Reporting rigorous qualitative results: Moving beyond small sample sizes.

Abstract

The value that qualitative research brings to the occupational therapy body of evidence is widely accepted. Including evidence relating to individuals’ lived experiences through qualitative studies parallels occupational therapy's practice focus and theoretical underpinnings of the person in context. Engaging with consumers of occupational therapy services, for example, ensures that our practices, clinical and academic, remain current and reflective of the experience of people we work with. Qualitative research, where participants provided rich and in-depth description of their personal experience, is thus akin to client centred practice which is our modus operandi (World Federation of Occupational Therapists, 2016). Qualitative research can be considered a natural extension of occupational therapy practice experience and expertise. After all, occupational therapists who are guided by a person-centred approach, will inevitably explore and consider their client's unique values and experiences in order to understand the context and meanings underlying occupational participation. We are comfortable interacting with clients and, consequently, occupational therapists should have prerequisite skills necessary for meaningful data collection with research participants using qualitative approaches. There is, however, a difference as the primary purpose of interaction is different – one aims to assist the other to enquire. Different techniques are used in these interactions reflecting the different methodological traditions from which they emerge. Clinicians know that ‘one size does not fit all’ in therapy. We thus interpret findings of reliable, standardised and valid assessments in the context of unique occupational performance needs, goals, roles and environments of the client, in order to collaboratively develop and intervention plan with our client. So it is with qualitative research data and methodology. The information collected will only ‘make sense’ if the assessment/enquiry methods used are rigorous, take account of the unique context and experiences of people involved, and ‘make sense’ from a range of perspectives. How do we know if qualitative research methodologies are rigorous? Can something that is so unique even incorporate attributes comparable across study questions and contexts? Just as therapy uses guidelines and methodological research to enhance the consistency and quality of practice processes, what tools can qualitative researchers in occupational therapy use to develop and implement robust research questions and procedures? Do we apply the same level of precision used to generate qualitative evidence in practice to the data collection, analysis and interpretation that we do in qualitative research? Is there a risk that qualitative findings from research is less rigorous than what we would use in practice? Are we taking the appropriate measures to ensure qualitative research produce findings that will have the potential to advance occupational therapy practice, research, and education? When it comes to the ‘quality’ of qualitative research, evidence suggests that ‘sample size’ is both a matter of contention and a meaningful guide to issues that need consideration. In the first instance, while sample size has been identified as a factor in study design, and it can be difficult to determine with precision, the size of the sample should be guided by ‘data saturation’ rather than sampling of people per se (Creswell, 2013). At the same time, the concept of data saturation has been challenged as a means to determine the quality of qualitative studies (O'Reiley & Parker, 2013). Other authors have proposed sample size can be determined on the number of participants rather than ‘data’, depending on the qualitative methodologies. For example, phenomenological studies may use between five and 20 participants (Creswell, 2013; Green & Thorogood, 2014) while three to 15 participants is acceptable in studies using interpretative phenomenological analysis (Smith, Flowers & Larkin, 2009). Still further, some qualitative researchers avoid suggestion of any particular approach, instead providing resources to researchers to help align their study design, procedures and sample size as best as possible with the question they are seeking to answer (for example, the Rosalind Franklin-Qualitative Research Appraisal Instrument and the Consolidated criteria for reporting qualitative research.) These resources have been developed precisely to help qualitative researchers design, conduct, and report comprehensive research that is credible, dependable and transferable to other contexts. The Australian Occupational Therapy Journal through its Editorial Board and Reviewers, stays abreast of discussions and developments in qualitative methodologies and approaches. Authors need to remember that, the journal will publish ‘papers that have a sound theoretical basis, methodological rigour with sufficient scope and scale to make important new contributions to the occupational therapy body of knowledge’ (Wiley & Sons, 2018). It will maintain its commitment to ‘disseminate scholarship and evidence to substantiate, influence and shape policy and occupational therapy practice locally and globally’ (Wiley & Sons). To achieve this commitment, authors of qualitative research studies must provide strong justification to support their methodological choices and clearly describe data collection, analysis and interpretation steps that will demonstrate trustworthiness of findings and design rigour.