Guidelines for
Critical Review Form:
Qualitative Studies (Version 2.0)
© Letts, L., Wilkins, S., Law, M., Stewart, D.,
Bosch, J., & Westmorland, M., 2007
Introduction
• These guidelines accompany the Critical Review Form: Qualitative Studies
originally developed by the McMaster University Occupational Therapy
Evidence-Based Practice Research Group and revised by Letts et al., 2007. They
are written in basic terms that can be understood by researchers as well as
clinicians and students interested in conducting critical reviews of the
literature.
• Guidelines are provided for the questions in the left hand column of the
form and the instructions/questions in the Comments column of each component.
• Examples
relate to occupational therapy research as much as possible.
• These guidelines assist readers to complete critical appraisal of
qualitative research articles. In recent years, there has been an increase in
the number of meta-syntheses i.e., articles that examine more than one
qualitative study and synthesize the data from these studies together. The
approaches to conducting meta-syntheses are still emerging, and criteria for
critical appraisal of meta-syntheses are not yet well-established. Over time,
we anticipate that we may either revise this review form to incorporate
meta-syntheses or develop another review form.
Critical Review Components
Citation
• Include full title, all authors (last name, initials), full journal
title, year, volume number, and page numbers.
• This
ensures that another person could easily retrieve the same article.
Study Purpose
• Was the purpose and/or research question stated clearly? - The purpose is usually stated briefly in the abstract of the
article, and again in more detail in the introduction. It may be phrased as a
research question.
• A clear statement of purpose or research questions helps you determine
if the topic is important, relevant, and of interest to you.
• For future reference, it is useful to provide a summary of the purpose
or research question in the comments section, so that you or someone else can
quickly get a sense of the article.
Literature
• Was relevant background literature reviewed? A review of the literature should be included in an article describing
research to provide some background to the study. It should provides a
synthesis of relevant information such as previous work/research, and
discussion of the clinical importance of the topic.
• The review of the literature could include both qualitative and
quantitative evidence related to the study purpose.
• It identifies gaps in current knowledge and research about the topic of
interest, and thus justifies the need for the study being reported. The
justification for the study should be clear and compelling. Readers should be
able to understand the researchers’ thinking in conducting the study.
• Consider how the study can be applied to occupational therapy practice
and/or your own situation before you continue with your review of the article.
If it is not useful or applicable, go on to the next article.
Study Design
• What was the study design? There
are many different types of research designs. These guidelines focus on the
most common types of qualitative designs in rehabilitation research.
• The essential features of the different types of study designs are
outlined to assist in determining which was used in the study you are
reviewing.
• Some researchers will not describe their study using these design
descriptions; they may simply refer to the research as a ‘qualitative design’.
In most cases, you should expect the authors to link their research to a
specific research tradition, or justify why they have not done so. When
reviewing articles in which the design is described only as qualitative, it can
be useful to consider which of these traditions best matches the study you are
reading; this will help you make a judgement about the appropriateness of the
design, sampling, data collection and analyses.
• Numerous issues can be considered in determining the appropriateness of
the design chosen. Some of the key issues are listed in the Comments section,
and are discussed below.
Design Types
▐ 1. Phenomenology
• Phenomenology answers the question: “What is it like to have a certain
experience?”. It seeks to understand the phenomenon of a lived experience -
this may be related to an emotion, such as loneliness or depression, to a
relationship, or to being part of an organization or group. The assumption
behind phenomenology is that there is an essence to shared experience. It comes
from the social sciences and requires a researcher to enter into an individual’s
life world and use the self to interpret the individual’s (or group’s)
experience. Phenomenology’s application to occupational therapy research is
discussed in detail by
Wilding & Whiteford (2005).
Example: A phenomenological approach was
chosen to explore the experiences of people with
arthritis who were participants in two different
types of arthritis education groups. Data were collected through observations
of the groups, individual interviews with group participants, followed by focus
groups after initial analyses were completed. Three themes are discussed by the
authors: validation through connection; restructuring illness identity; and
perceptions of self and disease symptoms. The themes provided insights into
notions underlying transformative learning theory (Ashe, Taylor, &
Dubouloz, 2005).
▐ 2. Ethnography
• Ethnography is a well-known form of qualitative research in
anthropology, and focuses on the question: “What is the culture of a group of
people, or people in a particular setting?”. The goal of ethnographic research
is to tell the whole story of a group’s daily life, to identify the cultural
meanings, beliefs and social patterns of the group, and can include the
description of material culture (buildings, tools, and other objects that have
cultural meaning). Culture is not limited to ethnic groups, and ethnographers
study the culture of organizations, programs and groups of people with common
social problems such as smoking and drug addiction. In the area of health care,
Krefting (1989) described a disability ethnography, which is a strategic
research approach focusing on a particular human problem
and those aspects of group life that impact on the problem.
Example:
An ethnographic study was conducted to explore the
process and outcomes of a program of occupation for seniors with dementia within a day hospital
setting, which was the culture being examined. Data from observations,
interviews with patients and staff, and field notes were analyzed to discover
the opportunities and barriers to conducting an occupational program in a day
hospital unit (Borell, Gustavsson, Sandman & Kielhofner, 1994). Jung,
Tryssenaar, & Wilkins (2005), in their ethnographic study, interviewed
novice tutors and their tutor guides or mentors in order to understand the
entry phase of “becoming a tutor” within the culture of problem based learning.
The overarching theme was of story telling or an oral tradition within which
novice tutors learned from their tutor mentors based on direct modeling and
vicarious sharing of stories.
▐ 3. Grounded Theory
• Grounded theory focuses on the task of theory construction. The
inductive nature of qualitative research is considered essential for generating
a theory. The focus is on searching to identify the core social processes
within a given social situation. Glaser and Strauss (1967) developed a research
process that takes the researcher into and close to the real world to ensure
that the results are “grounded” in the social world of the people being
studied. More recently, Charmaz (2003, 2006) has argued that the ongoing work
of Glaser (1978) and Strauss and Corbin (1990) has resulted in grounded theory
becoming more objectivist (positivistic) and suggested that a more
constructivist (interpretive) approach allows researchers to focus more on
human agency, social and subjective meaning, and problem-solving practices and
action. A grounded theory method is an emergent design dependent on
continuous data analysis. The theory is seen as a developmental process
and therefore is able to capture the nature of social interaction and its
structural content.
Example: Grounded theory was used to
explore the concept of playfulness in adults (Guitard, Ferland, & Dutil, 2005).
Through interviews with a heterogeneous group of fifteen adults, and inductive
analyses, the following components of playfulness were identified: creativity,
curiosity, sense of humour, pleasure, and spontaneity. The analyses also
resulted in the development of a visual model demonstrating the relationships
among the components of the model.
▐ 4. Participatory Action Research (PAR)
• PAR is an approach to research and social change that can be considered
a type of qualitative research. PAR involves individuals and groups researching
their own personal beings, socio-cultural settings and experiences. They
reflect on their values, shared realities, collective meanings, needs and
goals. Knowledge is generated and power is regained through deliberate actions
that nurture, empower and liberate persons and groups. The researcher works in
partnership with participants throughout the research process. PAR can be time
consuming
because
sometimes delays can occur when researchers from outside the community and
community members need to negotiate phases in the research. Research describing
PAR should ideally discuss the negotiation processes used in the research.
Example: Cockburn and Trentham (2002)
share two examples of participatory action research
projects in which they were involved. One project
involved adults with mental illness working to create meaningful work
experiences. The other involved older adults in a community capacity-building
process related to identifying and addressing issues in their housing complex.
Letts (2003) also shared a number of examples of participatory research projects
that involved occupational therapists.
▐ 5. Other Designs
• These are many other qualitative research designs described in the
literature. They come from different theoretical traditions and disciplines,
and some are extensions of the more popular ethnographic and phenomenological
designs. Some of the most frequently described designs in qualitative
literature include: heuristics, ethnomethodology, institutional ethnography,
hermeneutics, ecological psychology, feminism, and social interactionism. Readers
interested in further inquiry of qualitative research designs are directed to
the bibliography at the end of this document.
Appropriateness of Study Design
• The
choice of qualitative research designs should be congruent with the following:
o The beliefs and worldviews of the researcher i.e., the qualitative
researcher usually expresses an interest in understanding the social world from
the point of view of the
participants in it, and emphasizes the context in which events occur and
have meaning;
o The nature of the end results desired i.e., the qualitative research is
seeking meaning and understanding, which is best described in narrative form;
o The depth of understanding and description required from participants
i.e., qualitative
research usually involves the exploration of a
topic or issue in depth, with emphasis on seeking information from the people
who are experiencing or are involved in the issue;
o The type of reasoning involved: qualitative research is oriented towards
theory construction, and the reasoning behind data analysis is inductive i.e.,
the findings emerge from the data.
• Crabtree and Miller (1992) suggest that the best way to determine if the
choice of a particular qualitative research design is appropriate is to ask how
the particular topic of interest is usually shared in the group or culture of
interest. For example, if information about how clients responded to occupational therapy treatment is usually shared
through discussion and story -telling among individual therapists, then a
phenomenological approach may be the most appropriate way to study this
experience.
• Was a theoretical perspective identified? The thinking and theoretical perspective of the researcher(s) can
influence the study. The researcher should know something conceptually of the
phenomenon of interest, and should state the theoretical perspective up front.
For example, Ashe et al. (2005) presented findings from an earlier grounded
theory study to explain the context of their project, and also discussed the
link to adult learning theory.
Qualitative Methods
• A variety of different methods are used by qualitative researchers to
answer the research question. The most common ones are described here,
including the advantages and disadvantages of each.
▐ 1. Participant Observation
• A participant observer uses observation to research a culture or
situation from within. There is a difference between the researcher as simply
an onlooker and one who is actually participating while observing (i.e., doing
what the people are doing). The observer usually spends an extended period of
time within the setting to be studied and records ‘fieldnotes’ of his/her
observations. This type of research may be called ‘fieldwork’, which comes from
its roots in social and cultural anthropology.
• Participant observation is useful when the focus of interest is how
activities and interactions within a setting give meaning to beliefs or
behaviours. It fits with the assumption that everyone in a group or
organization is influenced by assumptions and beliefs that they take for
granted. It is therefore considered the qualitative method of choice when the
situation or issue of interest is obscured or hidden from public knowledge and there
are differences between what people say and what they do.
• Participant observation can be time-consuming and costly, as it can take
a long time to uncover the hidden meanings of the situation/context. However,
if a researcher is expecting to commit to a particular topic as part of an
ongoing program of research the investment of this time can prove very
valuable. The researcher should allow enough time to get at the complexity of
the situation being observed.
▐ 2. Interviews
• An interview implies some form of verbal discourse. The participant
provides the researcher with information through verbal interchange or
conversation. Non-verbal behaviours and the interview context are noted by the
researcher and become part of the data.
• Another term used frequently in qualitative research is ‘key informant
interviews’ which refers to the special nature of the participant being
interviewed - he or she is chosen by the researcher because of an important or
different viewpoint, status in a culture or organization, and/or knowledge of
the issue being studied. However, the method of data collection remains an
interview.
• Qualitative interviews place an emphasis on listening and following the
direction of the participant/informant. A variety of open-ended questions are
chosen to elicit the most information possible in the time available.
Frequently, the interview protocol provides
opportunities for the interviewer to probe following participant
responses to open-end questions.
• Interviews can be done relatively quickly, with little expense, and are
useful when a particular issue needs to be explored in depth. However, the
drawback to interviewing is related to the constraints imposed by language. The
types of questions asked will frame the participants' responses, and this
should be taken into account by the researcher.
▐ 3. Document Review
• Document review is often used in historical research, which involves the
study and analysis of data about past events. The specific methods used are
flexible and open because the purpose is to learn how past intentions and
events were related due to their meaning and value. Documents are reviewed
considering the context within which they were created. The historian learns about
particular persons at particular times and places that present unique
opportunities to learn about the topic of interest.
• It is a research method that requires the researcher to enter into an
in-depth learning process, to become a critical editor of texts, such as
diaries, media reports, or blogs. The researcher should explain the method used
and readers should feel comfortable that the method involved adequate depth and
a critical approach.
▐ 4. Focus Groups
• Focus groups are a formal method of interviewing a group of
people/participants on a topic of interest.
• The same principles used for individual interviews apply with focus
group interviews e.g., the use of open-ended questions, the focus on listening
and learning from the participants.
• Focus groups are useful when multiple viewpoints or responses are needed
on a specific topic/issue. Group members can build on one another’s ideas to
result in more in-depth discussions of the topic. Multiple responses can be
obtained through focus groups in a shorter period of time than individual
interviews. A researcher can also observe the interactions that occur among
group members.
• The disadvantages of focus groups relate to the potential constraints
that a group setting can place on individuals’ responses. A common challenge in
focus groups is to ensure that both reticent and gregarious participants have
an opportunity to be heard. The facilitator of the focus group must be skilled
in group process and interviewing techniques to ensure the success of the group.
▐ 5. Other
• Other forms of qualitative research methods include mapping cultural
settings and events; recording, using either audio or visual techniques such as
photography; life histories (biographies); and genograms.
• Some researchers consider surveys and questionnaires which are
open-ended in nature to be qualitative methods if the primary intent is to ‘listen’
to or learn from the participants/clients themselves about the topic of
interest. However, these tend to be limited, and often constrain the participants
in ways that other qualitative methods do not. Answering one open-ended
question at the end of a survey is not the same as participating in an in-depth
interview. It is difficult to ensure that the richness of participants’
experiences is really conveyed.Researchers need to be clear about the intent of such questions, and how
the results are analysed and interpreted.
Sampling
• The process of purposeful selection was described? - Sampling in qualitative research is purposeful and the process used
to select participants should be clearly described.
• The
sampling method needs to fit the study purpose or research question being
explored.
• Purposeful sampling selects participants for a specific reason e.g.,
age, culture, experience, not randomly.
• There are numerous sampling methods in qualitative research: the
sampling strategies used by the researcher should be explained and should
relate to the purpose of the study. For example, if the purpose of the study is
to learn about the impact of a new treatment program from the perspective of
all clients involved in the program and their families, the purposeful sampling
method should be broad to include maximum variation in perspectives and views.
On the other hand, if the purpose is to explore an issue in-depth, such as the
numerous factors and interactions that are involved in a family deciding when
and where to place an elderly member in a nursing home, an individual, ‘key
informant’ approach may be appropriate.
• Sampling was done until redundancy in data was reached? - The main indicator of sample size in qualitative research is often
the point at which redundancy, or theoretical saturation of the data, is
achieved. The researcher should indicate how and when the decision was reached
that there was sufficient depth of information and redundancy of data to meet
the purposes of the study.
• The sampling process should be flexible, evolving as the study
progresses, until the point of redundancy in emerging themes is reached.
• The sample should be described in such a way that the reader understands
the key characteristics of the participants involved. As a reader, you should
then be able to consider the sample in comparison to the purpose of your
critical review. You may decide at this point that the sample is different
enough from your own population of interest that further appraisal of the study
is not warranted.
• Informed consent was obtained? - The
authors should describe ethics procedures, including review by a research
ethics board and describing how informed consent was obtained and recorded.
Data Collection
▐ Descriptive Clarity
• Clear and complete descriptions? - In
qualitative research, the reader should have a sense of personally experiencing
the event/phenomenon being studied. This requires a clear and vivid description
of the important elements of the study that are connected with the data, namely
the participants, and the site or setting.
• The researcher includes relevant information about the participants,
often in the form of background demographic data. The unique characteristics of
key informants help to explain why they were selected. The credibility of the
informants should be explored. Particular toqualitative research, the types
and levels of participation of the participants should also be
described, so it is clear what contribution each participant made to the
data gathering, analysis, interpretation of the findings.
• It is often useful to consider what information is missing. This sheds
light on how the research can be understood.
• Role of the researcher and relationship with participants: Qualitative research involves the ‘researcher as instrument’, wherein
the researcher’s use of self is a primary tool for data collection.
Documentation of the researcher’s credentials and previous experience in
observation, interviewing and communicating should be provided to increase the
confidence of the reader in the process. The researcher’s role(s), level of
participation and relationship with participants also needs to be described, as
they can influence the findings.
• Identification of assumptions and biases of researcher: The researcher should declare his/her assumptions and biases about the
topic under study to make the researcher’s views about the phenomenon explicit.
• A vivid but concise description of the participants, site and researcher
should provide the reader with an understanding of the ‘whole picture’ of the
topic or phenomenon of interest.
▐ Procedural Rigour
• Procedural rigour was used in data collection strategies? The researcher should clearly describe the procedures used to ensure
that the reader can understand the tasks undertaken to collect the data. All
source(s) of information used by the researcher should be described.
• The reader should be able to describe the data-gathering process
including issues of gaining access to the site, data collection methods,
training data gatherers, the length of time spent gathering data, and the
amount of data collected.
Data Analyses
▐ Analytical Rigour
• Data analyses were inductive? - The
researcher(s) should describe how the findings emerged from the data.
• Different methods are used to analyze qualitative data - the reader
should be able to identify and describe the methods used in the study of
interest, and make a judgement as to whether the methods are appropriate given
the purpose of the study.
• Qualitative analyses are typically inductive i.e., starting with data
and organizing them into “chunks” which are typically referred to as codes,
categories and themes.
• You
should be able to summarize the major findings of the analyses in this section.
• Findings were consistent with and reflective of data? The codes, categories and/or themes developed by the researcher(s)
should be logically consistent and reflective of the data. There should be an
indication that the themes are inclusive of all data that exists, and data
should be appropriately assigned to codes, categories, and themes.
▐ Auditability
• Decision trail developed? - The
process used to identify codes, categories, patterns, themes and relationships
from the data is important to understand as it is complex. This process is best
articulated through the use of a decision or ‘audit’ trail, which tracks
decisions made
during the process including the development of rules for transforming
the data into codes, themes etc. Researchers often confront space limitations
in publishing their research, so frequently state that they used a decision
trail, but may not provide all of the details. You will need to judge whether
you have adequate information about the analyses, and the
rationale used to describe the interpretation of the data.
• Process of analyzing the data was described adequately? - The researchers should report on how data was transformed into codes
and themes and interrelationships that provide a picture of the phenomenon
under study. Often a qualitative researcher will use a specific analysis
method, such as an editing style or a template approach (Crabtree & Miller,
1999). The methods used should be described.
• The
rationale for the development of the themes should be described.
• These steps in auditing the analysis process provide evidence that the
findings are representative of the data as a whole.
▐ Theoretical Connections
• Did a meaningful picture of the phenomenon under study emerge? The findings or discussion section should clearly describe theoretical
concepts, relationships between concepts, and integration of relationships
among meanings that emerged from the data in order to yield a meaningful
picture of the phenomenon under study. The reader should be able to understand
concepts and relationships, including any conceptual frameworks that the
researchers propose.
Overall Rigour
• Rigour in qualitative studies is critical. While in quantitative
research one discusses concepts such as reliability and validity, qualitative researchers
argue for the use of different terminology when determining the rigour of a
qualitative study (Guba & Lincoln, 1989; Krefting, 1991; Taylor, 2000). The
overarching concept when considering rigour is trustworthiness.
• Was there evidence of the four components of trustworthiness? Trustworthiness ensures the quality of the findings and increases the
reader’s confidence in the findings. This requires that there be logical
connections among the various steps in the research process from the purpose of
the study through to the analyses and interpretation.
• The four
components of trustworthiness are:
• Credibility which is related to the “true”
picture of the phenomenon. Are descriptions and interpretations of the
participants’ experiences recognizable? Ways of ensuring credibility might
include:
o
collection of data over a prolonged period and from
a range of participants; o use of a variety of methods to
gather data;
o use of reflective approach
through keeping a journal of reflections, biases or
preconceptions and ideas;
o triangulation, a strategy used to
enhance trustworthiness through the use of multiple
sources and perspectives to reduce systematic bias. Main types of triangulation
are by sources (people, resources); by methods (interviews, observation, focus
groups); by researchers (team of researchers versus single
researcher) or by theories (team may bring different perspectives to
research question for example a rehabilitation therapist and a sociologist);
and
o the involvement of participants through member checking. Member checking
may consist of the involvement of participants in a range of activities to
verify data and interpretation such as returning transcriptions to participants
for review of accuracy of the interview content or returning to participants at
various stages during collection and analysis of data to ensure that the
researcher reflects or presents the experience of the phenomenon as it is
understood by the participants.
• Transferability which is related to whether the
findings can be transferred to other situations. Has the researcher described
participants and the setting in enough detail to allow for comparisons with
your population of interest? Are there concepts developed that might apply to
your clients and their contexts? Transferability is ensured through adequate
descriptions of sample and setting.
• Dependability which relates to the consistency
between the data and the findings. There should be a clear explanation of the
process of research including methods of data collection, analyses and
interpretation often indicated by evidence of an audit trail or peer review.
The audit trail describes the decision points made throughout the research
process.
• Confirmability which involves the strategies
used to limit bias in the research, specifically the neutrality of the data not
the researcher. This can be enhanced through the researcher being reflective
and keeping a journal, peer review such as asking a colleague to audit the
decision points throughout the process and checking with expert colleagues
about ideas and interpretation of data, checking with participants about ideas
and interpretation of data, and having a team of researchers.
Conclusions & Implications
• Conclusions were appropriate given the study findings? - Conclusions should be consistent and congruent with the findings as
reported by the researchers. All of the data and findings should be discussed
and synthesized.
• The findings contributed to theory development and future OT practice? - The conclusions of the study should be meaningful to the reader, and
should help the reader understand the theories developed. It should provide
insight into important professional issues facing occupational therapists. The
authors should relate the findings back to the existing literature and
theoretical knowledge in occupational therapy. Implications and recommendations
should be explicitly linked to occupational therapy practice situations and
research directions.
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