Health Psychology. Michael Murray
are then integrated into a tentative theoretical model that is tested as more data are collected.
This process follows a series of steps beginning with generating data. At this stage, the researcher may have some general ideas about the topic but this should not restrict the talk of the participant. From the very initial stages the researcher is sifting through the ideas presented and seeking more information about what are considered to be emerging themes. From a more positivist perspective, it is argued that the themes emerge from the data and that the researcher has simply to look for them. This approach is often associated with Glaser (1992). From a more social constructionist perspective, certain theoretical concepts of the researcher will guide both the data collection and the analysis. This approach is more associated with the symbolic interactionist tradition (Strauss, 1987; Charmaz, 2003).
Having collected some data, the researcher conducts a detailed coding of it, followed by the generation of bigger categories. Throughout the coding the researcher follows the process of constant comparative analysis. This involves making comparisons of codes within and between interview transcripts. This is followed by the stage of memo-writing, which requires the researcher to begin to expand upon the meaning of the broader conceptual categories. This in turn can lead to further data generation through theoretical sampling. This is the process whereby the researcher deliberately selects certain participants or certain research themes to explore further because of the data already analysed. At this stage, the researcher is both testing and strengthening the emergent theory. At a certain stage in this iterative process the researcher feels that he/she has reached the stage of data saturation – no new concepts are emerging and it is considered fruitless to continue with data collection.
A few examples are as follows: DiMillo et al. (2015) used grounded theory methodology to examine the stigmatization experiences of six BRCA1/2 gene mutation carriers following genetic testing; Searle et al. (2014) studied participants’ experiences of facilitated physical activity for the management of depression in primary care; Silva et al. (2013) used the method to study the balancing of motherhood with drug addiction in addicted mothers.
Hierarchy of Evidence
In traditional top-down approaches to research, a hierarchy of evidence or research methods is often utilized (Figure 7.2). In this pyramidical hierarchy of methods, meta-analyses and systematic reviews occupy the pinnacle and qualitative methods are at the base. Researchers who prefer the alternative, bottom-up approach are much more likely to employ qualitative and mixed methods. Critical health psychologists dispute the validity of the evidence hierarchy, which tends to be formulaic, restrictive and lacking in innovation.
Historical Analysis
Health and illness are socially and historically located phenomena. As such, psychologists have much to gain by detailed historical research (historical analysis) on the development of health beliefs and practices. They can work closely with medical or health historians to explore the evolution of scientific and popular beliefs about health and illness or they can work independently (see Chapter 6). An example is the work of Herzlich and Pierret (1987). Their work involved the detailed analysis of a variety of textual sources such as scientific medical writings, but also popular autobiographical and fictional accounts of the experience of illness. They noted the particular value of literary works because of their important contribution to shaping public discourse. Such textual analysis needs to be guided by an understanding of the political and philosophical ideas of the period.
Figure 7.2 Hierarchy of evidence
Source: Public domain
Health psychologists need also to be reflexive about the history of their own discipline. It arose at a particular historical period sometimes described as late modernity. Initially it was seen as providing a complement to the excessive physical focus of biomedicine. Now some see it as part of the broader lifestyle movement.
There are different approaches to the writing of history. There are those who can be broadly characterized as descriptive and who often provide a list of the growth of the discipline in laudatory terms (e.g., Stone et al., 1987). Conversely, there are those who adopt a more critical approach and attempt to dissect the underlying reasons for the development of the discipline. Within health psychology, this latter approach is still in its early stages (e.g., Stam, 2014).
Interpretative Phenomenological Analysis
Phenomenological research is concerned with exploring the lived experience of health, illness and disability. Its aim is to understand these phenomena from the perspective of the particular participant. This in turn has to be interpreted by the researcher. A technique that addresses this challenge is interpretative phenomenological analysis (IPA) (Smith, 2004). IPA focuses on the cognitive processing of the participant. Smith (2004) argues that it accords with the original direction of cognitive psychology that was concerned with exploring meaning-making rather than information-processing. IPA provides a guide to conducting the researcher’s making sense or meaning of reported experiences. It begins by accessing the participant’s perceptions through the conduct of an interview or series of interviews with a homogeneous sample of individuals. The interview is semi-structured and focuses on the particular issue of concern.
Data analysis in IPA goes through a number of stages. Initially, the researcher reads and re-reads the text and develops a higher order thematic analysis. Having identified the key themes or categories, the researcher then proceeds to look for connections between them by identifying clusters. At this stage, the researcher is drawing upon his/her broader understanding to make sense of what has been said. Once the researcher has finished the analysis of one case, he/she can proceed to conduct an analysis of the next case in a similar manner. Alternatively, the researcher can begin to apply the analytic scheme developed in the previous case. The challenge is to identify repeating patterns but also to be alert to new patterns. Further details of this form of analysis are available in Smith et al. (1999) and Smith and Osborn (2003).
A few examples are as follows: Conroy and De Visser (2013) studied the importance of authenticity for student non-drinkers; Mackay and Parry (2015) studied two perspectives on autistic behaviours; Burton et al. (2014) used an interpretative phenomenological analysis of sense-making within a dyadic relationship of living together with age-related macular degeneration; Ware et al. (2015) used IPA to study the experience of hepatitis C treatment for people with a history of mental health problems; Levi et al. (2014) investigated phenomenological hope among perceptions of traumatized war veterans.
Interventions
Interventions are deliberate attempts to facilitate improvements to health. The idea for the intervention can come from a theory or model, from discussions with those who are knowledgeable about the condition or situation that needs to be changed, or from ‘out of the blue’.
A key aspect of designing and/or implementing any intervention is evaluation – attempting to prove whether or not the intervention is effective or efficacious. Furthermore, reports of intervention studies are typically brief, opaque descriptions of what can often be complex interventions.
Reports of behaviour change studies typically provide brief summaries of what in reality may be a highly complex and unique intervention. One problem is that there is no meaningful method of classifying interventions for behaviour change into any single theory or method of description.
There is no meaningful method of relating the practice of behaviour change to any single theory or taxonomy. This means that the researcher does not know how to label what they have done in a way that communicates this in any precise manner to others (Marks, 2009). A key criterion for the reporting of an intervention must be transparency. Can another person or group repeat the study in his/her/their own setting with his/her/their own participants? The need to be concise in publishing studies means that the level of detail required for