Qualitative Research in Aphasia

Additional info about the basics of qualitative research but more expanded on.

What is the quote from Bruner that talks about one of the main reasons why we do qualitative research?

“In the end, even the strongest causal explanations of the human condition cannot make plausible sense without being interpreted in the light of the symbolic world that constitutes human culture.” (Bruner, 1990, p. 138)

How are our behaviors influenced by many different contexts and our environment?

The shared realities that human beings create and inhabit are complex. Take a mundane, everyday activity like meeting a friend for coffee. Because this is something we have done many times, we may not realize how many different systems of meaning we draw on when deciding how to behave and interpret the events we participate in and witness. But in this context, and all others, our behavior and view of all the elements that composed the coffee outing will be influenced by a large array of understandings.

How are we going to have to go about using qualitative research?

When we observe a simple, quotidian scene, we would need to reference many different systems of thought to begin explaining what is going on. Hence, we may have to use many different qualitative research methodologies and observation tools to help us explain and interpret what's going on.

What does qualitative research offers in order to develop a knowledge about certain human interactions?

Our ability to discover meaning and make sense of the world is an innate human capacity. It enables us to engage in a process of learning in which we can elucidate the systematicities of human interaction and, as Bruner suggests in the quote above, how these systematicities are impacted and influenced by our interactions with others. Qualitative research offers a set of analytic procedures that allow us to develop this knowledge and to begin understanding situations like the coffee shop. Hence, we are already born with a natural tendency for human connection and to make meaning out of and explain human interactions, which qualitative research allows us to do.

What is qualitative research suited for?

As researchers and clinicians, our practices must be informed by a growing awareness and appreciation of the lived experiences of people with aphasia and other disordered types. Qualitative research paradigms are uniquely suited to systematically investigating these rich and complex areas, and thus can help us create more relevant, meaningful, and just approaches to studying and treating aphasia and these other disordered areas. Qualitative research helps us get to the rich and thick descriptions of these complex areas when systematically investigating the lived-experiences of individuals within the field.

What is the importance of asking the right questions in qualitative research?

Every decision about designing a research study starts with the research question. Above all, a researcher selects a methodology that helps to answer a research question. The first question relates to a comparison that could be made between two types of containers. This question is not remarkably different than a researcher asking a question about what treatment is better for a group of people with aphasia. The second question asks something very different. It does not ask if something works, but how something works. This is a key objective of qualitative research, to understand how things function and unfold within a particular context, and what are the mechanisms, processes, and actions at work that help to achieve social interaction (Damico et al., 1999).

An example that represents a quantitative research question

“What works better for moving, a cardboard box or a plastic box?” To answer this question, a researcher may come up with a hypothesis about which container would be better. She may then devise a highly controlled experiment where two conditions exist that are identical in every way except for the type of container tested. She would be scrupulous in ensuring that certain things are controlled (e.g., materials in the box, who carries it, the amount of time it is carried) and measure a fixed set of outcomes related to the efficiency of the box. Then, she would determine if her hypothesis generated before the experiment was correct.

An example that represents a qualitative research question

“How does a moving box work?” A researcher approaches this question differently. She may start by observing people using the box, noting what goes in it, how the box changes with things in it, where people put it and how they move it around to meet their needs, what is around it, placed on top of it, does it ever fail and if so, when, how, and why? What happens to the box when it is unpacked, how does its purpose change and how do people feel about it then? Is it still a ‘moving box’ or does it now represent something else?

Why are ‘how’ questions more suited in qualitative research than ‘why’ questions?

Because of our focus on communication and its inextricable ties to context and culture, “how” questions are well suited for several issues in aphasia and the broader field of speech-language pathology. Communication does not occur in a vacuum. Because sensitivity to context is central in qualitative inquiry, “how” questions shift the researcher’s focus so that factors outside of the person with a communication disability can be observed and analyzed. Thus, the qualitative researcher is not only interested in documenting the actions of a person with aphasia, but also the interlocuters’ actions, the broader contextual issues such as social roles and cultural norms, and the perceptions and views of all involved.

What is the theoretical orientation of qualitative research?

In the early to middle part of the 20th century, logical positivism dominated psychology and many other disciplines. The ontology of this philosophy is based on the idea that physical and social worlds exist independent of human knowledge (Shanks & Bekmamedova, 2018). Positivist epistemology requires a researcher to accrue knowledge by forming a testable hypothesis that is then assessed via experiments or observations of the world (Park et al., 2020). The researcher is required to remain distant, neutral, and completely independent from the phenomena they are studying (Hanfling, 2003). Qualitative research allowed researchers to explore complex, real-life issues in subjective and contextually driven ways. Constructivism is probably the most influential approach to ontology amongst qualitative researchers. Constructivists believe that while a unitary, non-human world exists and plays a small role in shaping our knowledge, most knowledge is socially constructed (Tennyson & Volk, 2015). Constructivist approaches to epistemology posit that we can learn about the nature of these realities through interacting with others (Amineh & Asl, 2015).

What are our qualitative methods guided by?

Qualitative methods are guided by a set of philosophical assumptions. Methodological decisions made during the process of designing and carrying out qualitative research are driven by our philosophical assumptions and could fall anywhere along the continuum. As suggested by Damico (2014), “What we believe and how we use those beliefs to act upon the world through science is actually directed by the various theoretical orientations that we possess” (pg. 347).

What is ‘member checking’ and what does it consist of?

A practical example from aphasia research includes the process of going back to participants after some data has been collected to “verify” researcher interpretations. This is an especially important procedure in aphasia research because of the difficulty with accessing language and the fact that qualitative researchers are deriving meaning from words of people with aphasia. This process is commonly known as member checking and is considered useful for ensuring that the analysis is trustworthy.

Examples of using ‘member checking’ from a quantitative philosophical stance or philosophical assumption

How a researcher goes about this, though, reflects a philosophical stance that the researcher takes. If a researcher takes an interview transcript and initial codes generated by the researcher back to a participant and asks closed-ended questions about whether they agree with the words the researcher has used, the researcher is operating from an assumption that there is one, objective reality and everyone should agree on it. This process would fall on the more positivism side of the continuum.

Examples of using ‘member checking’ from a qualitative philosophical stance or philosophical assumption

Alternatively, the researcher could take the transcript and constructed meanings back to the participant and ask open questions like “What do these words mean to you?” or “Tell me more about what you meant when you said this.” The researcher would then engage in a dialogue with the participant to gather more data that would deepen the initial meanings she constructed and extend these ideas so that a richer understanding could be achieved. This process would indicate that the researcher is operating from the assumption that realities are multiple and dynamic, which would fall on the more social constructivism side of the continuum.

What are the goals and aims of qualitative research?

• Interpretative adequacy

• Explications and thick description

• Adopt a learning role

• Keep an open stance

• Focus on natural settings

What is ‘interpretative adequacy’ and what does it consist of?

The ultimate goal of qualitative research is interpretive adequacy. The qualitative researcher does not simply watch social action play out and describe what she observes. She interprets the nature and meaning of what she sees and then constructs and explains the essence of the social phenomenon, including the contextual elements, actions, and perspectives that help determine the answer to her question (Damico et al., 1999).

What is ‘explication’ and what does it consist of?

Take, for example, a researcher that wants to investigate how a person with severe aphasia can successfully communicate in group conversation. The researcher would need to richly describe how and when the person with aphasia engages in the group, how different vocal and multimodal strategies are layered within the talk and actions of others, and how the perceptions of self and others contribute to successful communication. This activity is called explication and is a way that researchers describe the factors contributing to how social action is predictably achieved (Damico, 2014).

How is ‘explication’ achieved?

Explication is achieved through thick descriptions (Geertz, 1973). Thick descriptions are used to characterize the systematic actions of participants and the motivations, significance, and procedural nature of those actions. The strength of this type of explication is rather than focusing on the fact that a given action happens, it helps us understand how the action happens. Explication details the mechanisms that give rise to the phenomenon in question. In the example above, explication would allow a clinician or researcher to better understand how communication strengths can be exploited by a person with aphasia during group conversation or how interruptions of a family member could be minimized so that a person with aphasia could speak for themselves.

How do qualitative researchers come to understanding a phenomenon?

In contrast to quantitative investigations, qualitative research does not aim to test predetermined hypotheses. Instead, qualitative researchers tend to frame much more open research questions oriented to understanding an area of interest. For example, in Cruice and colleagues’ (2003) study of quality of life in aphasia, the authors did not set out to test a hypothesis concerning this issue. Rather, they started with a much broader focus and set out to understand how four women with aphasia and members of their family defined life quality. Therefore, another objective of qualitative research is to adopt a learning role (Damico et al., 1999). By adopting a learning role, rather than a testing role, researchers can discover something new and unknown that represents the perspectives or actions of the participants themselves.

What does the idea of ‘adopting a learning role’ require?

Adopting a learning role requires the researcher to take an open stance during data analysis. Qualitative researchers do not process the data looking for evidence that either confirms or refutes a point of view. In most cases, researchers employ a purely inductive process. They bring knowledge to the analytical process which motivates them to attend to aspects of the data, known as sensitizing concepts (Charmaz, 2003). Once they have data to process, purely inductive researchers then try, to the maximum extent possible, to let the data speak for themselves.

What is the opposite of taking of ‘adopting a learning role’?

In other instances, researchers may take a more deductive approach, applying a previously created framework to the data to guide analysis. Even when researchers opt to use a priori ideas to inform the analytical process, if something interesting and unexpected appears in the data, many qualitative researchers will orient to this unforeseen occurrence. The places where pre-existing schemas do not exactly match the data or where a new perspective becomes apparent can then be used to refine old understandings and develop more credible findings. Qualitative research takes the time to refine old understandings where previous ones no longer fit with the data and develop more credible findings. Whereas, quantitative research applies a previously created framework to the data to guide analysis rather than refine old ideas to fit with the data. Returning to the continuum of positivism to social constructivism, inductive processes would fall on the social constructivism end of the continuum while deductive approaches would fall more closely toward positivism.

How do researchers conduct experiments in qualitative research?

Qualitative designs do not usually include conducting experiments. Instead, investigators tend to collect data in real world settings. Understanding what happens in natural settings is an important goal of qualitative research. Data gathering procedures include making careful written observations about people’s actions in commonplace environments; systematically examining the objects that people make and use; reading documents that people produce as part of their everyday lives such as diaries, clinic reports, text messages, etc.; or interviewing people who have experiences on a given topic. Gathering authentic data allows researchers to develop in-depth explications of the meanings and processes that underpin complex social phenomena. Because qualitative researchers avoid the artificial constraints experiments impose on investigations and focus their attention on the real world, findings flowing from their research is more likely to provide grounded, accurate, and relevant information about how the real world operates.

What are some traditions of inquiry in qualitative research?

• Ethnography

• Phenomenology

• Conversation Analysis

• Grounded Theory

• Case Study

What is ‘ethnography’?

Ethnography is a qualitative tradition of inquiry with disciplinary roots in anthropology that seeks to document and interpret human action and social life within a given cultural context (Kovarsky & Crago, 1990). Researchers using ethnographic methods usually immerse themselves in a cultural setting to better understand patterns of behavior, social action, dynamics, and perspectives of a group of people. For this reason, ethnographers may choose to focus a study at a macro-level (i.e., broad), micro-level (i.e., narrow), or both. Macro-level investigations zoom out in data collection and analysis phases to study a larger societal context and the processes and actions participants engage in. Micro-level investigations zoom in during these stages to identify how a given ritual or activity unfolds on a moment-to-moment basis. Either approach comes with fieldwork, or significant time spent in a cultural setting and careful observation and documentation of activities of the participants (i.e., participant observation) (Geertz, 1973; Spradley, 1980). Hence, ethnography allows you to immerse yourself in a culture or context in order to understand that culture or context.

Examples of ethnography being immersed in aphasia and other disordered populations

In aphasia, ethnography has been adapted so that patterns of behaviors of people with aphasia can be understood within specific organizational structures or practices. Studies like these and others using ethnographic methods have often pointed to challenges that people with aphasia may face as they navigate their recovery across healthcare systems. Taken together, findings indicate the problems in organizational structures and the rigidity in the “rules” or standard practices that healthcare workers must follow when trying to care for people with aphasia.

What is “phenomenology”?

Interpretive Phenomenological Analysis (IPA) is a qualitative research approach that investigates the ways that people make sense of profound, life changing experiences. Rooted in phenomenology (a branch of philosophy which focuses on subjective human experiences of the world), IPA studies involve exploring participants’ perceptions of and emotional responses to important events in their lives (Larkin et al., 2006). Typically, IPA designs feature a small number of participants (studies with between 2 and 15 participants exist). Researchers recruit participants who have lived experience of the phenomenon of interest. Next, researchers gather data by conducting semi-structured interviews, which allow participants to describe events and their reactions to them in their own words. This form of data provides rich, detailed accounts of the participants experiences as well as in-depth information on how they processed and made sense of these experiences. Interviews are carefully compared, and analysts identify similarities and differences in perceptions. In many cases, IPA-informed researchers construct themes and sub-themes from the data, developing an overview that captures the range and complexity of the experiences and reactions reported by participants (Smith et al., 1999). Hence, phenomenology allows you to understand how individuals deal with a certain life situation or navigate a disease for example.

Examples of phenomenology being immersed in aphasia and other disordered populations

An important point about the studies above is that they focus on the lived experience or first-hand account of a given phenomenon. Because of this, viewpoints are often gathered through narrative or semi-structured interviews with an explicit focus on how people derive meaning from a subjective experience. While IPA can be used to answer research questions about a more narrow and bounded experience (e.g., therapy experiences), special care must be taken in devising the interview topic guide and overall structure of the interview so that a broad view of experiences can be elicited, rather than degree of satisfaction with a particular technique or approach. For example, in a series of studies, Lanyon and colleagues (2017; 2018a; 2018b) set out to understand experiences related to community aphasia groups. The topic guide centered on the experience of aphasia and therapy more broadly along with specific questions about aphasia group experiences, attitudes, interactions within the group, and thoughts about improving service delivery. Because of this thoughtful approach to IPA, the authors were able to understand aphasia group participation considering changes to participants’ personal and social lives and to offer comprehensive recommendations to improve group therapy.

What tools to phenomenology provide to help study the lived experiences of individuals within disordered populations?

Aphasia impacts all domains of living and usually has a profound effect on how people with neurogenic injury see themselves and make sense of events in their lives. IPA provides a set of well-defined, field tested tools that researchers can use to systematically investigate the subjective aspects of aphasia and shed light on how people with aphasia navigate the challenges of living with a serious disability and even thrive after aphasia onset. Studies conducted within this tradition have the potential to enhance understandings of how people experience aphasia which can inform the development and implementation of services that meet the needs and priorities of people with aphasia.

What is “conversation analysis”?

Conversation analysis (CA) has its roots in the work of sociologists such as Harvey Sacks who sought to illuminate how people make sense of their day-to-day experiences, including having conversations. Within CA, a conversation is understood as a turn-based activity involving two or more participants. For conversation to occur, participants collaborate and jointly carry out ‘social actions’ such as initiating interactions, picking a topic to talk about, constructing sequences of turns (e.g., asking and answering questions), and concluding interaction (Sacks et al., 1974). During conversation, participants continuously work together to ensure that they share interpretations of one another’s intentions, meanings, and actions, as well as the situation in which a given conversation is taking place (Goodwin, 2006).

What does “conversation analysis” consist of?

One central principle of CA is the idea that conversation is a complex, orderly process. Participants orient to organizing principles underlying language to guide their actions and to make sense of the behavior of their co-interactants. Orientations concerning the co-production of sequences are especially important; participants share ideas about what sets of actions fit together (e.g., when a speaker asks a question, in most cases a hearer will furnish an answer) and use these to inform their behavior (Schegloff, 2007).

What is another key assumption of CA?

Another key assumption guiding all work within the discipline of CA is the notion that we cannot develop a sufficient understanding of how human beings communicate and operate in social settings unless we study data gathered in authentic, naturally occurring settings. Commonplace events where participants are participating in ‘normal’ communication activities such as having a casual chat with a friend are thus highly valued within this inquiry paradigm. Conversation analysts repeatedly observe audio or video recordings of people participating in different types of interaction. By carefully and repeatedly observing the antecedents and consequences of actions of interest, researchers can shed light on the operating principles underlying conversation and begin to understand the cognitive structures that participants rely on (Goodwin and Heritage, 1990).

What is “grounded theory”?

Grounded theory is a qualitative research methodology initially developed by Barney Glaser and Ansalem Strauss in the 1960s (Oktay, 2012). Glaser and Strauss developed their approach while collaborating on a study of how terminally ill people dealt with the knowledge of their coming deaths and how healthcare staff related to these patients. Since that time, several other authors have built upon this early work and expanded the paradigm. Though several flavors of grounded theory currently exist, they all share key features. Investigations start with a research question that typically deals with a pattern of behavior the author is interested in or on making sense of a broader phenomenon. For example, Charmaz undertook a number of studies designed to enable her to develop theories to explain how the experiences and identities of people living with chronic pain are impacted by their condition (e.g., Charmaz, 1990, 2006).

What is the focus of grounded theory?

The focus in grounded theory is on developing new explications for phenomena. Many grounded theorists attempt to develop an awareness of their own pre-existing perspectives and try to minimize the influence of their personal outlooks on the process of theory development (Glaser, 2012). If investigators can bracket their own views of a phenomenon, some grounded theory proponents argue that findings will be highly consonant with the data and provide accurate explanations for why people behave or think in particular ways. Hence, the focus is on developing your own awareness of your own preexisting perspective and attempting to minimize the influence of your personal outlook on the process of theory development. The goal is to bracket your own views of a phenomenon and findings will be highly consonant with the data and provide accurate explanations for why people behave or think in particular ways. Versus you just coming with a preexisting perspective and not bracketing your own views of that phenomenon.

What does grounded theory strongly encourage investigators to do?

Like many other qualitative traditions, grounded theory strongly encourages investigators to arrange data collection and processing stages into non-linear cycles. Initially, the researcher gathers data from a small number of cases. Coding of the first batch of interviews, observations, or other data sources yields tentative concepts (Charmaz, 2006). The researcher will then select the next data source likely to furnish data against which she can check the adequacy of preliminary concepts. Workflow within grounded theory studies can be highly flexible, and researchers can gather more data at any point in the analysis or writing stages of the research process to assess and refine their understandings.

What is the “constant comparative method?”

One key feature of grounded theory includes the constant comparative method. As the name implies, throughout the process of building complex and multifaceted theories, analysts continuously contrast different segments of data. Data segments can take a variety of forms including the life of a participant as described in interviews, documents produced by participants, and memos written by researchers. Grounded theory researchers compare segments to one another to begin to see patterns in the data. Nascent understandings are subjected to further evaluation by determining whether they comport with other relevant data. By repeatedly focusing on different parcels of data and assessing the adequacy of their ideas to describe, summarize, and explicate issues, grounded theorists gradually construct more complete and coherent theories. In fact, the goal of grounded theory is to generate a novel theory that explains how people engage in and make sense of a particular experience.

What is “case study?”

While the term case study has been used in various ways, in qualitative research it is often viewed as a tradition of inquiry for studying a bounded system (i.e., a case) over time through an in-depth exploration (Creswell & Poth, 2024). It is important to note that a “case” need not be a single participant and can represent any contained element that is worth exploring in a comprehensive way. Case study as a qualitative methodology has a long and distinguished history in the social sciences.

What are the four important criteria of a case study?

Four important criteria are required for ensuring a case study is the right approach. Investigators must clearly identify a specific object of inquiry, it must be within a bounded system so that it can be studied separately, the study must be conducted within a relatively short time frame, and something valuable can be learned from the study of a case (Damico & Simmons-Mackie, 2003). Data collection and analysis procedures are like ethnography in that researchers will draw from multiple data sources (e.g., participant observations, interviews, video recordings, artifacts) and inductively code and analyze the data so that a cogent and detailed description of the case is obtained.

How have case studies been helpful in understanding the disordered populations?

In the field of speech-language pathology, while employed less often, qualitative case study research has been helpful in understanding specific communication disabilities and the barriers and solutions that exist to overcome communication problems in a variety of contexts (Duchan, 2014). Furthermore, case study approaches offer a rich and holistic account of living with aphasia to gradually build explanations of how and why mechanisms in a person’s life interact over time (Sorin-Peters, 2004b).

What general series of steps do qualitative research methodologies operate from?

• Developing a research question

• Choosing a method of inquiry

• Deciding on a sampling strategy

• Choosing data collection

• Analysis strategies

• Ensuring rigor

Sampling

To determine a sampling strategy, qualitative researchers start by defining the questions they want to answer. Each inquiry tradition provides guidelines on determining appropriate ‘cases’ or examples of the phenomenon investigators will gather data on. Ethnographers interested in the ways in which physical environments support or inhibit communication may choose to observe several different nursing homes, or researchers who wish to conduct a phenomenological study of the challenges people with aphasia face in returning to work may choose to interview several people who have relevant experiences.

What is ‘purposive sampling?’

Purposive sampling involves intentionally selecting cases that are likely to provide data germane to a research question. The researcher who is interested in return-to-work options might try to recruit people with aphasia who have tried to return to work and failed to secure long term employment. Interviewing people from this group would likely provide a researcher with the in-depth data she needs to support a defensible analysis because the cases (participants) have personal experience with the phenomenon of interest.

What is ‘snowball sampling?’

Another approach to sampling that researchers use to reach cases (usually people) that can provide useful data is snowball sampling. When employing a snowball recruiting strategy, researchers recruit a small group of people to participate in the study. These initial participants are then asked to recommend other people they know who might also meet a study’s inclusion criteria. Snowball sampling is often convenient and is especially useful for helping researchers locate hard to reach participants, such as people with low incidence medical conditions, people from groups with low social visibility, or people from stigmatized groups (Parker et al., 2019).

What is ‘homogenous sampling?’

Some traditions suggest that samples of participants be homogenous or alike in some specific way, a practice known as homogenous sampling. For example, IPA suggests that participants should be similar enough in their lived experiences so researchers can achieve a better understanding of the overall perceptions of the phenomenon being studied (Creswell & Poth, 2024). The act of living with aphasia, therefore, may not make people similar enough to reveal a more complex understanding of the challenges, strategies, experiences, and so on, of a group of people. In a homogenous sampling technique, a researcher will deliberately minimize variation in the sample by focusing on a subset of people with aphasia (e.g., culturally and linguistically diverse people with aphasia) to reveal commonalities in experiences shared across the group.

What is ‘heterogenous sampling?’

Other qualitative research questions may be focused on understanding critical differences across a subset of people. These studies may opt to use heterogeneous sampling, a purposeful sampling strategy used to recruit participants with a range of diverse characteristics. Heterogeneous sampling is often used in traditions such as grounded theory or ethnography, where researchers are interested in increasing the usefulness of the findings because shared aspects of a given phenomenon are revealed despite participants’ distinctive characteristics (Patton, 2015). Heterogenous sampling may also be used in the early stages of investigation when an area is relatively unknown. For example, if it is well known that variables like age, gender, or aphasia severity impact how people may experience some aspect of life (e.g., friendship), researchers should develop a strategy that accounts for these variations in experiences in developing the study. Thinking about sampling and the degree to which an array of perceptions and experiences are represented in the participant pool is an integral part of generalization in qualitative research, a construct discussed at the end of this chapter.

What is ‘data collection'?’

Gathering data in qualitative research can take many forms. Because many qualitative research questions are focused on gathering the perspectives of a particular group of people, interviews and focus groups are often data collection strategies employed by researchers. Depending upon the tradition of inquiry, one or more data sources may need to be collected and analyzed. In ethnographic methods, for example, participant observations may be used as a primary data source while interviews and artifacts (i.e., things people make and use) are used as supplementary data sources.

What are some special considerations that may need to be made in order for individuals in disordered populations to be able to fully participate in data collection strategies?

Special considerations may need to be made so that people with aphasia can fully participate in data collection strategies. These are most integral in qualitative studies that use interviews or focus groups as the primary data source, and several tutorials have been developed in aphasiology to guide researchers in the process of collecting these types of data. For example, Wilson and Kim (2021) suggest researchers 1) determine what communication support strategies work best for each participant and employ these strategies and tools as needed during the interview process, 2) carefully consider how interview questions are worded and verify elicited information with yes/no questions, and 3) impose greater amounts of silence during interviews to ensure people with aphasia have the conversational space to think and respond to questions.

What are some ‘data collection techniques?’

• Interviews

• Focus groups

• Participant observation

• Artifact analysis

• Conversation or other forms of talk-in-interaction

What are the pros and cons of bringing biases into qualitative research?

In qualitative research, analysts interpret data to yield findings. Therefore, during data analysis, the researchers (and their potential biases) are an active part of the process. While the perspectives that each researcher brings to the process are expected to influence the results that emerge, researchers also try to maximize the extent to which findings are grounded in the data. Procedures for maintaining disciplined subjectivity help researchers become aware of their assumptions and account for their impact on findings (Simmons-Mackie & Damico, 1999). If researchers do not consciously attend to and account for their biases, there is a danger that their interpretations will reflect preconceived assumptions and lack sufficient consistency with the data. On the other hand, the experiences that researchers bring to the analysis process could be viewed as a strength. In reframing their approach to thematic analysis, Braun and Clarke (2019) talk specifically about the researcher’s role in knowledge production, also known as reflexive thematic analysis or thematic analysis.

What is ‘thematic analysis’ or ‘reflexive thematic analysis?’

Reflexive thematic analysis, the new term for this specific approach to thematic analysis, fully acknowledges that bias can never be completely removed, and that the researcher strives to be fully aware of their own assumptions and that this informs interpretation of the data.

What is ‘etic’ and ‘emic’?

Practicing disciplined subjectivity means balancing the perspectives that the researcher brings to the data analysis process (i.e., etic or outsider’s perspective) with the perspectives the participants convey in their actions and their words (i.e., emic or insider’s perspective).

What does ‘transcription of the data’ consist of?

Several types of qualitative data require transcription for data analysis. Transcription can be thought of as the first step in analysis because the researcher is active in the process and must make several decisions during this phase, impacting data interpretation. The type of transcription produced from an audio or videorecording will depend upon the research question and tradition of inquiry. For example, CA requires specific transcription systems and procedures, including the transcription of non-verbal communication behaviors, while transcription of interview data may simply require a verbatim record of what participants said. Because of the revisions, errors, and syntactical structures produced by people with aphasia, automatic speech recognition software is often only useful as a first step in transcription. A second step in the transcription would require decisions on what transcription notations to use for non-verbal communication and other facets of talk (e.g., gaze, pauses, interrupted speech), adding in descriptive symbols to represent these actions in the transcript, and line-by-line reviewing and editing of the orthographic transcription produced by speech recognition software. While this process is straightforward for interview or focus group data, analysis of conversation or other forms of talk-in-interaction often require specialized processes (see Azios & Simmons-Mackie, 2022 for detailed steps in CA in aphasia).

What are the stages of ‘thematic analysis’?

Most forms of qualitative research will require investigators to interpret patterns, or themes, within the data. Though a variety of approaches exist (e.g., Braun & Clark, 2006), most projects include several common stages. Researchers usually begin thematic analysis by familiarizing themselves with the data, which may take many forms of interviews, documents generated in clinical settings, field notes, photos, websites, or devices constructed by participants. Next, researchers typically code the data; they work through the corpus, applying simple descriptive labels to individual data segments. For example, in ethnographies, researchers may review their field notes and provide labels for each of the events described in these records. After coding, these labels are usually grouped into larger categories. These categories help researchers develop overarching patterns, or themes, that summarize and communicate major aspects of the data. Themes provide theories that explain phenomena of interest. While we have described the process of thematic analysis in terms of stages, in practice thematic analysis is iterative. In most cases, researchers do not proceed through the stages in a linear manner. Instead, coding, categorization, and theme generation tend to overlap, and analysts may move backwards and forwards between different stages as the project progresses. Further, the codes, categories, and themes that researchers create change over the lifetime of a study, as different items are combined or split apart to provide more adequate accounts of the data.

What are some ways to ‘ensure rigor’ in qualitative research?

• Peer Debriefing

• Audit Trail

• Data Triangulation

• Member Checking

What is ‘peer debriefing’?

While qualitative researchers may opt to work on data analysis independently, most findings are the product of collaboration between a number of people. Typically, researchers are assigned specific tasks during the analysis stage of a project. As processing and interpretation of data progresses through the coding, categorization, theme generation, and writing up stages, team members will meet with one another. During these meetings, teams may share and compare codes, categories, and themes and discuss the extent to which these structures are consonant with the data. If necessary, the nascent understandings teams construct can be refined to achieve greater adequacy and groundedness. Peer debriefing is thought to play an important role in helping researchers address the influence of the biases they bring to research projects and to help increase the rigor of study results and conclusions.

What is ‘audit trail’ and what does it consists of ?

The audit trail is a collection of documents that provides information on how data was collected, analyzed and used to develop the findings of a study. It is a ‘trail’ since it essentially details how researchers got from the raw data to their published interpretations. The audit trail consists of raw, deidentified data (e.g., transcriptions of interviews, field notes, diary entries) as well as written records of decisions related to data processing and descriptions of how these processes were carried out. Typically, different versions of code lists, memos concerning the analysts developing understanding of the data, records of the themes and sub-themes that researchers created and changed over the course of the study, and records of meetings in which team members engaged in peer-debriefing or discussed data analysis and the findings of a study all form part of the audit trail (Carcary, 2009). Because the trail makes the analytical process transparent and shows how the interpretation of the data was constructed over time, it enables research consumers to assess the extent to which findings are grounded in the raw data.

What is ‘data triangulation’ and what does it consist of?

Data triangulation is a procedure whereby analysts gather multiple sources of data that focus on the same phenomenon (Flick, 2004). For example, Simmons-Mackie and colleagues (2024) conducted a study of the acute care experiences of family members of people with aphasia. In this study, the authors used open-ended survey questions, focus groups, and comments about the findings from other family members to develop a more detailed understanding of the challenges associated with understanding and coping with aphasia during this early period. As was the case in this study, researchers collected multiple sources of data related to the same phenomenon and refined nascent interpretations to better align with multiple data sources. Triangulation can thus promote the credibility and groundedness of research findings.

What is ‘member checking’ and what does it involve?

Member checking is a process whereby researchers share their interpretations and findings with the study participants who then are given the opportunity to provide feedback on research results. Member checking helps to foster the trustworthiness of research findings, since people with a deep and often personal understanding of the area of interest who were themselves not involved in the analysis process provide input about the extent to which findings reflect their perspective.

What is ‘lamination’ and what does it involve?

Lamination is a technique closely related to member checking which allows researchers to generate and verify interpretations through sources of data other than the researcher. The term lamination is a metaphor for layering of the different levels and types of interpretation to form a more defensible account of the findings (Damico & Simmons-Mackie, 2003). Like in member checking the researcher may return to the participants to gather novel interpretations of the data analysis so far, but the researcher could also gather perspectives from other sources (e.g., other cultural informants outside of the study). For example, in a study of key wording practices in aphasia groups, researchers asked group facilitators not involved in the study to share their interpretations of the tentative conclusions formed from the analysis as a form of lamination (Archer et al., 2019).

More additional info regarding qualitative research

Many qualitative researchers are constructivists and thus believe that knowledge is the product of an active, socio-historically informed process. Regardless of the tradition of inquiry chosen, therefore, findings presented in studies are not reflections of facts that existed in the world independent of human thought. Rather, findings arise out of the interplay between the available data and the analyses carried out by a particular group of investigators. If the research has been conducted well and based on high quality data, the findings will be unique and highly grounded interpretations that consumers of research such as practicing clinicians can use to develop an authentic understanding of a given area.

What is the value of choosing a tradition of inquiry that is right for a research question in qualitative research?

Since all of qualitative research generally falls under this theoretical umbrella, is there value in choosing a tradition of inquiry based upon your research question? In many instances, the answer to this question is yes. First, choosing a tradition of inquiry that is right for a research question can help researchers (especially those with less experience) make decisions about how to go about different steps in the research process. This is because each tradition sets out a framework for conducting a study. The focus of the study will be directed by the tradition of inquiry, along with the type of problem that needs to be solved, the unit of analysis, data collection and analysis strategies, and how the written product is produced (Creswell & Poth, 2024). For example, a researcher using a grounded theory approach usually investigates a phenomenon that may be less known, relies heavily on participant perspectives to understand process and interaction involved in the phenomenon, primarily collects many interviews to reveal the complexity of the phenomenon, and then analyzes the data using a prescriptive process (i.e., constant comparative method). On the other hand, an ethnographer may find value in studying a culture that they understand well from the outside (e.g., institutional culture) but want to obtain an insider perspective of that cultural space. The ethnographer may rely more heavily on immersing themselves in this culture, recording participant observations through field notes, even engaging in the culture themselves to learn more about how and why people in the culture interact with one another and what they value. Data may also be collected during field work and include interviews of people in the culture or artifacts that people make and use. The number of steps in analysis are far fewer and less rigid so that the researcher can make use of multiple data sources to better represent both a micro and macro-level understanding of the intersection of action, values, and culture.

How should researchers choose procedures that support the research goal?

In other situations, particularly in the field of speech-language pathology, the research question may not neatly fall into a single tradition of inquiry. What if the goal of the qualitative study is to obtain feedback on a treatment to better understand consumer perspectives? What if a researcher aims to understand something a bit narrower than the ‘lived experience’ such as how people with aphasia navigate service encounters or participate in advocacy-related activities? In these cases, a specific qualitative tradition of inquiry may not fit the research needs and, therefore, researchers should select analytic approaches that help explicate the phenomenon under investigation in a theoretically informed way (Braun & Clarke, 2020). There is never a single approach that fits each research question. For many reasons, methodologies (e.g., traditions of inquiry) are not necessarily better than methods. The field of aphasiology has seen a large increase in relying on theoretically informed methods (e.g., reflexive thematic analysis; Braun & Clarke, 2019) that offer the tools and techniques for carrying out research when the methodology of an established tradition of inquiry does not fit the research needs. In any case, researchers should choose procedures that support the research goal, respect the worldview or theoretical background of the researcher, and are tailored to the central characteristics of the subject matter (Levitt et al., 2017).

What is ‘generalization’ and what does it involve?

A common argument against qualitative research is that it lacks generalization. However, the issue of generalization starts with how it is defined. Many researchers, from both experimental and qualitative backgrounds, have devoted considerable thought to the issue of generalization and how it might be conceptualized across research frameworks. In experimental studies, a researcher may carefully control the experimental context and manipulation of variables so that the degree of generalization from a sample to a population might be ascertained. This is contrary to qualitative researchers who strongly believe that context impacts all human behavior, so there is little use in assuming any situation would unfold exactly as it had before. Given this, is qualitative research generalizable?

What is ‘analytic generalization’ and what does it involve?

The answer to this question lies in how one defines generalization. Most qualitative researchers think of generalization as the ability to transfer findings to another context or situation (i.e., transferability) or the likelihood that the findings would be applicable if the situation were similar (although not identical), a term known as extrapolation (Patton, 2015). Generalization in qualitative research creates working hypotheses that consumers of the research can use to gauge if similar actions and the mechanisms that influence them would likely be present in other contexts. For example, a speech-language therapist working in a hospital may read a qualitative study about the negative healthcare experiences of Black individuals with aphasia, and one of the themes may detail the actions of healthcare providers that contributed to stigma, reluctance to continue care, and mental health problems. The therapist, while evaluating a Black man with aphasia in his hospital room, is interrupted by a physician who communicates in similar ways to the participants in the study. By reading this study and understanding the contextual elements and underlying entities that give rise to poor healthcare experiences for this group of people, the speech-language therapist can reasonably speculate that the same systems and actions that negatively impacted the research participants may impact the Black man with aphasia as well. The speech-language therapist then amends the communication training program used in her hospital to address specific strategies and approaches that may need to be considered for individuals with aphasia whose racial or ethnic backgrounds are different than the healthcare workers in the hospital. This type of generalization is termed analytic generalization and can be used when the evidence provided by a study supports a broader model of the underlying reality of the social world (Damico & Ball, 2010).

How do we know that qualitative research is generalizable?

A common argument against qualitative research is that it lacks generalization. However, the issue of generalization starts with how it is defined. Many researchers, from both experimental and qualitative backgrounds, have devoted considerable thought to the issue of generalization and how it might be conceptualized across research frameworks. In experimental studies, a researcher may carefully control the experimental context and manipulation of variables so that the degree of generalization from a sample to a population might be ascertained. This is contrary to qualitative researchers who strongly believe that context impacts all human behavior, so there is little use in assuming any situation would unfold exactly as it had before. Given this, is qualitative research generalizable? When generalization is defined in these types of ways, the answer to the question is clear. Yes! Qualitative research can be generalized, but as with all forms of generalization, it should be considered a working assumption that the consumer of the research uses to determine the extent to which the findings may be applied to a given situation. As stated by Cronbach (1975), “When we give proper weight to local conditions, any generalization is a working hypothesis, not a conclusion” (p. 125).

How can qualitative research advance social justice agendas?

Qualitative research can advance social justice agendas, and many experts have promoted the method for its power in accessing and understanding the worlds and meanings of those that are most vulnerable in our society (Denzin & Lincoln, 2005). Qualitative research paradigms provide us with a pathway to understanding justice from the viewpoint of the people who are most affected by injustice. Adopting the emic (i.e., insider) stance encouraged by many qualitative paradigms will help ensure that those of us who are not members of minority groups but who wish to use our relative privilege to campaign for more equitable structures and institutions, can do so in a way which avoids paternalization and aligns with the values and priorities of members of these groups. Using community members perspectives to inform social justice work is especially important in a field like aphasiology, where most clinicians and researchers are not themselves people with aphasia. Collaborative, community-focused qualitative methods can help us build intervention and research approaches which meet the real needs of our clients and contribute to the creation of institutions which meet with their definitions of justice.