing, there appears to be a lacuna about how, for instance, the researcher's own values and preconceptions about the topic under investigation, will impact the analytical process or how a final agreement is reached in the development of the final agreed overview of how themes and subthemes fit together. In fact, in their article they give focus significantly on this process and indicate that even something like listening to the interviews compared to simply reading the transcripts will have an impact on the interpretation one gives to the narrative. This provides food for thought for future IPA studies.
Conflict of interest statement There are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. References [1] J.M. Brocki, A.J. Wearden, A critical evaluation of the use of interpretative phenomenological analysis (IPA) in health psychology, Psychol. Health 21 (1) (2006) 87–108. [2] P. Flowers, J.A. Smith, P. Sheeran, N. Beail, ‘Coming out’ and sexual debut: understanding the social context of HIV risk-related behaviour, J. Community Appl. Soc. Psychol. 8 (1998) 409–421. [3] J.A. Smith, Evaluating the contribution of interpretative phenomenological analysis: a reply to the commentaries and further development of criteria, Health Psychol. Rev. 5 (1) (2011) 9–27. [4] J.A. Smith, M. Jarman, M. Osborn, Doing interpretative phenomenological analysis, in: M. Murray, K. Chamberlain (Eds.), Qualitative Health Psychology: Theories and Methods, Sage, London, 1999, pp. 218–240. [5] J.A. Smith, M. Osborn, Interpretative phenomenological analysis, in: J.A. Smith (Ed.), Qualitative Psychology: A Practical Guide to Research Methods, Sage, London, 2003, pp. 51–80. [6] J. Rhodes, J. Smith, “The top of my head came off”: an interpretative phenomenological analysis of the experience of depression, Couns. Psychol. Q. 23 (4) (2010) 399–409. [7] J.A. Smith, J. Rhodes, Being depleted and being shaken: an interpretative phenomenological analysis of the experiential features of a first episode of depression, Psychol. Psychother. Theory Res. Pract. 88 (2) (2015) 197–209. [8] H. Van Parys, J.A. Smith, P. Rober, Growing up with a mother with depression: an interpretative phenomenological analysis, Qual. Rep. 19 (15) (2014) 1–18. [9] M. Osborn, J. Smith, The fearfulness of chronic pain and the centrality of the therapeutic relationship in containing it: an interpretative phenomenological analysis, Qual. Res. Psychol. 5 (4) (2008) 276–288. [10] J. Smith, M. Osborn, Pain as an assault on the self: an interpretative phenomenological analysis of the psychological impact of chronic benign low back pain, Psychol. Health 22 (5) (2007) 517–534. [11] S. Michie, J. Smith, V. Senior, T. Marteau, Understanding why negative genetic test results sometimes fail to reassure, American Journal of Medical Genetics A 119 (3) (2003) 340–347. [12] J. Smith, S. Michie, M. Stephenson, O. Quarrell, Risk perception and decisionmaking processes in candidates for genetic testing for Huntington's disease: an interpretative phenomenological analysis, J. Health Psychol. 7 (2) (2002) 131–144. [13] Greenhalgh, T., Annandale, E., Ashcroft, R., Barlow, J., Black, N., Bleakley, A., … Ziebland, S. (2016). An open letter to the BMJ editors on qualitative research. British Medical Journal (Online), 352, 1–4. doi: https://doi.org/10.1136/bmj.i563 [14] J.A. Smith, Evaluating the contribution of interpretative phenomenological analysis, Health Psychol. Rev. 5 (1) (2011) 55–61. [15] V. Eatough, J. Smith, I was like a wild wild person': understanding feelings of anger using interpretative phenomenological analysis, Br. J. Psychol. 97 (4) (2006) 483–498. [16] I. Nizza, J. Smith, J. Kirkham, ‘Put the illness in a box’: a longitudinal interpretative phenomenological analysis of changes in a sufferer's pictorial representations of pain following participation in a pain management programme, Br. J. Pain 12 (3) (2018) 163–170. [17] D. Biggerstaff, A. Thompson, Interpretative phenomenological analysis (IPA): a qualitative methodology of choice in healthcare research, Qual. Res. Psychol. 5 (3) (2008) 214–224. [18] A. Turner, A. Coyle, What does it mean to be a donor offspring? The identity experiences of adults conceived by donor insemination and the implications for counselling and therapy, Hum. Reprod. 15 (9) (2000) 2041–2051. [19] P. Flowers, C. Knussen, B. Duncan, Re-appraising HIV testing among Scottish gay men: the impact of new HIV treatments, J. Health Psychol. 6 (6) (2001) 665–678. [20] P. Shinebourne, J.A. Smith, 'It is just habitual': an interpretative phenomenological analysis of the experience of long-term recovery from addiction, Int. J. Ment. Heal. Addict. 9 (3) (2011) 282–295. [21] J. Smith, Towards a relational self: social engagement during pregnancy and psychological preparation for motherhood, The British Journal of Social Psychology 38 (4) (1999) 409–426. [22] P. Shinebourne, J.A. Smith, The communicative power of metaphors: an analysis and interpretation of metaphors in accounts of the experience of addiction, Psychol. Psychother. Theory Res. Pract. 83 (1) (2010) 59–73. [23] R. Dallos, A. Vetere, Researching Psychotherapy and Counselling, Open University Press, Maidenhead, 2005. [24] K. Rodham, F. Fox, N. Doran, Exploring analytical trustworthiness and the process of reaching consensus in interpretative phenomenological analysis: lost in transcription, Int. J. Soc. Res. Methodol. 18 (1) (2013) 1–13. [25] J.A. Smith, Reflecting on the development of interpretative phenomenological analysis and its contribution to qualitative research in psychology, Qual. Res. Psychol. 1 (1) (2004) 39–54. [26] T.J.T. Kennedy, L.A. Lingard, Making sense of grounded theory in medical
2. Concluding comments This paper attempted to set the scene for IPA and its use in medical research. It analysed the meaningful relationship which IPA may have with medical literature, its method, its uniqueness compared to other qualitative designs and how to assess good IPA quality. Good qualitative research according to Yardley [28] considers the impact and importance of the study. As mentioned above, a number of IPA studies attempt to explain, in more realism and personal experience, what is being reported in quantitative studies or perhaps to look at the lived experience of some conditions. IPA studies in the medical field can, in time, help wider society and the medical profession update treatment provision and guidelines to consider the lived experience. In so doing, it may be that researchers will engage in the process of making medicine more comprehensible to the patient's eyes, increase communication efficacy and open the eyes of medical researcher to other horizons in terms of research. Acknowledgments The inspiration for this series of papers arises from the international Write a Scientific Paper course (WASP - http://www.ithams.com/wasp) 55
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[32] J. Smith, M. Osborn, Pain as an assault on the self: An interpretative phenomenological analysis of the psychological impact of chronic benign low back pain, Psychol. Health 22 (5) (2007) 517–534. [33] J.A. Smith, M. Osborn, Interpretative phenomenological analysis, in: J.A. Smith (Ed.), Qualitative psychology: A practical guide to research methods, Sage, London, 2003, pp. 51–80.
education, Med. Educ. 40 (2006) 101–108. [27] K. Charmaz, Grounded theory, in: J. Smith (Ed.), Qualitative Psychology: A Practical Guide to Research Methods, Sage, London, 2003, pp. 81–110. [28] L. Yardley, Dilemmas in qualitative health research, Psychol. Health 15 (2000) 215–228. [29] L. Yardley, Demonstrating the validity of qualitative research, J. Posit. Psychol. 12 (3) (2017) 295–296. [30] R. Elliott, C. Fischer, D. Rennie, Evolving guidelines for publication of qualitative research studies in psychology and related fields, The British Journal of Clinical Psychology 38 (1999) 215–229. [31] M. Osborn, J. Smith, The personal experience of chronic benign lower back pain: An interpretative phenomenological analysis, Br. J. Health Psychol. 31 (1) (1998) 65–83.
Miriam Geraldi Gauci, University of Malta, Msida, Malta E-mail address: [email protected].
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