Qualitative Research: Five Approaches

Qualitative Research: Five Approaches

By

Aysha Siddiqui

Walden University

Narrative Research

Definition: Narrative Research is a study that focuses on the lives and experiences of individuals, collects data from stories of persons (Creswell, 2013).  According to Lieblich (1998) ‘people are story tellers’ and their experiences, thoughts, personalities can give researchers an insight into many ideas. Freud also used the case studies of men and women in psychotherapy to understand their personalities. Like any other research method, narrative research has been met with criticism too. Some researchers argue that one limitation this method has is the threat to validity: people may not narrate and tell the story as they have experienced it (Polkinghorne, 2007). Creswell (2013) describes four types of narrative research:

• A biographical study: Form of narrative study in which the researcher writes and records the experiences of another person’s life.
• Autoethnogrpahy: is the record of individuals’ layers of experience when they are part of a study.
• A life history: gives portrayal of an individual’s life whole life with narrative study being about a personal experience or multiple experiences.
• An oral history: consists of records of personal reflections of events, their experience with the event from one or many individuals.

Research problem, Narrative Research: Is there a high risk of suicide among patients with arthritis in old age?

Arthritis among people who are older is in substantial numbers, but not very high.  Timonen et al., highlight that suicidal rate among females who suffer from Rheumatoid Arthritis (RA) should be taken into serious account. Choice of the narrative research is suitable for this study because this is a unique experience and the focus being on the suicide risk makes it an experience that may require an insight on the lives of specific individuals. How suicide risk is high, what causes it in patients with RA can demand a chronological system of recording data. This is possible with Narrative research.

Phenomenological Research

Phenomenological research is focused on understand the ‘essence of the experience’, as written by Creswell (2013). It describes the experience of a phenomenon that some or many individuals have lived and have shared. Smith (2007) writes that phenomenological research is concerned with understanding how participants make sense of the world around them in a social or personal manner.  The data is collected through statements, descriptions and observations (Creswell, 2013). The phenomenological research method, some researchers argue  has the challenge of cost, duration and the practical aspect of finding, collecting data may be high as is considered to be in any qualitative method (Caelli, 2001).

            Research Problem, Phenomenological Research: Do homeschooled kids feel socially challenged when they enter college life?

            Homeschooled kids are considered to less socially active due to lack of exposure to social interactions in a traditional public school manner ( Lebeda, 2007). On the flip side of the same situation, Cogan (2010) reports that homeschooled kids are shown to soccer higher on ACT, SAT and other achievement tests. This leads to attaining admissions in high achieving Universities in the country. This has left a gap in the research conducted on the phenomenon that homeschooled kids maybe gaining out of the flexibility they have being homeschooled, but they maybe losing the social awareness of the real world. This a phenomenon that can be studied by understanding the lives and experiences of individuals who actually have been homeschooled and then moved on to Universities for higher education.

Phenomenological research is most suitable for this research problem because this is an experience that has been lived by homeschooled individuals (Creswell, 2013). This study will record the experience of participants that are a group with one common experience among them of being homeschooled and university education. Lester (1999) explains that phenomenological research understand a problem as is lived by a group of people and are effective in understand from the point of view of the individuals. Homeschooling is a unique experience that can only be understood from the experience of those who have done it.

Grounded Theory Research

Grounded Theory research is defined as a study that intends to move beyond description and ‘to generate or discover a theory’ for a process or an action (Creswell, 2013). The method usually involves interviews with 20-60 individuals and data is analyzed through coding, axial coding and selective coding (Creswell, 2013). Glaser et al., write that grounded theory is a way to derive theory from data which is a major task in the field of sociology in today’s world. Grounded Theory can also obviate theories that are still dubious or are in working capacity.  Some researchers have stated grounded theory is the method that doesn’t bind itself to long standing assumptions and reaches for unbroken grounds with new modes (Suddaby, 2006).

Research Problem, Grounded Theory: Is Nursing a more suitable career for women or men are equally capable to handle it?

Chiovitti & Piran (2003) suggest that use of grounded theory research in fields of nursing and management helps researcher achieve the rigor that they require for a study on these topics. Associating nursing with women has been the trend and maybe the tradition in some cultures, so conducting a study that aims to understand the gender bias with a career is breaking new ground. Anthony (2004) reports that gender bias and discrimination in nursing education has been observed since years: to overcome this it’s important to understand the history of male contributors to nursing.

Ethnographic Research

Ethnographic research focuses on ‘describing and interpreting a culture- sharing group’ and understanding the group through observation, interviews (Creswell, 2013). Data analysis is conducted through description of the group themes, and how the group works. Some researchers argue that ethnographic research due to its sporadic and hap hazard nature is highly challenged in validity and reliability like other qualitative researchers (LeCompte & Goetz, 1982). Still, ethnographic research opens avenues for researchers like none other and gives an ability to conduct open ended research. LeCompte, Schensul (2010) report that ethnography is a systematic approach to learning about social and cultural life of communities, institutions in a scientific manner. They further add that this approach uses rigorous ways to avoid bias and collect data in a systematic manner about unique cultures, groups.  

            Research Problem, Ethnographic Research: Is there family influence in the choices of television shows by adolescents?

            Lull (1990) conducted a study on how people make choices about what television shows to watch and used the ethnographic approach with direct observation, in depth interviewing.  The research problem that aims to understand the television choices among adolescents is most suitable to use ethnographic approach as family influence can be cultural (Morley, 2005). Television viewing is affected by parenting, family culture and dynamics in a family. All these factors are then influenced by culture, so this research problem can be studied using an ethnographic approach.

Case Study Research

Case study research focuses on developing description of a particular case or number of related cases (Creswell, 2013) and analyzes data by cases and description of cross cases. Some researchers believe that case study approach is similar to the hypothesis-testing approach (Eisenhardt, 1989). Flyvbjerg (2006) reports that case study approaches are usually misunderstood in five ways: theoretical over practical knowledge, a single study is not enough to understand a concept, case study is most effective for hypothesis, case studies contain bias and cannot be specified. The study further adds that social sciences can benefit from substantial, properly executed case studies.

            Research Problem, Case Study Research: Do information technology experts enjoy the nature of their work?

            Benbasat et al.(1987) report that case study is most suitable for a study that is on a topic which is in it’s formative, early stages and they give the example of case study research for information technology studies. Information technology has seen a lot of boom recently, however, it is still exclusive to people who are trained to be experts in it. Professionals from other fields like healthcare, medicine or art are unable to relate to this field. Hence, a case study approach to get description of their experience from information technology experts is justified for this research problem.       

References

Anthony, A. S. (2004). Gender bias and discrimination in nursing education: can we change it? Nurse Educator, 29(3), 121-125.

Benbasat, I., Goldstein, D. K., & Mead, M. (1987). The case research strategy in studies of information systems. MIS quarterly, 369-386.

Caelli, K. (2001). Engaging with phenomenology: is it more of a challenge than it needs to be? Qualitative Health Research, 11(2), 273-281.

Chiovitti, R. F., & Piran, N. (2003). Rigour and grounded theory research.Journal of advanced nursing, 44(4), 427-435.

Cogan, M. F. (2010). Exploring Academic Outcomes of Homeschooled Students. Journal of College Admission, 208, 18-25.

Creswell, J. W. (2013). Qualitative inquiry and research design: Choosing among five approaches. Sage publications.

Eisenhardt, K. M. (1989). Building theories from case study research. Academy of management review, 14(4), 532-550.

Flyvbjerg, B. (2006). Five misunderstandings about case-study research.Qualitative inquiry, 12(2), 219-245.

Lebeda, S. (2007). Homeschooling: Depriving children of social development. J. Contemp. Legal Issues, 16, 99.

LeCompte, M. D., & Schensul, J. J. (2010). Designing and conducting ethnographic research (Vol. 1). Rowman Altamira.

LeCompte, M. D., & Goetz, J. P. (1982). Problems of reliability and validity in ethnographic research. Review of educational research, 52(1), 31-60.

Lester, S. (1999). An introduction to phenomenological research. Stan Lester Developments, 1-4.

Lieblich, A. (1998). Narrative research: Reading, analysis, and interpretation(Vol. 47). Sage.

Lull, J. (1990). Inside family viewing: ethnographic research on television's audiences. Routledge.

Morley, D. (2005). Family television: Cultural power and domestic leisure. Routledge.

Polkinghorne, D. E. (2007). Validity issues in narrative research. Qualitative inquiry, 13(4), 471-486.

Suddaby, R. (2006). From the editors: What grounded theory is not. Academy of management journal, 49(4), 633-642.

Humoral Immunity Response

Humoral Immunity Response                     

       By

              Aysha Siddiqui

Walden University

Introduction

Definition of Humoral Immunity

Humoral immunity response is part of the adaptive immunity and is the primary defense mechanism against extracellular microbes, their toxins (Abbas, Lichtman, Pillai, 2012). Humoral immunity is interceded by antibodies and with capsules rich in ‘polysacchrides and lipids’ it is the main defense. The National Institute of Health (NIH) describes humoral immunity response consisting of a number of components that include the naturally occurring antibodies (NAB), pentraxins (family of plasma proteins), complement and contact cascades.

Description of Humoral Immunity: Humoral immune responses to nonprotein antigens are handled by recognizing the antigens of specific immunoglobulin receptors of naïve B cells (Abbas, Litchman, Pillai, 2012). Humoral immune response to a protein antigen is called ‘T-dependant responses and initiated by binding of the protein to specific Ig receptors of naïve B cells in lymphoid follicles’ (Abba, Litchman, Pillai, 2012).

           

Disease associated with Humoral Immunity Response

Stockert et al., (1998) report that growing evidence shows humoral response to autoimmunogenic tumor antigens and tumors develop an antibody response to NY-ESO-1 (humoral response). Breast cancer has shown to be associated with the humoral immunity response by the fact that malignant tumors show different types of molecules that maybe regarded as foreign antigens by the immunity system (Abbas, Litchman, Pillai, 2012). Research has also shown that chronic inflammation leads to cancer development, while enhanced humoral immunity along with innate immune activation alters risk of cancer (Tan, Coussens, 2007).

Behavioral Intervention to Influence Humoral Immunity

            Segerstrom, Miller (2004) report that there are more than 300 research studies with evidence of a relation between stress and immunity response. They report that humoral immunity is not compromised but cellular immunity is affected in times of acute stress (lasting a few minutes) and with chronic stress, humoral immunity is also compromised.

            Behavioral intervention to influence humoral immunity would need to focus around stress reducing techniques. The reason is because stress has been connected to immunity in lot of research. According to Segerstrom, Miller (2004) age can play a crucial role as well, since they conclude that stressors can have varying affect on immunity among older and younger age groups.  Some researchers argue that how can stress get into the body? The sympathetic fibers travel from the brain to the primary and secondary lymphoid tissues (Ader, Cohen, Felten, 1995).

            Segerstrom, Miller (2004) write that according to Maier and Watkins (1998) a close connection exists between stress and immune function: ‘the immunological changes associated with stress were adapted from the immunological changes in response to infection’. Their study explains a ‘sickness behavior’ which includes behavioral changes like lack of socializing, sexual activity and increase in response to pain, depressing moods. This is when body is working towards reserving energy to fight future infections.

Behavioral intervention would include steps like:

• Identification of stressors
• Observation of bodily response to stressors
• Identification of past history of stress, anxiety or depression
• Recording of family history of physiological conditions and immunity deficient diseases
•  Understanding of regularity, duration and timings of exacerbations
• Coping techniques development that are suitable to the individual and their surroundings,

Complementary/alternative modality or lifestyle change

            Complementary or alternative modality or medicine (CAM) cover a broad spectrum of ancient as well we modern techniques, practices to fight and treat disease (Barnes et al., 2008).People who are using or seeking CAM are usually aiming to improve their health and well being.

            To help a patient with breast cancer whose humoral immunity maybe affected, we could use CAM as a mean to improve health as well. Massage therapy is an effective CAM technique that is also known to reduce pain in cancer patients (Pan et al., 2000). Massage therapy is a technique that involves getting deep tissue or muscle massage with an intention to work towards a healing process. Billhult, Dahlberg (2001) describe that in their controlled study female cancer patients described massage therapy as a ‘relief from suffering’ experience. Cassileth, Deng (2004) highlight the importance of awareness of massage therapy and other CAM techniques used by cancer patients for their care providers.

                                                            References

Abbas, A. K., Lichtman, A. H., & Pillai, S. (2012). Basic immunology: functions and disorders of the immune system. Elsevier Health Sciences.

Ader, R., Cohen, N., & Felten, D. (1995). Psychoneuroimmunology: interactions between the nervous system and the immune system. The Lancet, 345(8942), 99-103.

Barnes, P. M., Bloom, B., & Nahin, R. L. (2008). Complementary and alternative medicine use among adults and children: United States, 2007.

Cassileth, B. R., & Deng, G. (2004). Complementary and alternative therapies for cancer. The Oncologist, 9(1),, 80-89.

Pan, C. X., Morrison, R. S., Ness, J., Fugh-Berman, A., & Leipzig, R. M. (2000). Complementary and alternative medicine in the management of pain, dyspnea, and nausea and vomiting near the end of life: a systematic review. Journal of pain and symptom management, 20(5), 374-387.

Segerstrom, S. C., & Miller, G. E. (2004). Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychological bulletin, 130(4), 601.

Shishido, S. N., Varahan, S., Yuan, K., Li, X., & Fleming, S. D. (2012). Humoral innate immune response and disease. Clinical Immunology, 144(2), 142-158.

Tan, T. T., & Coussens, L. M. (2007). Humoral immunity, inflammation and cancer. Current opinion in immunology, 19(2), 209-216.

Stress management for Parents of children with Autism Spectrum Disorder (ASD)

Stress management technique: The population is parents of children with Autism Spectrum Disorder (ASD) and the technique is practicing yoga two to three times a week. This is a two in one technique which helps the parents as well as the Autistic child. Practicing Yoga helps with the Autistic behavior of the child especially with anxiety which is a big source of negative behavior, and this in turn helps with the stress parents of Autistic children experience. Yoga as a stress coping technique also includes practice of meditation and muscle relaxation. Radhakrishna (2010) did a study to explore integrated approach to yoga therapy (IAYT) as treatment to increase imitative skills in children with ASD. The study was conducted over a 10 month period and the results showed improvement in children’s imitation skills like pointing to facial, body parts and parents also reported improved free play time at home.

This technique includes practicing Yoga and meditation at least two to three times a week. The parents would conduct the exercise two day a week with their children and the children could practice on their own maybe at school or at a group class. A measure to evaluate the effectiveness of this stress management technique would be a log book or fill in sheet with yes/no to questions. The questions would range from what change in behavior is observed in the child with ASD and explore the feelings of the parents after the exercise. Questions about feelings of the parent would include those that are directed at their stress level, maybe feeling less anxious or stressed after the practice. The evaluation form would include a small box or section to report any other difference the parents feel that are not mentioned in the list of questions. A form would accompany the stack of question list that is filled out only once when the parents start recording. This form includes a brief history of ASD diagnosis, child’s current age and schooling details as well as other sibling information. This is crucial in our evaluation since we are looking at stress faced by the parents as a result of the challenges they face with their other children as well who don’t suffer from ASD.

The most important benefit of providing multiple stress management technique to stress sufferers is having a choice in case one technique fails. This is subject to the fact that every person handles stress differently, reacts in a different manner and may need individualized coping techniques that depend on the kind, time and intensity of the stress (learning resources, Smith, 2011). Manuck et al (1991) studied individual differences in cellular immune response to stress. Their study found that individuals differ significantly in their ‘immunological response to behavioral stimuli’ and such differences are also seen in response to stress.

There can be barriers to effective stress management. One barrier which can come up considering our stress management technique could be financial restraints. Yoga and meditation is an activity that can require some supervision and training initially. This can be done by a trained person and in form of individual training or as a group. Usually Yoga experts require some fee or charge a price for training individual or to allow them to participate in a group class. If the insurance carrier doesn’t cover this kind of expense related to the special condition of the ASD suffering child and his parents, then expense to use Yoga as a therapy would be completely covered by the parents. This can be a barrier in using this as a stress coping technique. Baspure et al (2012) looked at possible barriers to using Yoga as therapy for schizophrenic patients in India. Their study concluded that despite overcoming the barrier of cost effectiveness of the therapy technique, getting daily training under specialized supervision was still a barrier in many parts of the country. The therapy would be effective if practiced at least for one month, and to have specialized training for that long was a challenge.

There can be cultural or religious barriers as well. Yoga stems from Hindu and Buddhism practices, which can be unappealing in some cultures or religions for reasons of bias, personal views and social taboos. This kind of barrier can be relevant in other coping techniques as well.

References

Baspure, S., Jagannathan, A., Kumar, S., Varambally, S., Thirthalli, J., Venkatasubramanain, G. Gangadhar, B. N. (2012). Barriers to yoga therapy as an add-on treatment for schizophrenia in India. International journal of yoga, 5(1), 70.

Manuck, S. B., Cohen, S., Rabin, B. S., Muldoon, M. F., & Bachen, E. A. (1991). Individual differences in cellular immune response to stress. Psychological science, 2(2), 111-115.

Radhakrishna, S. (2010). Application of integrated yoga therapy to increase imitation skills in children with autism spectrum disorder. International journal of yoga, 3(1), 26.

Smith, M., & Segal, R. (2011, December). Stress management: How to reduce, prevent and cope with stress. Retrieved from http://helpguide.org/mental/stress_management_relief_coping.htm

Innate and Adaptive immunity

Innate immunity is an individual’s natural immunity which exists in healthy human beings (Abbas, Lichtman & Pillai, 2012) and intervenes with prevention against infections. Some researchers report that innate immunity is the initial incomplete response until a more acquired and definite response develops (Fearon & Locksley, 1996). It may also determine that which antigens the body responds to and the nature of the response. Adaptive immunity, on the other hand is develop later than innate immunity and adapts to the ‘microbial invaders’ (Abbas, Lichtman & Pillai, 2012). Adaptive immunity requires division and expansion of lymphocytes before it can provide defense against infections. It consists of antibodies that are a product of the lymphocytes. According to Medzhitove & Janeway (1997) since many years innate immunity has been seen as the secondary immunity compared to adaptive immunity in terms of hierarchy of immune functions. They report that however recently innate immunity has gained recognition among researchers. Atopic Dermatitis (AD) is an inflammatory skin disease that has increased in the past few years and believed to be caused by deficiency in the innate immunity system (De Benedetto et al, 2009). Boguniewicz & Leung (2011) report that Atopic dermatitis (AD) is a chronic inflammatory skin disease that often precedes asthma and allergic disorders. Researchers are starting to believe that other than healing and protecting the skin, innate immunity irregularities should be addressed as well. Natural Killer cells (NK) have been distinguished as cells of innate immunity but now researchers are reporting that they share same properties as the lymphocytes that are part of the adaptive immunity (Sun, Beilke, & Lanier, 2009). Transfer of NK cells into organisms have shown increased immunity in case of a viral change. NK cells directly participate in adaptive immune responses by interacting with dendritic cells majority of the time (Raulet, 2004). This interaction can result in positive or negative cell activity and in reciprocation NK cells function is regulated by dendritic cells. NK cells are also directly expressed to T-cells and that’s how they affect the adaptive immune system. Cytokines are proteins that are released by the CD4 T-cells aka helper T cells (Abbas et al, 2012). These cytokines activate B cells and other cell types, macrophages and stimulate the function of these cells. This is how they affect the adaptive immune system. As a health psychologist, I would use the method of diet control and health eating to help boost adaptive immunity. Research shows that obesity is characterized by expansion of tissue adipose that can cause inflammatory immune cells (Sell, Habich  & Eckel, 2012). Obesity also affects the production of cytokines and the function of macrophages.

References

Abbas, A. K., Lichtman, A. H., & Pillai, S. (2012). Basic immunology: functions and disorders of the immune system. Elsevier Health Sciences.

De Benedetto, A., Agnihothri, R., McGirt, L. Y., Bankova, L. G., & Beck, L. A. (2009). Atopic Dermatitis: A Disease Caused by Innate Immune Defects&quest.Journal of Investigative Dermatology, 129(1), 14-30.

Fearon, D. T., & Locksley, R. M. (1996). The instructive role of innate immunity in the acquired immune response. Science, 272(5258), 50-54.

Medzhitov, R., & Janeway Jr, C. A. (1997). Innate immunity: impact on the adaptive immune response. Current opinion in immunology, 9(1), 4-9.

Raulet, D. H. (2004). Interplay of natural killer cells and their receptors with the adaptive immune response. Nature immunology, 5(10), 996-1002.

Sun, J. C., Beilke, J. N., & Lanier, L. L. (2009). Adaptive immune features of natural killer cells. Nature, 457(7229), 557-561.

Ulcerative Colitis

Ulcerative Colitis is ‘a condition in which the lining of the large intestine (colon) and rectum become inflamed’, as defined by the National Institute of Health (NIH). The symptoms of ulcerative colitis include pain in the abdomen, blood in the stool, often occurring diarrhea, fever, weight loss and feeling to pass stools (NIH). This condition can also affect children’s growth and slow it down. According to O'morain et al (1989) ulcerative colitis can be often misdiagnosed as Crohn’s disease due to similarity of symptoms, but laboratory findings and patient’s activities can be the index used to diagnose. At least thirty percent of the patients who suffer from this disease have surgery once in their lifetime (Moskovitz et al, 2000).

Levenstein et al (2000) conducted a study to understand the effects psychological factors on exacerbations occurrences of ulcerative colitis. They hypothesized that ‘perceived’ stress causes a higher risk of exacerbations. Sixty two patients were followed for 45 to 68 months with reports on their perceived stress, depression and other stressful events along with records of exacerbations. The results concluded that short term stress may have a lesser affect but long term stress can increase the risks of exacerbations. A reverse relation has also been observed between chronic stress and ulcerative colitis when chronic stress is at high risk in patients with ulcerative colitis (Riley et al, 1990).

Sewitch et al (2001) suggest in the conclusion of their study that social support developing techniques have reported to help patients suffering from ulcerative colitis with chronic stress. Patients who experienced higher levels of stress report to have benefitted from social support in a smaller network like family support group or church group. For patients who suffer from ulcerative colitis, social support would include their care providers ranging from surgeons to dieticians. Surgery in the life time of a person who suffers from ulcerative colitis can happen in thirty percent of cases and social support post surgery can also be crucial in these cases. Clinical intervention with help from counselors, psychologists post surgery mental and physical recovery could be an effective measure (Moskovitz et al, 2000).

                                                                   References

Levenstein, S., Prantera, C., Varvo, V., Scribano, M. L., Andreoli, A., Luzi, C. & Marcheggiano, A. (2000). Stress and exacerbation in ulcerative colitis: a prospective study of patients enrolled in remission. The American journal of gastroenterology, 95(5), 1213-1220.

Ulcerative Colitis- National Institute of Health (NIH)-

Doi: http://www.nlm.nih.gov/medlineplus/ency/article/000250.htm

Riley, S. A., Mani, V., Goodman, M. J., & Lucas, S. (1990). Why do patients with ulcerative colitis relapse. Gut, 31(2), 179-183.

Sewitch, M. J., Abrahamowicz, M., Bitton, A., Daly, D., Wild, G. E., Cohen, A  & Dobkin, P. L. (2001). Psychological distress, social support, and disease activity in patients with inflammatory bowel disease. The American journal of gastroenterology, 96(5), 1470-1479.