Browsing by Person "Waterfield, Jackie"

Now showing 1 - 16 of 16

Can sample size in qualitative research be determined a priori?
(Informa UK Limited, 2018-03-27) Sim, Julius; Saunders, Benjamin; Waterfield, Jackie; Kingstone, Tom
There has been considerable recent interest in methods of determining sample size for qualitative research a priori, rather than through an adaptive approach such as saturation. Extending previous literature in this area, we identify four distinct approaches to determining sample size in this way: rules of thumb, conceptual models, numerical guidelines derived from empirical studies, and statistical formulae. Through critical discussion of these approaches, we argue that each embodies one or more questionable philosophical or methodological assumptions, namely: a nave realist ontology; a focus on themes as enumerable 'instances', rather than in more conceptual terms; an incompatibility with an inductive approach to analysis; inappropriate statistical assumptions in the use of formulae; and an unwarranted assumption of generality across qualitative methods. We conclude that, whilst meeting certain practical demands, determining qualitative sample size a priori is an inherently problematic approach, especially in more interpretive models of qualitative research.
Cultural aspects of pain: A study of Indian Asian women in the UK
(Wiley-Blackwell, 2018-01-12) Holt, Stephanie; Waterfield, Jackie
Objectives: Culture and ethnicity are acknowledged as important factors in the context of the biopsychosocial model. They may contribute to explaining the experience of pain, therapeutic encounters within healthcare, and the strategies that individuals use to cope with pain. The present study explored these issues in a sample of Indian Asian women in the UK. Methods: Based on a phenomenological approach, 17 women participated in five semi-struc tured group interviews. Data were analysed using qualitative content analysis, so as to identify core themes and subthemes inductively from the data. Results: Six themes were identified: meaning of pain; personal experience of pain; causes of pain; coping strategies; family and friends; experience of healthcare. Pain was conceptualized in both physical and mental terms, and its experience was explained largely in terms of functional consequences. The causes of pain offered suggested externalized beliefs, relating to events in participants' lives, rather than being expressed in biomedical terms. Alongside culture-specific therapies, the women spoke of coping strategies based on rest and activity. Although satisfaction with healthcare appeared to be high overall, problems due to communication - sometimes related to a language barrier - were voiced by some participants. Conclusions: Greater attention to cultural aspects of the pain experience may assist health professionals in communicating with and managing patients with pain from ethnic minority backgrounds.
Evaluating Acupuncture and Standard carE for pregnant women with Back pain (EASE Back): a feasibility study and pilot randomised trial
(NIHR Journals Library, 2016-04-01) Foster, Nadine E.; Bishop, Annette; Bartlam, Bernadette; Ogollah, Reuben; Barlas, Panos; Holden, Melanie A.; Ismail, Khaled M. K.; Jowett, Sue; Kettle, Christine; Kigozi, Jesse; Lewis, Martyn; Lloyd, Alison; Waterfield, Jackie; Young, Julie
Background: Many pregnant women experience low back pain. Acupuncture appears to be a safe, promising intervention but evidence is needed about its clinical effectiveness and cost-effectiveness. Objectives: To assess the feasibility of a future large randomised controlled trial (RCT) testing the additional benefit of adding acupuncture to standard care (SC) for pregnancy-related back pain.
Focus group methodology: Some ethical challenges
(Springer, 2019-07-16) Sim, Julius; Waterfield, Jackie
Focus group methodology generates distinct ethical challenges that do not correspond fully to those raised by one-to-one interviews. This paper explores, in both conceptual and practical terms, three key issues: consent; confidentiality and anonymity; and risk of harm. The principal challenge in obtaining consent lies in giving a clear account of what will take place in the group, owing to unpredictability of the discussion and interaction that will occur. As consent can be seen in terms of creating appropriate expectations in the participant, this may therefore be hard to achieve. Moreover, it is less straightforward for the participant to revoke consent than in one-to-one interviews. Confidentiality and anonymity are potentially problematic because of the researcher’s limited control over what participants may subsequently communicate outside the group. If the group discussion encourages over-disclosure by some participants, this problem becomes more acute. Harm in a focus group may arise from the discussion of sensitive topics, and this may be amplified by the public nature of the discussion. A balance should be struck between avoiding or closing down potentially distressing discussion and silencing the voices of certain participants to whom such discussion may be important or beneficial. As a means of addressing the above issues, we outline some strategies that can be adopted in the consent process, in a preliminary briefing session, during moderation of the focus group, and in a subsequent debriefing, and suggest that these strategies can be employed synergistically so as to reinforce each other.
How do UK physiotherapists address weight loss among individuals with hip osteoarthritis? A mixed‐methods study
(Wiley, 2019-01-21) Holden, Melanie Ann; Waterfield, Jackie; Whittle, Rebecca; Bennell, Kim; Quicke, Jonathan George; Chesterton, Linda; Mallen, Christian David
Background Weight loss is recommended as a core treatment for individuals with hip osteoarthritis who are overweight or obese. Physiotherapists play an important role in managing patients with hip osteoarthritis, but little is known about how they address weight. We aimed to explore how UK‐based physiotherapists currently address weight loss among individuals with hip OA.
Identifying priorities for physiotherapy research in the UK: The James Lind Alliance Physiotherapy Priority Setting Partnership
(Elsevier, 2019-07-29) Rankin, Gabrielle; Summers, Rachael; Cowan, Katherine; Barker, Karen; Button, Kate; Carroll, Sean Paul; Fashanu, Billy; Moran, Fidelma; O'Neill, Brenda; Ten Hove, Ruth; Waterfield, Jackie; Westwater-Wood, Sarah; Wellwood, Ian; We gratefully acknowledge funding from the Char-tered Society of Physiotherapy (CSP) Charitable Trust. TheNational Institute for Health Research (NIHR) funds theinfrastructure of the James Lind Alliance (JLA).
To identify unanswered questions for physiotherapy research and help set and prioritise the top 10 generic research priorities for the UK physiotherapy profession; updating previous clinical condition- specific priorities to include patient and carer perspectives, and reflect changes in physiotherapy practice, service provision and new technologies. The James Lind Alliance (JLA) Priority Setting Partnership (PSP) methodology was adopted, utilising evidence review, survey and consensus methods. Anyone with experience and/or an interest in UK physiotherapy: patients, carers, members of the public, physiotherapists, student physiotherapists, other healthcare professionals, researchers, educators, service providers, commissioners and policy makers. Five hundred and ten respondents (50% patients, carers or members of the public) identified 2152 questions (termed "uncertainties"). Sixty-five indicative questions were developed from the uncertainties using peer reviewed thematic analysis. These were ranked in a second national survey (1,020 responses (62% were complete)). The top 25 questions were reviewed in a final prioritisation workshop using an adapted nominal group technique. The top 10 research priorities focused on optimisation (top priority); access; effectiveness; patient and carer knowledge, experiences, needs and expectations; supporting patient engagement and self-management; diagnosis and prediction. This study is currently the UK's most inclusive consultation exercise to identify patients'and healthcare professionals'priorities for physiotherapy research. The exercise deliberately sought to capture generic issues relevant to all specialisms within physiotherapy. The research priorities identified a range of gaps in existing evidence to inform physiotherapy policy and practice. The results will assist research commissioning bodies and inform funding decisions and strategy. [Abstract copyright: Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.]
Intra-individual variations in the bifurcation of the radial nerve and the length of the posterior interosseous nerve
(2011-09-07) Benham, Alex; Introwicz, Barbara; Waterfield, Jackie; Sim, Julius; Derricott, Hayley; Mahon, Mike
Anatomical literature on the radial nerve predominantly features inter-individual variations, with comparatively few studies investigating intra-individual variations. The radial nerve has a complex and variable course, particularly in relation to the location at which the nerve bifurcates to form the superficial branch of the radial nerve and the posterior interosseous nerve. Variations of the radial nerve may change the way the nerve and its branches, their blood supply and nerve transmission respond to forces. This study investigated the presence of intra-individual differences in the bifurcation point of the radial nerve and the length of the posterior interosseous nerve from the bifurcation to the radial tunnel. Eighteen embalmed human cadavers were dissected to reveal the radial nerve. Measurements were taken from the level of the lateral humeral epicondyle to the bifurcation of the radial nerve, and from the bifurcation to the radial tunnel. All cadavers presented with intra-individual variations between the left and right limbs. Significant differences were found between the left and right limbs for the measurement from the lateral humeral epicondyle to the bifurcation (median difference _ 18.0 mm; p _ 0.016) but not for the measurement from the bifurcation to the radial tunnel (median difference _ 7.0 mm; p _ 0.396). In conclusion, the location of the radial nerve bifurcation is subject to both intra- and inter-individual variations. Its specific relationship to the lateral humeral epicondyle also varies, occurring both distal and proximal to the level of the epicondyle. Clinical implications of these findings warrant further investigation.
Men's perspectives of male hormonal contraception
(2016-08) Lloyd, Alison; Waterfield, Jackie
Background: In recent years there have been great developmental advances in male hormonal contraception (MHC). Despite this, research relating to men-s perspectives of MHC is sparse and is usually based on questionnaires completed as part of clinical trials. This study explored men-s perspectives of MHC, specifically how they were formed and what factors might be influencing them. Methods: This qualitative study used semi-structured interviews with 10 heterosexual men aged between 18 and 44 within the UK. Using a philosophical standpoint of social constructionism, data were analysed employing a modified grounded theory method. Joint analysis and reflexivity were applied to reduce bias and ensure rigour in the analytical process. Results: Four principal higher order themes emerged from the data: Sexual health and trust within a sexual relationship; Choice; Change; and Health. This paper presents the findings from the first two. Participants believed that MHC use would be affected by issues such as individual sexual relationships, sexual health, and trust. Issues relating to efficacy, contraceptive choice, age, knowledge and methods of administration were seen as core issues relating to the decision to take a MHC drug. Conclusions: This study was successful in its aim, finding that overall MHC would be well received by men and that their perspectives were not that different from attitudes towards female hormone contraception. It also identified potential barriers based on the concerns that men have for themselves and for society were an MHC to become available.
A mixed methods exploration of physiotherapist’s approaches to analgesic use among patients with hip osteoarthritis
(Elsevier, 2018-08-17) Holden, Melanie Ann; Whittle, Rebecca; Waterfield, Jackie; Chesterton, Linda; Cottrell, Elizabeth; Quicke, Jonathan George; Mallen, Christian David
Objective To explore how physiotherapists currently address analgesic use among patients with hip osteoarthritis, and their beliefs about the acceptability of prescribing for these patients.
Perineal resuturing versus expectant management following vaginal delivery complicated by a dehisced wound (PREVIEW): a nested qualitative study
(2017-02-10) Dudley, L.; Kettle, Christine; Waterfield, Jackie; Ismail, Khaled M. K.
Objective: To explore women's lived experiences of a dehisced perineal wound following childbirth and how they felt participating in a pilot and feasibility randomised controlled trial (RCT). Design: A nested qualitative study using semistructured interviews, underpinned by descriptive phenomenology. Participants and setting: A purposive sample of six women at 6-9 months postnatal who participated in the RCT were interviewed in their own homes. Results: Following Giorgi's analytical framework the verbatim transcripts were analysed for key themes. Women's lived experiences revealed 4 emerging themes: (1) Physical impact, with sub-themes focusing upon avoiding infection, perineal pain and the impact of the wound dehiscence upon daily activities; (2) Psychosocial impact, with sub-themes of denial, sense of failure or self-blame, fear, isolation and altered body image; (3) Sexual impact; and (4) Satisfaction with wound healing. A fifth theme 'participating in the RCT' was 'a priori' with sub-themes centred upon understanding the randomisation process, completing the trial questionnaires, attending for hospital appointments and acceptability of the treatment options. Conclusions: To the best of our knowledge, this is the first qualitative study to grant women the opportunity to voice their personal experiences of a dehisced perineal wound and their views on the management offered. The powerful testimonies presented disclose the extent of morbidity experienced while also revealing a strong preference for a treatment option.
Physical Therapists' Views and Experiences of Pregnancy-Related Low Back Pain and the Role of Acupuncture: Qualitative Exploration
(Oxford, 2015-09-01) Waterfield, Jackie; Bartlam, Bernadette; Bishop, Annette; Holden, Melanie A.; Barlas, Panos; Foster, Nadine E.
Background Low back pain is often accepted as a normal- part of pregnancy. Despite research suggesting that quality of life for women who are pregnant is adversely affected, most are advised to self-manage. Although the use of acupuncture for the management of persistent nonspecific low back pain has been recommended in recent UK national guidelines, its use in the management of pregnancy-related low back pain remains limited. Objectives This study aimed to explore the perceptions and experiences of physical therapists involved in treating women who are pregnant and have low back pain with the objective of informing the pretrial training program for a pilot randomized trial (Evaluating Acupuncture and Standard care for pregnant womEn with Back pain [EASE Back]). Design A qualitative phenomenological method with purposive sampling was used in the study. Methods Three focus groups and 3 individual semistructured interviews were undertaken, and an iterative exploratory thematic analysis was performed. To ensure transparency of the research process and the decisions made, an audit trail was created. Results Twenty-one physical therapists participated, and emergent issues included: a lack of experience in treating pregnancy-related complaints, mixed messages from previous acupuncture education, a mistrust of the current evidence for acupuncture safety and effectiveness, and personal and professional fear of causing harm. Conclusions The findings suggest that UK physical therapists are reluctant to use acupuncture in the management of pregnancy-related low back pain. The explanations for these findings include perceived lack of knowledge and confidence, as well as a pervasive professional culture of caution, particularly fears of inducing early labor and of litigation. These findings have been key to informing the content of the training program for physical therapists delivering acupuncture within the pilot EASE Back trial.
Preparing to manage patients in pain. The student perspective: a pilot
(Ingenta, 2015-12-01) Etherton, Jo; Waterfield, Jackie
Objectives: This pilot study aims to explore the experience of preparing to manage patients in pain, from a student perceptive. Specifically: Do physiotherapy students consider themselves 'prepared' for practice with patients in pain and what has contributed to this sense of 'preparedness'? Design: A phenomenological approach was taken to provide a rich description of the student experience. Data was collected via semi structured, one to one interviews with the researcher. Setting: Data collection occurred in a neutral room on the University of East Anglia (UEA) campus. Participants: Inclusion criteria were: final year about to qualify and consented to participate. Three UEA BSc Physiotherapy students were interviewed. Results: Six themes were identified within the data: time, confidence, relationships, professionalism, theory - practice gap and team working. Key findings included: student's personal experiences with patients informed their perceptions of preparedness; students have greater confidence in working with a bio-medical compared to a bio-psychosocial model; preparing to manage patients in pain includes developing understanding of professional responsibility, which equated to reducing a patients pain; students have theoretical understanding of patient-centered and bio-psychosocial care, but experiences in application of these principles are varied and clinical educators actively 'gate keep' opportunities for students to work with patients in pain. Conclusions: Findings from the three themes presented here suggest physiotherapy students did not always perceive themselves prepared to manage patients in pain. However, comments were made without awareness that the shared examples indicated a lack preparedness. This perception is primarily informed by situated learning and experiences with patients in relatively acute pain. Opportunities for contextualisation of theoretical knowledge for managing persistent and chronic pain states during placement could be limited, perhaps by clinical educators actively 'gate-keeping' opportunities for students to work with certain 'types' of patients with pain.
Saturation in qualitative research: exploring its conceptualization and operationalization
(2017-09-14) Saunders, Benjamin; Sim, Julius; Kingstone, Tom; Baker, Shula; Waterfield, Jackie; Bartlam, Bernadette; Burroughs, Heather; Jinks, Clare
Saturation has attained widespread acceptance as a methodological principle in qualitative research. It is commonly taken to indicate that, on the basis of the data that have been collected or analysed hitherto, further data collection and/or analysis are unnecessary. However, there appears to be uncertainty as to how saturation should be conceptualized, and inconsistencies in its use. In this paper, we look to clarify the nature, purposes and uses of saturation, and in doing so add to theoretical debate on the role of saturation across different methodologies. We identify four distinct approaches to saturation, which differ in terms of the extent to which an inductive or a deductive logic is adopted, and the relative emphasis on data collection, data analysis, and theorizing. We explore the purposes saturation might serve in relation to these different approaches, and the implications for how and when saturation will be sought. In examining these issues, we highlight the uncertain logic underlying saturation - as essentially a predictive statement about the unobserved based on the observed, a judgement that, we argue, results in equivocation, and may in part explain the confusion surrounding its use. We conclude that saturation should be operationalized in a way that is consistent with the research question(s), and the theoretical position and analytic framework adopted, but also that there should be some limit to its scope, so as not to risk saturation losing its coherence and potency if its conceptualization and uses are stretched too widely.
The Role of Qualitative Research in Clinical Trial Development
(2016-07-13) Bartlam, Bernadette; Waterfield, Jackie; Bishop, Annette; Holden, Melanie A.; Barlas, Panos; Ismail, Khaled M. K.; Kettle, Christine; Foster, Nadine E.
This article outlines the rationale for adopting a mixed methods approach within randomized controlled trials (RCTs) and explores challenges associated in doing so. Taking the example of the EASE Back feasibility and pilot study (Evaluating Acupuncture and Standard care for pregnant womEn with BACK pain: ISRCTN49955124), we detail why and how we operationalized a concurrent-sequential mixed methods research design. We present key findings from the exploratory research (focus groups and interviews) and explain how these were integrated with descriptive findings (a national survey of physical therapists) in order to inform and refine the design of the explanatory phase (the pilot RCT). We conclude with a discussion of lessons learned and implications for future research design and conduct.
The sample size debate: Response to Norman Blaikie
(Informa UK Limited, 2018-03-27) Sim, Julius; Saunders, Benjamin; Waterfield, Jackie; Kingstone, Tom
In his detailed response to our paper on sample size in qualitative research, Norman Blaikie raises important issues concerning conceptual definitions and taxonomy. In particular, he points out the problems associated with a loose, generic application of adjectives such as 'qualitative' or 'inductive'. We endorse this concern, though we suggest that in some specific contexts a broad categorization may be more appropriate than a more nuanced distinction - provided that it is clear in which sense the terms are employed. However, other concepts, such as saturation, do not lend themselves to generic use, and require a more detailed conceptualization. Blaikie's analysis also makes it clear that meaningful discussion of sample size in qualitative research cannot occur with reference to an undifferentiated conception of the nature of qualitative research; clear distinctions need to be made within this approach in terms of methodology, ontological and epistemological assumptions and broader research paradigms.
The Understanding of Pain by Older Adults Who Consider Themselves to Have Aged Successfully
(2014-12-03) Collis, David; Waterfield, Jackie
Objectives: Despite an ageing population and an increased prevalence of chronic pain, the relationship between chronic pain and the concept of successful ageing is unclear. The aim of the present research was to explore older people's views on past and present experiences of pain, and its management, and how these experiences relate to their perceptions of successful ageing. Methods: Semi-structured interviews with six participants, aged 75 years or older, who considered themselves to have aged successfully, explored what this concept meant to them and their experiences of pain. Data analysis used methods drawn from grounded theory. The themes reported in this article are 'understanding of pain' and 'perceptions of ageing'. Results: None of the participants recalled painful experiences that were not attributable to physical trauma. They believed that pain is part of life and a natural consequence of the ageing process. While some accepted this with little resistance, others felt frustration at what they considered a dismissive attitude towards older people experiencing pain from healthcare practitioners. The concept of successful ageing was previously unfamiliar to participants, and their conceptualization of ageing derived from comparing themselves with their peers. Conclusions: The findings of the present study suggest that predictable experiences of pain as one ages may contribute to an acceptance of pain as a biomedical certainty, a belief reinforced both by health professionals and society. However, one may have chronic pain and yet consider oneself to have aged successfully, and it should therefore be recognized that there is a distinction between having pain and having a problem with pain.