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Using the framework method for the analysis of qualitative data in multi-disciplinary health research

Using the framework method for the analysis of qualitative data in multi-disciplinary health... Background: The Framework Method is becoming an increasingly popular approach to the management and analysis of qualitative data in health research. However, there is confusion about its potential application and limitations. Discussion: The article discusses when it is appropriate to adopt the Framework Method and explains the procedure for using it in multi-disciplinary health research teams, or those that involve clinicians, patients and lay people. The stages of the method are illustrated using examples from a published study. Summary: Used effectively, with the leadership of an experienced qualitative researcher, the Framework Method is a systematic and flexible approach to analysing qualitative data and is appropriate for use in research teams even where not all members have previous experience of conducting qualitative research. Keywords: Qualitative research, Qualitative content analysis, Multi-disciplinary research The Framework Method for the management and analysis We then present a step-by-step guide to the application of of qualitative data has been used since the 1980s [1]. The the Framework Method, illustrated using a worked method originated in large-scale social policy research but example (See Additional File 1) from a published is becoming an increasingly popular approach in medical study [3] to illustrate the main stages of the process. and health research; however, there is some confusion Technical terms are included in the glossary (below). about its potential application and limitations. In this Finally, we discuss the strengths and limitations of article we discuss when it is appropriate to use the the approach. Framework Method and how it compares to other qualitative analysis methods. In particular, we explore Glossary of key terms used in the Framework how it can be used in multi-disciplinary health research Method teams. Multi-disciplinary and mixed methods studies are Analytical framework: A set of codes organised into becoming increasingly commonplace in applied health categories that have been jointly developed by researchers research. As well as disciplines familiar with qualitative involved in analysis that can be used to manage and research, such as nursing, psychology and sociology, teams organise the data. The framework creates a new structure often include epidemiologists, health economists, manage- for the data (rather than the full original accounts given ment scientists and others. Furthermore, applied health by participants) that is helpful to summarize/reduce the research often has clinical representation and, increasingly, data in a way that can support answering the research patient and public involvement [2]. We argue that while questions. leadership is undoubtedly required from an experienced Analytic memo: A written investigation of a particular qualitative methodologist, non-specialists from the wider concept, theme or problem, reflecting on emerging team can and should be involved in the analysis process. issues in the data that captures the analytic process (see Additional file 1, Section 7). * Correspondence: [email protected] Categories: During the analysis process, codes are Health Services Management Centre, University of Birmingham, Park House, grouped into clusters around similar and interrelated ideas 40 Edgbaston Park Road, Birmingham B15 2RT, UK Full list of author information is available at the end of the article or concepts. Categories and codes are usually arranged in © 2013 Gale et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Gale et al. BMC Medical Research Methodology 2013, 13:117 Page 2 of 8 http://www.biomedcentral.com/1471-2288/13/117 a tree diagram structure in the analytical framework. groups or organisations. While in-depth analyses of key While categories are closely and explicitly linked to the themes can take place across the whole data set, the views raw data, developing categories is a way to start the of each research participant remain connected to other process of abstraction of the data (i.e. towards the general aspects of their account within the matrix so that the rather than the specific or anecdotal). context of the individual’s views is not lost. Comparing Charting: Entering summarized data into the Framework and contrasting data is vital to qualitative analysis and the Method matrix (see Additional File 1, Section 6). ability to compare with ease data across cases as well as Code: A descriptive or conceptual label that is assigned within individual cases is built into the structure and to excerpts of raw data in a process called ‘coding’ process of the Framework Method. (see Additional File 1, Section 3). The Framework Method provides clear steps to follow Data: Qualitative data usually needs to be in textual form and produces highly structured outputs of summarised before analysis. These texts can either be elicited texts data. It is therefore useful where multiple researchers are (written specifically for the research, such as food diaries), working on a project, particularly in multi-disciplinary or extant texts (pre-existing texts, such as meeting research teams were not all members have experience minutes, policy documents or weblogs), or can be produced of qualitative data analysis, and for managing large by transcribing interview or focus group data, or creating data sets where obtaining a holistic, descriptive overview ‘field’ notes while conducting participant-observation or of the entire data set is desirable. However, caution is observing objects or social situations. recommended before selecting the method as it is not a Indexing: The systematic application of codes from suitable tool for analysing all types of qualitative data or the agreed analytical framework to the whole dataset for answering all qualitative research questions, nor is it (see Additional File 1, Section 5). an ‘easy’ version of qualitative research for quantitative Matrix: A spreadsheet contains numerous cells into researchers. Importantly, the Framework Method cannot which summarized data are entered by codes (columns) accommodate highly heterogeneous data, i.e. data must and cases (rows) (see Additional File 1, Section 6). cover similar topics or key issues so that it is possible to Themes: Interpretive concepts or propositions that categorize it. Individual interviewees may, of course, have describe or explain aspects of the data, which are the very different views or experiences in relation to each final output of the analysis of the whole dataset. Themes topic, which can then be compared and contrasted. The are articulated and developed by interrogating data Framework Method is most commonly used for the categories through comparison between and within thematic analysis of semi-structured interview transcripts, cases. Usually a number of categories would fall which is what we focus on in this article, although it could, under each theme or sub-theme [3]. in principle, be adapted for other types of textual data Transcript: A written verbatim (word-for-word) account [13], including documents, such as meeting minutes or of a verbal interaction, such as an interview or conversation. diaries [12], or field notes from observations [10]. For quantitative researchers working with qualitative Background colleagues or when exploring qualitative research for the The Framework Method sits within a broad family of firsttime, thenatureofthe Framework Method is seductive analysis methods often termed thematic analysis or because its methodical processes and ‘spreadsheet’ qualitative content analysis. These approaches identify approach seem more closely aligned to the quantitative commonalities and differences in qualitative data, before paradigm [14]. Although the Framework Method is a highly focusing on relationships between different parts of systematic method of categorizing and organizing what the data, thereby seeking to draw descriptive and/or may seem like unwieldy qualitative data, it is not a panacea explanatory conclusions clustered around themes. The for problematic issues commonly associated with qualita- tive data analysis such as how to make analytic choices and Framework Method was developed by researchers, Jane Ritchie and Liz Spencer, from the Qualitative Research make interpretive strategies visible and auditable. Qualita- Unit at the National Centre for Social Research in the tive research skills are required to appropriately interpret the matrix, and facilitate the generation of descriptions, United Kingdom in the late 1980s for use in large-scale policy research [1]. It is now used widely in other areas, categories, explanations and typologies. Moreover, reflexiv- including health research [3-12]. Its defining feature is the ity, rigour and quality are issues that are requisite in the Framework Method just as they are in other qualitative matrix output: rows (cases), columns (codes) and ‘cells’ of summarised data, providing a structure into which the methods. It is therefore essential that studies using the researcher can systematically reduce the data, in order Framework Method for analysis are overseen by an experi- enced qualitative researcher, though this does not preclude to analyse it by case and by code [1]. Most often a ‘case’ is an individual interviewee, but this can be those new to qualitative research from contributing to the adapted to other units of analysis, such as predefined analysis as part of a wider research team. Gale et al. BMC Medical Research Methodology 2013, 13:117 Page 3 of 8 http://www.biomedcentral.com/1471-2288/13/117 There are a number of approaches to qualitative data the researcher in advance (e.g. an interviewee-led open analysis, including those that pay close attention to language ended interview and grounded theory [20]). In all these and how it is being used in social interaction such as cases, it maybeappropriate to usethe FrameworkMethod discourse analysis [15] and ethnomethodology [16]; those to manage thedata. Thedifferencewould become that are concerned with experience, meaning and language apparent in how themes are selected: in the deductive such as phenomenology [17,18] and narrative methods [19]; approach, themes and codes are pre-selected based on and those that seek to develop theory derived from data previous literature, previous theories or the specifics through a set of procedures and interconnected stages such of the research question; whereas in the inductive as Grounded Theory [20,21]. Many of these approaches are approach, themes are generated from the data though associated with specific disciplines and are underpinned by open (unrestricted) coding, followed by refinement of philosophical ideas which shape the process of analysis [22]. themes. In many cases, a combined approach is appropriate The Framework Method, however, is not aligned with when the project has some specific issues to explore, but a particular epistemological, philosophical, or theoretical also aims to leave space to discover other unexpected approach. Rather it is a flexible tool that can be adapted aspects of the participants’ experience or the way they for use with many qualitative approaches that aim to assign meaning to phenomena. In sum, the Framework generate themes. Method can be adapted for use with deductive, inductive, or The development of themes is a common feature of combined types of qualitative analysis. However, there are qualitative data analysis, involving the systematic search some research questions where analysing data by case and for patterns to generate full descriptions capable of theme is not appropriate and so the Framework Method shedding light on the phenomenon under investigation. In should be avoided. For instance, depending on the research particular, many qualitative approaches use the ‘constant question, life history data might be better analysed using comparative method’, developed as part of Grounded narrative analysis [19]; recorded consultations between Theory, which involves making systematic comparisons patients and their healthcare practitioners using conversa- across cases to refine each theme [21,23]. Unlike Grounded tion analysis [26]; and documentary data, such as resources Theory, the Framework Method is not necessarily con- for pregnant women, using discourse analysis [27]. cerned with generating social theory, but can greatly It is not within the scope of this paper to consider facilitate constant comparative techniques through the study design or data collection in any depth, but before review of data across the matrix. moving on to describe the Framework Method analysis Perhaps because the Framework Method is so obviously process, it is worth taking a step back to consider briefly systematic, it has often, as other commentators have noted, what needs to happen before analysis begins. The selection been conflated with a deductive approach to qualitative of analysis method should have been considered at the analysis [13,14]. However, the tool itself has no allegiance proposal stage of the research and should fit with the to either inductive or deductive thematic analysis; where research questions and overall aims of the study. Many the research sits along this inductive-deductive continuum qualitative studies, particularly ones using inductive ana- depends on the research question. A question such as, ‘Can lysis, are emergent in nature; this can be a challenge and patients give an accurate biomedical account of the the researchers can only provide an “imaginative rehearsal” onset of their cardiovascular disease?’ is essentially a of what is to come [28]. In mixed methods studies, the role yes/no question (although it may be nuanced by the extent of the qualitative component within the wider goals of the of their account or by appropriate use of terminology) and project must also be considered. In the data collection so requires a deductive approach to both data collection stage, resources must be allocated for properly trained and analysis (e.g. structured or semi-structured interviews researchers to conduct the qualitative interviewing because and directed qualitative content analysis [24]). Similarly, a it is a highly skilled activity. In some cases, a research team may decidethattheywould like to uselay people,patients deductive approach may be taken if basing analysis on a pre-existing theory, such as behaviour change theories, for or peers to do the interviews [29-32] and in this case they example in the case of a research question such as ‘How must be properly trained and mentored which requires time and resources. At this early stage it is also useful to does the Theory of Planned Behaviour help explain GP prescribing?’ [11]. However, a research question such as, consider whether the team will use Computer Assisted ‘How do people construct accounts of the onset of their Qualitative Data Analysis Software (CAQDAS), which can cardiovascular disease?’ would require a more inductive assist with data management and analysis. approach that allows for the unexpected, and permits more As any form of qualitative or quantitative analysis is socially-located responses [25] from interviewees that may not a purely technical process, but influenced by the include matters of cultural beliefs, habits of food prepar- characteristics of the researchers and their disciplinary ation, concepts of ‘fate’, or links to other important events paradigms, critical reflection throughout the research in their lives, such as grief, which cannot be predicted by process is paramount, including in the design of the Gale et al. BMC Medical Research Methodology 2013, 13:117 Page 4 of 8 http://www.biomedcentral.com/1471-2288/13/117 study, the construction or collection of data, and the the passage as important. In more inductive studies, analysis. All members of the team should keep a research at this stage ‘open coding’ takes place, i.e. coding anything diary, where they record reflexive notes, impressions of the that might be relevant from as many different perspectives data and thoughts about analysis throughout the process. as possible. Codes could refer to substantive things Experienced qualitative researchers become more skilled at (e.g. particular behaviours, incidents or structures), values sifting through data and analysing it in a rigorous and (e.g. those that inform or underpin certain statements, reflexive way. They cannot be too attached to certainty, but such as a belief in evidence-based medicine or in patient must remain flexible and adaptive throughout the research choice), emotions (e.g. sorrow, frustration, love) and more in order to generate rich and nuanced findings that impressionistic/methodological elements (e.g. interviewee embrace and explain the complexity of real social life and found something difficult to explain, interviewee became can be applied to complex social issues. It is important to emotional, interviewer felt uncomfortable) [33]. In purely remember when using the Framework Method that, unlike deductive studies, the codes may have been pre-defined quantitative research where data collection and data ana- (e.g. by an existing theory, or specific areas of interest lysis are strictly sequential and mutually exclusive stages of to the project) so this stage may not be strictly necessary the research process, in qualitative analysis there is, to a and you could just move straight onto indexing, although greater or lesser extent depending on the project, ongoing it is generally helpful even if you are taking a broadly interplay between data collection, analysis, and theory deductive approach to do some open coding on at least a development. For example, new ideas or insights from few of the transcripts to ensure important aspects of the participants may suggest potentially fruitful lines of enquiry, data are not missed. Coding aims to classify all of the data or close analysis might reveal subtle inconsistencies in an so that it can be compared systematically with other parts account which require further exploration. of the data set. At least two researchers (or at least one from each discipline or speciality in a multi-disciplinary Procedure for analysis research team) should independently code the first few Stage 1: Transcription transcripts, if feasible. Patients, public involvement repre- A good quality audio recording and, ideally, a verbatim sentatives or clinicians can also be productively involved (word for word) transcription of the interview is needed. at this stage, because they can offer alternative viewpoints For Framework Method analysis, it is not necessarily thus ensuring that one particular perspective does not important to include the conventions of dialogue transcrip- dominate. It is vital in inductive coding to look out for the tions which can be difficult to read (e.g. pauses or two unexpected and not to just code in a literal, descriptive people talking simultaneously), because the content is what way so the involvement of people from different perspec- is of primary interest. Transcripts should have large margins tives can aid greatly in this. As well as getting a holistic and adequate line spacing for later coding and making impression of what was said, coding line-by-line can often notes. The process of transcription is a good opportunity to alert the researcher to consider that which may ordinarily become immersed in the data and is to be strongly encour- remain invisible because it is not clearly expressed or does aged for new researchers. However, in some projects, the not ‘fit’ with the rest of the account. In this way the devel- decision maybemadethatitisabetteruse of resourcesto oping analysis is challenged; to reconcile and explain outsource this task to a professional transcriber. anomalies in the data can make the analysis stronger. Coding can also be done digitally using CAQDAS, which Stage 2: Familiarisation with the interview is a useful way to keep track automatically of new codes. Becoming familiar with the whole interview using the audio However, some researchers prefer to do the early stages of recording and/or transcript and any contextual or reflective coding with a paper and pen, and only start to use notes that were recorded by the interviewer is a vital stage CAQDAS once they reach Stage 5 (see below). in interpretation. It can also be helpful to re-listen to all or parts of the audio recording. In multi-disciplinary or large Stage 4: Developing a working analytical framework research projects, those involved in analysing the data may After coding the first few transcripts, all researchers be different from those who conducted or transcribed the involved should meet to compare the labels they have interviews, which makes this stage particularly important. applied and agree on a set of codes to apply to all subse- One margin can be used to record any analytical notes, quent transcripts. Codes can be grouped together into thoughts or impressions. categories (using a tree diagram if helpful), which are then clearly defined. This forms a working analytical Stage 3: Coding framework. It is likely that several iterations of the ana- After familiarization, the researcher carefully reads the lytical framework will be required before no additional transcript line by line, applying a paraphrase or label codes emerge. It is always worth having an ‘other’ code (a ‘code’) that describes what they have interpreted in under each category to avoid ignoring data that does not Gale et al. BMC Medical Research Methodology 2013, 13:117 Page 5 of 8 http://www.biomedcentral.com/1471-2288/13/117 fit; the analytical framework is never ‘final’ until the last Gradually, characteristics of and differences between the transcript has been coded. data are identified, perhaps generating typologies, interro- gating theoretical concepts (either prior concepts or ones Stage 5: Applying the analytical framework emerging from the data) or mapping connections between The working analytical framework is then applied by categories to explore relationships and/or causality. If the indexing subsequent transcripts using the existing categor- data are rich enough, the findings generated through this ies and codes. Each code is usually assigned a number or process can go beyond description of particular cases to abbreviation for easy identification (and so the full names explanation of, for example, reasons for the emergence of a of the codes do not have to be written out each time) and phenomena, predicting how an organisation or other social written directly onto the transcripts. Computer Assisted actor is likely to instigate or respond to a situation, or iden- Qualitative Data Analysis Software (CAQDAS) is particu- tifying areas that are not functioning well within an organ- larly useful at this stage because it can speed up the process isation or system. It is worth noting that this stage often and ensures that, at later stages, data is easily retrievable. It takes longer than anticipated and that any project plan is worth noting that unlike software for statistical analyses, should ensure that sufficient time is allocated to meetings which actually carries out the calculations with the correct and individual researcher time to conduct interpretation instruction, putting the data into a qualitative analysis soft- and writing up of findings (see Additional file 1, Section 7). ware package does not analyse the data; it is simply an ef- fective way of storing and organising the data so that they Discussion are accessible for the analysis process. The Framework Method has been developed and used successfully in research for over 25 years, and has recently Stage 6: Charting data into the framework matrix become a popular analysis method in qualitative health Qualitative data are voluminous (an hour of interview research. The issue of how to assess quality in qualitative can generate 15–30 pages of text) and being able to research has been highly debated [20,34-40], but ensuring manage and summarize (reduce) data is a vital aspect of rigour and transparency in analysis is a vital component. the analysis process. A spreadsheet is used to generate a There are, of course, many ways to do this but in the matrix and the data are ‘charted’ into the matrix. Framework Method the following are helpful: Charting involves summarizing the data by category from each transcript. Good charting requires an ability  Summarizing the data during charting, as well as to strike a balance between reducing the data on the one being a practical way to reduce the data, means that hand and retaining the original meanings and ‘feel’ of all members of a multi-disciplinary team, including the interviewees’ words on the other. The chart should lay, clinical and (quantitative) academic members include references to interesting or illustrative quotations. can engage with the data and offer their perspectives These can be tagged automatically if you are using CAQDAS during the analysis process without necessarily to manage your data (N-Vivo version 9 onwards has the needing to read all the transcripts or be involved in capability to generate framework matrices), or otherwise a the more technical parts of analysis. capital ‘Q,’ an (anonymized) transcript number, page and  Charting also ensures that researchers pay close line reference will suffice. It is helpful in multi-disciplinary attention to describing the data using each teams to compare and contrast styles of summarizing in participant’s own subjective frames and expressions in the early stages of the analysis process to ensure con- the first instance, before moving onto interpretation. sistency within the team. Any abbreviations used should be  The summarized data is kept within the wider agreed by the team. Once members of the team are familiar context of each case, thereby encouraging thick with the analytical framework and well practised at coding description that pays attention to complex layers of and charting, on average, it will take about half a day per meaning and understanding [38]. hour-long transcript to reach this stage. In the early stages,  The matrix structure is visually straightforward and it takes much longer. can facilitate recognition of patterns in the data by any member of the research team, including through Stage 7: Interpreting the data drawing attention to contradictory data, deviant It is useful throughout the research to have a separate cases or empty cells. note book or computer file to note down impressions,  The systematic procedure (described in this article) ideas and early interpretations of the data. It may be makes it easy to follow, even for multi-disciplinary worth breaking off at any stage to explore an interesting teams and/or with large data sets. idea, concept or potential theme by writing an analytic  It is flexible enough that non-interview data (such as memo [20,21] to then discuss with other members of field notes taken during the interview or reflexive the research team, including lay and clinical members. considerations) can be included in the matrix. Gale et al. BMC Medical Research Methodology 2013, 13:117 Page 6 of 8 http://www.biomedcentral.com/1471-2288/13/117 It is not aligned with a particular epistemological lead for a large mixed methods study is a different person). viewpoint or theoretical approach and therefore can The qualitative lead would ideally be joined by other re- be adapted for use in inductive or deductive analysis searchers with at least some prior training in or experi- or a combination of the two (e.g. using pre-existing ence of qualitative analysis. The responsibilities of the lead theoretical constructs deductively, then revising the qualitative researcher are: to contribute to study design, theory with inductive aspects; or using an inductive project timelines and resource planning; to mentor junior approach to identify themes in the data, before qualitative researchers; to train clinical, lay and other returning to the literature and using theories (non-qualitative) academics to contribute as appropriate deductively to help further explain certain themes). to the analysis process; to facilitate analysis meetings in a It is easy to identify relevant data extracts to way that encourages critical and reflexive engagement illustrate themes and to check whether there is with the data and other team members; and finally to lead sufficient evidence for a proposed theme. the write-up of the study. Finally, there is a clear audit trail from original raw data to final themes, including the illustrative Conclusion quotes. We have argued that Framework Method studies can be conducted by multi-disciplinary research teams that There are also a number of potential pitfalls to this include, for example, healthcare professionals, psycholo- approach: gists, sociologists, economists, and lay people/service users. The inclusion of so many different perspectives The systematic approach and matrix format, as we means that decision-making in the analysis process can noted in the background, is intuitively appealing to be very time consuming and resource-intensive. It may those trained quantitatively but the ‘spreadsheet’ require extensive, reflexive and critical dialogue about look perhaps further increases the temptation for how the ideas expressed by interviewees and identified those without an in-depth understanding of in the transcript are related to pre-existing concepts and qualitative research to attempt to quantify theories from each discipline, and to the real ‘problems’ qualitative data (e.g. “13 out of 20 participants said in the health system that the project is addressing. This X). This kind of statement is clearly meaningless kind of team effort is, however, an excellent forum for because the sampling in qualitative research is not driving forward interdisciplinary collaboration, as well as designed to be representative of a wider population, clinical and lay involvement in research, to ensure that ‘the but purposive to capture diversity around a whole is greater than the sum of the parts,’ by enhancing phenomenon [41]. the credibility and relevance of the findings. Like all qualitative analysis methods, the Framework The Framework Method is appropriate for thematic Method is time consuming and resource-intensive. analysis of textual data, particularly interview transcripts, When involving multiple stakeholders and disciplines where it is important to be able to compare and contrast in the analysis and interpretation of the data, as is data by themes across many cases, while also situating good practice in applied health research, the time each perspective in context by retaining the connection needed is extended. This time needs to be factored to other aspects of each individual’s account. Experienced into the project proposal at the pre-funding stage. qualitative researchers should lead and facilitate all aspects There is a high training component to successfully of the analysis, although the Framework Method’ssystem- using the method in a new multi-disciplinary team. atic approach makes it suitable for involving all members Depending on their role in the analysis, members of of a multi-disciplinary team. An open, critical and reflexive the research team may have to learn how to code, approach from all team members is essential for rigorous index, and chart data, to think reflexively about how qualitative analysis. their identities and experience affect the analysis Acceptance of the complexity of real life health systems process, and/or they may have to learn about the and the existence of multiple perspectives on health issues methods of generalisation (i.e. analytic generalisation is necessary to produce high quality qualitative research. and transferability, rather than statistical If done well, qualitative studies can shed explanatory generalisation [41]) to help to interpret legitimately and predictive light on important phenomena, relate the meaning and significance of the data. constructively to quantitative parts of a larger study, and contribute to the improvement of health services While the Framework Method is amenable to the and development of health policy. The Framework participation of non-experts in data analysis, it is critical Method, when selected and implemented appropriately, to the successful use of the method that an experienced can be a suitable tool for achieving these aims through qualitative researcher leads the project (even if the overall producing credible and relevant findings. Gale et al. BMC Medical Research Methodology 2013, 13:117 Page 7 of 8 http://www.biomedcentral.com/1471-2288/13/117 Summary 4. Elkington H, White P, Addington-Hall J, Higgs R, Petternari C: The last year of life of COPD: a qualitative study of symptoms and services. Respir Med 2004, 98(5):439–445. The Framework Method is an excellent tool for 5. Murtagh J, Dixey R, Rudolf M: A qualitative investigation into the levers supporting thematic (qualitative content) analysis and barriers to weight loss in children: opinions of obese children. Archives Dis Child 2006, 91(11):920–923. because it provides a systematic model for managing 6. Barnard M, Webster S, O’Connor W, Jones A, Donmall M: The drug treatment and mapping the data. outcomes research study (DTORS): qualitative study. London: Home Office; 2009. The Framework Method is most suitable for analysis 7. Ayatollahi H, Bath PA, Goodacre S: Factors influencing the use of IT in the emergency department: a qualitative study. Health Inform J 2010, of interview data, where it is desirable to generate 16(3):189–200. themes by making comparisons within and between 8. Sheard L, Prout H, Dowding D, Noble S, Watt I, Maraveyas A, Johnson M: cases. Barriers to the diagnosis and treatment of venous thromboembolism in advanced cancer patients: a qualitative study. Palliative Med 2012, The management of large data sets is facilitated by the 27(2):339–348. Framework Method as its matrix form provides an 9. Ellis J, Wagland R, Tishelman C, Williams ML, Bailey CD, Haines J, Caress A, intuitively structured overview of summarised data. Lorigan P, Smith JA, Booton R, et al: Considerations in developing and delivering a nonpharmacological intervention for symptom The clear, step-by-step process of the Framework management in lung cancer: the views of patients and informal Method makes it is suitable for interdisciplinary and caregivers. J Pain Symptom Manag (0) 2012, 44(6):831–842. collaborative projects. 10. Gale N, Sultan H: Telehealth as ‘peace of mind’: embodiment, emotions and the home as the primary health space for people with chronic The use of the method should be led and facilitated obstructive pulmonary disorder. Health place 2013, 21:140–147. by an experienced qualitative researcher. 11. Rashidian A, Eccles MP, Russell I: Falling on stony ground? A qualitative study of implementation of clinical guidelines’ prescribing recommendations in primary care. Health policy 2008, 85(2):148–161. Additional files 12. Jones RK: The unsolicited diary as a qualitative research tool for advanced research capacity in the field of health and illness. Qualitative Health Res 2000, 10(4):555–567. Additional file 1: Illustrative Example of the use of the Framework 13. Pope C, Ziebland S, Mays N: Analysing qualitative data. British Med J 2000, Method. 320:114–116. 14. Pope C, Mays N: Critical reflections on the rise of qualitative research. Competing interests British Med J 2009, 339:737–739. The authors declare that they have no competing interests. 15. Fairclough N: Critical discourse analysis: the critical study of language. London: Longman; 2010. 16. Garfinkel H: Ethnomethodology’sprogram. Soc Psychol Quarter 1996, 59(1):5–21. Authors’ contributions 17. Merleau-Ponty M: The phenomenology of perception. London: Routledge and All authors were involved in the development of the concept of the article Kegan Paul; 1962. and drafting the article. NG wrote the first draft of the article, GH and EC 18. Svenaeus F: The phenomenology of health and illness.In Handbook of prepared the text and figures related to the illustrative example, SRa did the phenomenology and medicine. Netherlands: Springer; 2001:87–108. literature search to identify if there were any similar articles currently 19. Reissmann CK: Narrative methods for the human sciences. London: Sage; 2008. available and contributed to drafting of the article, and SRe contributed to 20. Charmaz K: Constructing grounded theory: a practical guide through drafting of the article and the illustrative example. All authors read and qualitative analysis. London: Sage; 2006. approved the final manuscript. 21. Glaser A, Strauss AL: The discovery of grounded theory. Chicago: Aldine; 1967. 22. Crotty M: The foundations of social research: meaning and perspective in the Acknowledgments research process. London: Sage; 1998. All authors were funded by the National Institute for Health Research (NIHR) 23. Boeije H: A purposeful approach to the constant comparative method in through the Collaborations for Leadership in Applied Health Research and the analysis of qualitative interviews. Qual Quant 2002, 36(4):391–409. Care for Birmingham and Black Country (CLAHRC-BBC) programme. The 24. Hsieh H-F, Shannon SE: Three approaches to qualitative content analysis. views in this publication expressed are those of the authors and not Qual Health Res 2005, 15(9):1277–1288. necessarily those of the NHS, the NIHR or the Department of Health. 25. Redwood S, Gale NK, Greenfield S: ‘You give us rangoli, we give you talk’: using an art-based activity to elicit data from a seldom heard group. Author details BMC Med Res Methodol 2012, 12(1):7. Health Services Management Centre, University of Birmingham, Park House, 26. Mishler EG: The struggle between the voice of medicine and the voice of 40 Edgbaston Park Road, Birmingham B15 2RT, UK. School of Health and the lifeworld.In The sociology of health and illness: critical perspectives. Thirdth Population Sciences, University of Birmingham, Edgbaston, Birmingham B15 edition. Edited by Conrad P, Kern R. New York: St Martins Press; 1990. 2TT, UK. School of Life and Health Sciences, Aston University, Aston Triangle, 27. Hodges BD, Kuper A, Reeves S: Discourse analysis. British Med J 2008, Birmingham B4 7ET, UK. East and North Hertfordshire NHS Trust, Lister 337:570–572. hospital, Coreys Mill Lane, Stevenage SG1 4AB, UK. 28. Sandelowski M, Barroso J: Writing the proposal for a qualitative research methodology project. Qual Health Res 2003, 13(6):781–820. Received: 17 December 2012 Accepted: 6 September 2013 29. Ellins J: It’s better together: involving older people in research. HSMC Published: 18 September 2013 Newsletter Focus Serv Users Publ 2010, 16(1):4. 30. Phillimore J, Goodson L, Hennessy D, Ergun E: Empowering Birmingham’s migrant and refugee community organisations: making a difference. York: References Joseph Rowntree Foundation; 2009. 1. Ritchie J, Lewis J: Qualitative research practice: a guide for social science 31. Leamy M, Clough R: How older people became researchers. York: Joseph students and researchers. London: Sage; 2003. Rowntree Foundation; 2006. 2. Ives J, Damery S, Redwod S: PPI, paradoxes and Plato: who's sailing the ship? J Med Ethics 2013, 39(3):181–185. 32. Glasby J, Miller R, Ellins J, Durose J, Davidson D, McIver S, Littlechild R, 3. Heath G, Cameron E, Cummins C, Greenfield S, Pattison H, Kelly D, Tanner D, Snelling I, Spence K: Understanding and improving transitions of Redwood S: Paediatric ‘care closer to home’: stake-holder views and older people: a user and carer centred approach, Final report NIHR service barriers to implementation. Health Place 2012, 18(5):1068–1073. delivery and organisation programme. London: The Stationery Office; 2012. Gale et al. BMC Medical Research Methodology 2013, 13:117 Page 8 of 8 http://www.biomedcentral.com/1471-2288/13/117 33. Saldaña J: The coding manual for qualitative researchers. London: Sage; 2009. 34. Lincoln YS: Emerging criteria for quality in qualitative and interpretive research. Qual Inquiry 1995, 1(3):275–289. 35. Mays N, Pope C: Qualitative research in health care: assessing quality in qualitative research. BMJ British Med J 2000, 320(7226):50. 36. Seale C: Quality in qualitative research. Qual Inquiry 1999, 5(4):465–478. 37. Dingwall R, Murphy E, Watson P, Greatbatch D, Parker S: Catching goldfish: quality in qualitative research. J Health serv Res Policy 1998, 3(3):167–172. 38. Popay J, Rogers A, Williams G: Rationale and standards for the systematic review of qualitative literature in health services research. Qual Health Res 1998, 8(3):341–351. 39. Morse JM, Barrett M, Mayan M, Olson K, Spiers J: Verification strategies for establishing reliability and validity in qualitative research. Int J Qual Methods 2008, 1(2):13–22. 40. Smith JA: Reflecting on the development of interpretative phenomenological analysis and its contribution to qualitative research in psychology. Qual Res Psychol 2004, 1(1):39–54. 41. Polit DF, Beck CT: Generalization in quantitative and qualitative research: Myths and strategies. Int J Nurs Studies 2010, 47(11):1451–1458. doi:10.1186/1471-2288-13-117 Cite this article as: Gale et al.: Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology 2013 13:117. 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Using the framework method for the analysis of qualitative data in multi-disciplinary health research

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Springer Journals
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Copyright © Gale et al.; licensee BioMed Central Ltd. 2013
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Medicine & Public Health; Theory of Medicine/Bioethics; Statistical Theory and Methods; Statistics for Life Sciences, Medicine, Health Sciences
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1471-2288
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10.1186/1471-2288-13-117
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24047204
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Abstract

Background: The Framework Method is becoming an increasingly popular approach to the management and analysis of qualitative data in health research. However, there is confusion about its potential application and limitations. Discussion: The article discusses when it is appropriate to adopt the Framework Method and explains the procedure for using it in multi-disciplinary health research teams, or those that involve clinicians, patients and lay people. The stages of the method are illustrated using examples from a published study. Summary: Used effectively, with the leadership of an experienced qualitative researcher, the Framework Method is a systematic and flexible approach to analysing qualitative data and is appropriate for use in research teams even where not all members have previous experience of conducting qualitative research. Keywords: Qualitative research, Qualitative content analysis, Multi-disciplinary research The Framework Method for the management and analysis We then present a step-by-step guide to the application of of qualitative data has been used since the 1980s [1]. The the Framework Method, illustrated using a worked method originated in large-scale social policy research but example (See Additional File 1) from a published is becoming an increasingly popular approach in medical study [3] to illustrate the main stages of the process. and health research; however, there is some confusion Technical terms are included in the glossary (below). about its potential application and limitations. In this Finally, we discuss the strengths and limitations of article we discuss when it is appropriate to use the the approach. Framework Method and how it compares to other qualitative analysis methods. In particular, we explore Glossary of key terms used in the Framework how it can be used in multi-disciplinary health research Method teams. Multi-disciplinary and mixed methods studies are Analytical framework: A set of codes organised into becoming increasingly commonplace in applied health categories that have been jointly developed by researchers research. As well as disciplines familiar with qualitative involved in analysis that can be used to manage and research, such as nursing, psychology and sociology, teams organise the data. The framework creates a new structure often include epidemiologists, health economists, manage- for the data (rather than the full original accounts given ment scientists and others. Furthermore, applied health by participants) that is helpful to summarize/reduce the research often has clinical representation and, increasingly, data in a way that can support answering the research patient and public involvement [2]. We argue that while questions. leadership is undoubtedly required from an experienced Analytic memo: A written investigation of a particular qualitative methodologist, non-specialists from the wider concept, theme or problem, reflecting on emerging team can and should be involved in the analysis process. issues in the data that captures the analytic process (see Additional file 1, Section 7). * Correspondence: [email protected] Categories: During the analysis process, codes are Health Services Management Centre, University of Birmingham, Park House, grouped into clusters around similar and interrelated ideas 40 Edgbaston Park Road, Birmingham B15 2RT, UK Full list of author information is available at the end of the article or concepts. Categories and codes are usually arranged in © 2013 Gale et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Gale et al. BMC Medical Research Methodology 2013, 13:117 Page 2 of 8 http://www.biomedcentral.com/1471-2288/13/117 a tree diagram structure in the analytical framework. groups or organisations. While in-depth analyses of key While categories are closely and explicitly linked to the themes can take place across the whole data set, the views raw data, developing categories is a way to start the of each research participant remain connected to other process of abstraction of the data (i.e. towards the general aspects of their account within the matrix so that the rather than the specific or anecdotal). context of the individual’s views is not lost. Comparing Charting: Entering summarized data into the Framework and contrasting data is vital to qualitative analysis and the Method matrix (see Additional File 1, Section 6). ability to compare with ease data across cases as well as Code: A descriptive or conceptual label that is assigned within individual cases is built into the structure and to excerpts of raw data in a process called ‘coding’ process of the Framework Method. (see Additional File 1, Section 3). The Framework Method provides clear steps to follow Data: Qualitative data usually needs to be in textual form and produces highly structured outputs of summarised before analysis. These texts can either be elicited texts data. It is therefore useful where multiple researchers are (written specifically for the research, such as food diaries), working on a project, particularly in multi-disciplinary or extant texts (pre-existing texts, such as meeting research teams were not all members have experience minutes, policy documents or weblogs), or can be produced of qualitative data analysis, and for managing large by transcribing interview or focus group data, or creating data sets where obtaining a holistic, descriptive overview ‘field’ notes while conducting participant-observation or of the entire data set is desirable. However, caution is observing objects or social situations. recommended before selecting the method as it is not a Indexing: The systematic application of codes from suitable tool for analysing all types of qualitative data or the agreed analytical framework to the whole dataset for answering all qualitative research questions, nor is it (see Additional File 1, Section 5). an ‘easy’ version of qualitative research for quantitative Matrix: A spreadsheet contains numerous cells into researchers. Importantly, the Framework Method cannot which summarized data are entered by codes (columns) accommodate highly heterogeneous data, i.e. data must and cases (rows) (see Additional File 1, Section 6). cover similar topics or key issues so that it is possible to Themes: Interpretive concepts or propositions that categorize it. Individual interviewees may, of course, have describe or explain aspects of the data, which are the very different views or experiences in relation to each final output of the analysis of the whole dataset. Themes topic, which can then be compared and contrasted. The are articulated and developed by interrogating data Framework Method is most commonly used for the categories through comparison between and within thematic analysis of semi-structured interview transcripts, cases. Usually a number of categories would fall which is what we focus on in this article, although it could, under each theme or sub-theme [3]. in principle, be adapted for other types of textual data Transcript: A written verbatim (word-for-word) account [13], including documents, such as meeting minutes or of a verbal interaction, such as an interview or conversation. diaries [12], or field notes from observations [10]. For quantitative researchers working with qualitative Background colleagues or when exploring qualitative research for the The Framework Method sits within a broad family of firsttime, thenatureofthe Framework Method is seductive analysis methods often termed thematic analysis or because its methodical processes and ‘spreadsheet’ qualitative content analysis. These approaches identify approach seem more closely aligned to the quantitative commonalities and differences in qualitative data, before paradigm [14]. Although the Framework Method is a highly focusing on relationships between different parts of systematic method of categorizing and organizing what the data, thereby seeking to draw descriptive and/or may seem like unwieldy qualitative data, it is not a panacea explanatory conclusions clustered around themes. The for problematic issues commonly associated with qualita- tive data analysis such as how to make analytic choices and Framework Method was developed by researchers, Jane Ritchie and Liz Spencer, from the Qualitative Research make interpretive strategies visible and auditable. Qualita- Unit at the National Centre for Social Research in the tive research skills are required to appropriately interpret the matrix, and facilitate the generation of descriptions, United Kingdom in the late 1980s for use in large-scale policy research [1]. It is now used widely in other areas, categories, explanations and typologies. Moreover, reflexiv- including health research [3-12]. Its defining feature is the ity, rigour and quality are issues that are requisite in the Framework Method just as they are in other qualitative matrix output: rows (cases), columns (codes) and ‘cells’ of summarised data, providing a structure into which the methods. It is therefore essential that studies using the researcher can systematically reduce the data, in order Framework Method for analysis are overseen by an experi- enced qualitative researcher, though this does not preclude to analyse it by case and by code [1]. Most often a ‘case’ is an individual interviewee, but this can be those new to qualitative research from contributing to the adapted to other units of analysis, such as predefined analysis as part of a wider research team. Gale et al. BMC Medical Research Methodology 2013, 13:117 Page 3 of 8 http://www.biomedcentral.com/1471-2288/13/117 There are a number of approaches to qualitative data the researcher in advance (e.g. an interviewee-led open analysis, including those that pay close attention to language ended interview and grounded theory [20]). In all these and how it is being used in social interaction such as cases, it maybeappropriate to usethe FrameworkMethod discourse analysis [15] and ethnomethodology [16]; those to manage thedata. Thedifferencewould become that are concerned with experience, meaning and language apparent in how themes are selected: in the deductive such as phenomenology [17,18] and narrative methods [19]; approach, themes and codes are pre-selected based on and those that seek to develop theory derived from data previous literature, previous theories or the specifics through a set of procedures and interconnected stages such of the research question; whereas in the inductive as Grounded Theory [20,21]. Many of these approaches are approach, themes are generated from the data though associated with specific disciplines and are underpinned by open (unrestricted) coding, followed by refinement of philosophical ideas which shape the process of analysis [22]. themes. In many cases, a combined approach is appropriate The Framework Method, however, is not aligned with when the project has some specific issues to explore, but a particular epistemological, philosophical, or theoretical also aims to leave space to discover other unexpected approach. Rather it is a flexible tool that can be adapted aspects of the participants’ experience or the way they for use with many qualitative approaches that aim to assign meaning to phenomena. In sum, the Framework generate themes. Method can be adapted for use with deductive, inductive, or The development of themes is a common feature of combined types of qualitative analysis. However, there are qualitative data analysis, involving the systematic search some research questions where analysing data by case and for patterns to generate full descriptions capable of theme is not appropriate and so the Framework Method shedding light on the phenomenon under investigation. In should be avoided. For instance, depending on the research particular, many qualitative approaches use the ‘constant question, life history data might be better analysed using comparative method’, developed as part of Grounded narrative analysis [19]; recorded consultations between Theory, which involves making systematic comparisons patients and their healthcare practitioners using conversa- across cases to refine each theme [21,23]. Unlike Grounded tion analysis [26]; and documentary data, such as resources Theory, the Framework Method is not necessarily con- for pregnant women, using discourse analysis [27]. cerned with generating social theory, but can greatly It is not within the scope of this paper to consider facilitate constant comparative techniques through the study design or data collection in any depth, but before review of data across the matrix. moving on to describe the Framework Method analysis Perhaps because the Framework Method is so obviously process, it is worth taking a step back to consider briefly systematic, it has often, as other commentators have noted, what needs to happen before analysis begins. The selection been conflated with a deductive approach to qualitative of analysis method should have been considered at the analysis [13,14]. However, the tool itself has no allegiance proposal stage of the research and should fit with the to either inductive or deductive thematic analysis; where research questions and overall aims of the study. Many the research sits along this inductive-deductive continuum qualitative studies, particularly ones using inductive ana- depends on the research question. A question such as, ‘Can lysis, are emergent in nature; this can be a challenge and patients give an accurate biomedical account of the the researchers can only provide an “imaginative rehearsal” onset of their cardiovascular disease?’ is essentially a of what is to come [28]. In mixed methods studies, the role yes/no question (although it may be nuanced by the extent of the qualitative component within the wider goals of the of their account or by appropriate use of terminology) and project must also be considered. In the data collection so requires a deductive approach to both data collection stage, resources must be allocated for properly trained and analysis (e.g. structured or semi-structured interviews researchers to conduct the qualitative interviewing because and directed qualitative content analysis [24]). Similarly, a it is a highly skilled activity. In some cases, a research team may decidethattheywould like to uselay people,patients deductive approach may be taken if basing analysis on a pre-existing theory, such as behaviour change theories, for or peers to do the interviews [29-32] and in this case they example in the case of a research question such as ‘How must be properly trained and mentored which requires time and resources. At this early stage it is also useful to does the Theory of Planned Behaviour help explain GP prescribing?’ [11]. However, a research question such as, consider whether the team will use Computer Assisted ‘How do people construct accounts of the onset of their Qualitative Data Analysis Software (CAQDAS), which can cardiovascular disease?’ would require a more inductive assist with data management and analysis. approach that allows for the unexpected, and permits more As any form of qualitative or quantitative analysis is socially-located responses [25] from interviewees that may not a purely technical process, but influenced by the include matters of cultural beliefs, habits of food prepar- characteristics of the researchers and their disciplinary ation, concepts of ‘fate’, or links to other important events paradigms, critical reflection throughout the research in their lives, such as grief, which cannot be predicted by process is paramount, including in the design of the Gale et al. BMC Medical Research Methodology 2013, 13:117 Page 4 of 8 http://www.biomedcentral.com/1471-2288/13/117 study, the construction or collection of data, and the the passage as important. In more inductive studies, analysis. All members of the team should keep a research at this stage ‘open coding’ takes place, i.e. coding anything diary, where they record reflexive notes, impressions of the that might be relevant from as many different perspectives data and thoughts about analysis throughout the process. as possible. Codes could refer to substantive things Experienced qualitative researchers become more skilled at (e.g. particular behaviours, incidents or structures), values sifting through data and analysing it in a rigorous and (e.g. those that inform or underpin certain statements, reflexive way. They cannot be too attached to certainty, but such as a belief in evidence-based medicine or in patient must remain flexible and adaptive throughout the research choice), emotions (e.g. sorrow, frustration, love) and more in order to generate rich and nuanced findings that impressionistic/methodological elements (e.g. interviewee embrace and explain the complexity of real social life and found something difficult to explain, interviewee became can be applied to complex social issues. It is important to emotional, interviewer felt uncomfortable) [33]. In purely remember when using the Framework Method that, unlike deductive studies, the codes may have been pre-defined quantitative research where data collection and data ana- (e.g. by an existing theory, or specific areas of interest lysis are strictly sequential and mutually exclusive stages of to the project) so this stage may not be strictly necessary the research process, in qualitative analysis there is, to a and you could just move straight onto indexing, although greater or lesser extent depending on the project, ongoing it is generally helpful even if you are taking a broadly interplay between data collection, analysis, and theory deductive approach to do some open coding on at least a development. For example, new ideas or insights from few of the transcripts to ensure important aspects of the participants may suggest potentially fruitful lines of enquiry, data are not missed. Coding aims to classify all of the data or close analysis might reveal subtle inconsistencies in an so that it can be compared systematically with other parts account which require further exploration. of the data set. At least two researchers (or at least one from each discipline or speciality in a multi-disciplinary Procedure for analysis research team) should independently code the first few Stage 1: Transcription transcripts, if feasible. Patients, public involvement repre- A good quality audio recording and, ideally, a verbatim sentatives or clinicians can also be productively involved (word for word) transcription of the interview is needed. at this stage, because they can offer alternative viewpoints For Framework Method analysis, it is not necessarily thus ensuring that one particular perspective does not important to include the conventions of dialogue transcrip- dominate. It is vital in inductive coding to look out for the tions which can be difficult to read (e.g. pauses or two unexpected and not to just code in a literal, descriptive people talking simultaneously), because the content is what way so the involvement of people from different perspec- is of primary interest. Transcripts should have large margins tives can aid greatly in this. As well as getting a holistic and adequate line spacing for later coding and making impression of what was said, coding line-by-line can often notes. The process of transcription is a good opportunity to alert the researcher to consider that which may ordinarily become immersed in the data and is to be strongly encour- remain invisible because it is not clearly expressed or does aged for new researchers. However, in some projects, the not ‘fit’ with the rest of the account. In this way the devel- decision maybemadethatitisabetteruse of resourcesto oping analysis is challenged; to reconcile and explain outsource this task to a professional transcriber. anomalies in the data can make the analysis stronger. Coding can also be done digitally using CAQDAS, which Stage 2: Familiarisation with the interview is a useful way to keep track automatically of new codes. Becoming familiar with the whole interview using the audio However, some researchers prefer to do the early stages of recording and/or transcript and any contextual or reflective coding with a paper and pen, and only start to use notes that were recorded by the interviewer is a vital stage CAQDAS once they reach Stage 5 (see below). in interpretation. It can also be helpful to re-listen to all or parts of the audio recording. In multi-disciplinary or large Stage 4: Developing a working analytical framework research projects, those involved in analysing the data may After coding the first few transcripts, all researchers be different from those who conducted or transcribed the involved should meet to compare the labels they have interviews, which makes this stage particularly important. applied and agree on a set of codes to apply to all subse- One margin can be used to record any analytical notes, quent transcripts. Codes can be grouped together into thoughts or impressions. categories (using a tree diagram if helpful), which are then clearly defined. This forms a working analytical Stage 3: Coding framework. It is likely that several iterations of the ana- After familiarization, the researcher carefully reads the lytical framework will be required before no additional transcript line by line, applying a paraphrase or label codes emerge. It is always worth having an ‘other’ code (a ‘code’) that describes what they have interpreted in under each category to avoid ignoring data that does not Gale et al. BMC Medical Research Methodology 2013, 13:117 Page 5 of 8 http://www.biomedcentral.com/1471-2288/13/117 fit; the analytical framework is never ‘final’ until the last Gradually, characteristics of and differences between the transcript has been coded. data are identified, perhaps generating typologies, interro- gating theoretical concepts (either prior concepts or ones Stage 5: Applying the analytical framework emerging from the data) or mapping connections between The working analytical framework is then applied by categories to explore relationships and/or causality. If the indexing subsequent transcripts using the existing categor- data are rich enough, the findings generated through this ies and codes. Each code is usually assigned a number or process can go beyond description of particular cases to abbreviation for easy identification (and so the full names explanation of, for example, reasons for the emergence of a of the codes do not have to be written out each time) and phenomena, predicting how an organisation or other social written directly onto the transcripts. Computer Assisted actor is likely to instigate or respond to a situation, or iden- Qualitative Data Analysis Software (CAQDAS) is particu- tifying areas that are not functioning well within an organ- larly useful at this stage because it can speed up the process isation or system. It is worth noting that this stage often and ensures that, at later stages, data is easily retrievable. It takes longer than anticipated and that any project plan is worth noting that unlike software for statistical analyses, should ensure that sufficient time is allocated to meetings which actually carries out the calculations with the correct and individual researcher time to conduct interpretation instruction, putting the data into a qualitative analysis soft- and writing up of findings (see Additional file 1, Section 7). ware package does not analyse the data; it is simply an ef- fective way of storing and organising the data so that they Discussion are accessible for the analysis process. The Framework Method has been developed and used successfully in research for over 25 years, and has recently Stage 6: Charting data into the framework matrix become a popular analysis method in qualitative health Qualitative data are voluminous (an hour of interview research. The issue of how to assess quality in qualitative can generate 15–30 pages of text) and being able to research has been highly debated [20,34-40], but ensuring manage and summarize (reduce) data is a vital aspect of rigour and transparency in analysis is a vital component. the analysis process. A spreadsheet is used to generate a There are, of course, many ways to do this but in the matrix and the data are ‘charted’ into the matrix. Framework Method the following are helpful: Charting involves summarizing the data by category from each transcript. Good charting requires an ability  Summarizing the data during charting, as well as to strike a balance between reducing the data on the one being a practical way to reduce the data, means that hand and retaining the original meanings and ‘feel’ of all members of a multi-disciplinary team, including the interviewees’ words on the other. The chart should lay, clinical and (quantitative) academic members include references to interesting or illustrative quotations. can engage with the data and offer their perspectives These can be tagged automatically if you are using CAQDAS during the analysis process without necessarily to manage your data (N-Vivo version 9 onwards has the needing to read all the transcripts or be involved in capability to generate framework matrices), or otherwise a the more technical parts of analysis. capital ‘Q,’ an (anonymized) transcript number, page and  Charting also ensures that researchers pay close line reference will suffice. It is helpful in multi-disciplinary attention to describing the data using each teams to compare and contrast styles of summarizing in participant’s own subjective frames and expressions in the early stages of the analysis process to ensure con- the first instance, before moving onto interpretation. sistency within the team. Any abbreviations used should be  The summarized data is kept within the wider agreed by the team. Once members of the team are familiar context of each case, thereby encouraging thick with the analytical framework and well practised at coding description that pays attention to complex layers of and charting, on average, it will take about half a day per meaning and understanding [38]. hour-long transcript to reach this stage. In the early stages,  The matrix structure is visually straightforward and it takes much longer. can facilitate recognition of patterns in the data by any member of the research team, including through Stage 7: Interpreting the data drawing attention to contradictory data, deviant It is useful throughout the research to have a separate cases or empty cells. note book or computer file to note down impressions,  The systematic procedure (described in this article) ideas and early interpretations of the data. It may be makes it easy to follow, even for multi-disciplinary worth breaking off at any stage to explore an interesting teams and/or with large data sets. idea, concept or potential theme by writing an analytic  It is flexible enough that non-interview data (such as memo [20,21] to then discuss with other members of field notes taken during the interview or reflexive the research team, including lay and clinical members. considerations) can be included in the matrix. Gale et al. BMC Medical Research Methodology 2013, 13:117 Page 6 of 8 http://www.biomedcentral.com/1471-2288/13/117 It is not aligned with a particular epistemological lead for a large mixed methods study is a different person). viewpoint or theoretical approach and therefore can The qualitative lead would ideally be joined by other re- be adapted for use in inductive or deductive analysis searchers with at least some prior training in or experi- or a combination of the two (e.g. using pre-existing ence of qualitative analysis. The responsibilities of the lead theoretical constructs deductively, then revising the qualitative researcher are: to contribute to study design, theory with inductive aspects; or using an inductive project timelines and resource planning; to mentor junior approach to identify themes in the data, before qualitative researchers; to train clinical, lay and other returning to the literature and using theories (non-qualitative) academics to contribute as appropriate deductively to help further explain certain themes). to the analysis process; to facilitate analysis meetings in a It is easy to identify relevant data extracts to way that encourages critical and reflexive engagement illustrate themes and to check whether there is with the data and other team members; and finally to lead sufficient evidence for a proposed theme. the write-up of the study. Finally, there is a clear audit trail from original raw data to final themes, including the illustrative Conclusion quotes. We have argued that Framework Method studies can be conducted by multi-disciplinary research teams that There are also a number of potential pitfalls to this include, for example, healthcare professionals, psycholo- approach: gists, sociologists, economists, and lay people/service users. The inclusion of so many different perspectives The systematic approach and matrix format, as we means that decision-making in the analysis process can noted in the background, is intuitively appealing to be very time consuming and resource-intensive. It may those trained quantitatively but the ‘spreadsheet’ require extensive, reflexive and critical dialogue about look perhaps further increases the temptation for how the ideas expressed by interviewees and identified those without an in-depth understanding of in the transcript are related to pre-existing concepts and qualitative research to attempt to quantify theories from each discipline, and to the real ‘problems’ qualitative data (e.g. “13 out of 20 participants said in the health system that the project is addressing. This X). This kind of statement is clearly meaningless kind of team effort is, however, an excellent forum for because the sampling in qualitative research is not driving forward interdisciplinary collaboration, as well as designed to be representative of a wider population, clinical and lay involvement in research, to ensure that ‘the but purposive to capture diversity around a whole is greater than the sum of the parts,’ by enhancing phenomenon [41]. the credibility and relevance of the findings. Like all qualitative analysis methods, the Framework The Framework Method is appropriate for thematic Method is time consuming and resource-intensive. analysis of textual data, particularly interview transcripts, When involving multiple stakeholders and disciplines where it is important to be able to compare and contrast in the analysis and interpretation of the data, as is data by themes across many cases, while also situating good practice in applied health research, the time each perspective in context by retaining the connection needed is extended. This time needs to be factored to other aspects of each individual’s account. Experienced into the project proposal at the pre-funding stage. qualitative researchers should lead and facilitate all aspects There is a high training component to successfully of the analysis, although the Framework Method’ssystem- using the method in a new multi-disciplinary team. atic approach makes it suitable for involving all members Depending on their role in the analysis, members of of a multi-disciplinary team. An open, critical and reflexive the research team may have to learn how to code, approach from all team members is essential for rigorous index, and chart data, to think reflexively about how qualitative analysis. their identities and experience affect the analysis Acceptance of the complexity of real life health systems process, and/or they may have to learn about the and the existence of multiple perspectives on health issues methods of generalisation (i.e. analytic generalisation is necessary to produce high quality qualitative research. and transferability, rather than statistical If done well, qualitative studies can shed explanatory generalisation [41]) to help to interpret legitimately and predictive light on important phenomena, relate the meaning and significance of the data. constructively to quantitative parts of a larger study, and contribute to the improvement of health services While the Framework Method is amenable to the and development of health policy. The Framework participation of non-experts in data analysis, it is critical Method, when selected and implemented appropriately, to the successful use of the method that an experienced can be a suitable tool for achieving these aims through qualitative researcher leads the project (even if the overall producing credible and relevant findings. Gale et al. BMC Medical Research Methodology 2013, 13:117 Page 7 of 8 http://www.biomedcentral.com/1471-2288/13/117 Summary 4. Elkington H, White P, Addington-Hall J, Higgs R, Petternari C: The last year of life of COPD: a qualitative study of symptoms and services. Respir Med 2004, 98(5):439–445. The Framework Method is an excellent tool for 5. Murtagh J, Dixey R, Rudolf M: A qualitative investigation into the levers supporting thematic (qualitative content) analysis and barriers to weight loss in children: opinions of obese children. Archives Dis Child 2006, 91(11):920–923. because it provides a systematic model for managing 6. Barnard M, Webster S, O’Connor W, Jones A, Donmall M: The drug treatment and mapping the data. outcomes research study (DTORS): qualitative study. London: Home Office; 2009. The Framework Method is most suitable for analysis 7. Ayatollahi H, Bath PA, Goodacre S: Factors influencing the use of IT in the emergency department: a qualitative study. Health Inform J 2010, of interview data, where it is desirable to generate 16(3):189–200. themes by making comparisons within and between 8. Sheard L, Prout H, Dowding D, Noble S, Watt I, Maraveyas A, Johnson M: cases. Barriers to the diagnosis and treatment of venous thromboembolism in advanced cancer patients: a qualitative study. Palliative Med 2012, The management of large data sets is facilitated by the 27(2):339–348. Framework Method as its matrix form provides an 9. Ellis J, Wagland R, Tishelman C, Williams ML, Bailey CD, Haines J, Caress A, intuitively structured overview of summarised data. Lorigan P, Smith JA, Booton R, et al: Considerations in developing and delivering a nonpharmacological intervention for symptom The clear, step-by-step process of the Framework management in lung cancer: the views of patients and informal Method makes it is suitable for interdisciplinary and caregivers. J Pain Symptom Manag (0) 2012, 44(6):831–842. collaborative projects. 10. Gale N, Sultan H: Telehealth as ‘peace of mind’: embodiment, emotions and the home as the primary health space for people with chronic The use of the method should be led and facilitated obstructive pulmonary disorder. Health place 2013, 21:140–147. by an experienced qualitative researcher. 11. Rashidian A, Eccles MP, Russell I: Falling on stony ground? A qualitative study of implementation of clinical guidelines’ prescribing recommendations in primary care. Health policy 2008, 85(2):148–161. Additional files 12. Jones RK: The unsolicited diary as a qualitative research tool for advanced research capacity in the field of health and illness. Qualitative Health Res 2000, 10(4):555–567. Additional file 1: Illustrative Example of the use of the Framework 13. Pope C, Ziebland S, Mays N: Analysing qualitative data. British Med J 2000, Method. 320:114–116. 14. Pope C, Mays N: Critical reflections on the rise of qualitative research. Competing interests British Med J 2009, 339:737–739. The authors declare that they have no competing interests. 15. Fairclough N: Critical discourse analysis: the critical study of language. London: Longman; 2010. 16. Garfinkel H: Ethnomethodology’sprogram. Soc Psychol Quarter 1996, 59(1):5–21. Authors’ contributions 17. Merleau-Ponty M: The phenomenology of perception. London: Routledge and All authors were involved in the development of the concept of the article Kegan Paul; 1962. and drafting the article. NG wrote the first draft of the article, GH and EC 18. Svenaeus F: The phenomenology of health and illness.In Handbook of prepared the text and figures related to the illustrative example, SRa did the phenomenology and medicine. Netherlands: Springer; 2001:87–108. literature search to identify if there were any similar articles currently 19. Reissmann CK: Narrative methods for the human sciences. London: Sage; 2008. available and contributed to drafting of the article, and SRe contributed to 20. Charmaz K: Constructing grounded theory: a practical guide through drafting of the article and the illustrative example. All authors read and qualitative analysis. London: Sage; 2006. approved the final manuscript. 21. Glaser A, Strauss AL: The discovery of grounded theory. Chicago: Aldine; 1967. 22. Crotty M: The foundations of social research: meaning and perspective in the Acknowledgments research process. London: Sage; 1998. All authors were funded by the National Institute for Health Research (NIHR) 23. Boeije H: A purposeful approach to the constant comparative method in through the Collaborations for Leadership in Applied Health Research and the analysis of qualitative interviews. Qual Quant 2002, 36(4):391–409. Care for Birmingham and Black Country (CLAHRC-BBC) programme. The 24. Hsieh H-F, Shannon SE: Three approaches to qualitative content analysis. views in this publication expressed are those of the authors and not Qual Health Res 2005, 15(9):1277–1288. necessarily those of the NHS, the NIHR or the Department of Health. 25. Redwood S, Gale NK, Greenfield S: ‘You give us rangoli, we give you talk’: using an art-based activity to elicit data from a seldom heard group. Author details BMC Med Res Methodol 2012, 12(1):7. Health Services Management Centre, University of Birmingham, Park House, 26. Mishler EG: The struggle between the voice of medicine and the voice of 40 Edgbaston Park Road, Birmingham B15 2RT, UK. School of Health and the lifeworld.In The sociology of health and illness: critical perspectives. Thirdth Population Sciences, University of Birmingham, Edgbaston, Birmingham B15 edition. Edited by Conrad P, Kern R. New York: St Martins Press; 1990. 2TT, UK. School of Life and Health Sciences, Aston University, Aston Triangle, 27. Hodges BD, Kuper A, Reeves S: Discourse analysis. British Med J 2008, Birmingham B4 7ET, UK. East and North Hertfordshire NHS Trust, Lister 337:570–572. hospital, Coreys Mill Lane, Stevenage SG1 4AB, UK. 28. Sandelowski M, Barroso J: Writing the proposal for a qualitative research methodology project. Qual Health Res 2003, 13(6):781–820. Received: 17 December 2012 Accepted: 6 September 2013 29. Ellins J: It’s better together: involving older people in research. HSMC Published: 18 September 2013 Newsletter Focus Serv Users Publ 2010, 16(1):4. 30. Phillimore J, Goodson L, Hennessy D, Ergun E: Empowering Birmingham’s migrant and refugee community organisations: making a difference. York: References Joseph Rowntree Foundation; 2009. 1. Ritchie J, Lewis J: Qualitative research practice: a guide for social science 31. Leamy M, Clough R: How older people became researchers. York: Joseph students and researchers. London: Sage; 2003. Rowntree Foundation; 2006. 2. Ives J, Damery S, Redwod S: PPI, paradoxes and Plato: who's sailing the ship? J Med Ethics 2013, 39(3):181–185. 32. Glasby J, Miller R, Ellins J, Durose J, Davidson D, McIver S, Littlechild R, 3. Heath G, Cameron E, Cummins C, Greenfield S, Pattison H, Kelly D, Tanner D, Snelling I, Spence K: Understanding and improving transitions of Redwood S: Paediatric ‘care closer to home’: stake-holder views and older people: a user and carer centred approach, Final report NIHR service barriers to implementation. Health Place 2012, 18(5):1068–1073. delivery and organisation programme. London: The Stationery Office; 2012. Gale et al. BMC Medical Research Methodology 2013, 13:117 Page 8 of 8 http://www.biomedcentral.com/1471-2288/13/117 33. Saldaña J: The coding manual for qualitative researchers. London: Sage; 2009. 34. Lincoln YS: Emerging criteria for quality in qualitative and interpretive research. Qual Inquiry 1995, 1(3):275–289. 35. Mays N, Pope C: Qualitative research in health care: assessing quality in qualitative research. BMJ British Med J 2000, 320(7226):50. 36. Seale C: Quality in qualitative research. Qual Inquiry 1999, 5(4):465–478. 37. Dingwall R, Murphy E, Watson P, Greatbatch D, Parker S: Catching goldfish: quality in qualitative research. J Health serv Res Policy 1998, 3(3):167–172. 38. Popay J, Rogers A, Williams G: Rationale and standards for the systematic review of qualitative literature in health services research. Qual Health Res 1998, 8(3):341–351. 39. Morse JM, Barrett M, Mayan M, Olson K, Spiers J: Verification strategies for establishing reliability and validity in qualitative research. Int J Qual Methods 2008, 1(2):13–22. 40. Smith JA: Reflecting on the development of interpretative phenomenological analysis and its contribution to qualitative research in psychology. Qual Res Psychol 2004, 1(1):39–54. 41. Polit DF, Beck CT: Generalization in quantitative and qualitative research: Myths and strategies. Int J Nurs Studies 2010, 47(11):1451–1458. doi:10.1186/1471-2288-13-117 Cite this article as: Gale et al.: Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology 2013 13:117. 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Journal

BMC Medical Research MethodologySpringer Journals

Published: Sep 18, 2013

Keywords: Qualitative research; Qualitative content analysis; Multi-disciplinary research

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