The Quality of Husserlian Phenomenological Research in the Health Sciences: A Methodological Systematic Review.

Abstract

Review question/objective The objective of this systematic review is to provide a narrative summary synthesis of the quality of existing Husserlian phenomenological research studies in the health sciences. As a methodological systematic review, only studies that focus on adult patients' experiences of preventive, screening, diagnosis, treatment or rehabilitation interventions/procedures will be considered to serve as a paradigm “case” of the use of the Husserlian phenomenological approach within the broad field of health. The review question is: What is the quality of existing Husserlian phenomenological research studies in the health sciences? The motivation for this systematic review is not to fault authors of existing Husserlian phenomenological research, but to explore the problems encountered in existing research literature, if any, and to provide guidance to authors for future health research guided by this specific philosophical perspective. In order to avoid repetition, the term ‘Husserlian phenomenological approach’ as used in the text refers to the approach described by Edmund Husserl in English translations of hisblished work; or as described in English language commentaries by internationally recognized scholars; or from Husserlian phenomenological scholars including the structured framework presented by Spiegelberg. Each time the ‘content of Husserlian phenomenological research studies’ is used in the text it should be understood to mean ‘content of Husserlian phenomenological research studies as reflected in the stated philosophical perspective, research methodology, data collection methods, data analysis methods, presentation and interpretation of the results, and the conclusions’. Definition of terms: Husserlian phenomenological research studies refers to primary qualitative research studies that are explicitly grounded in the work of Husserl reflected in explicit statements or descriptions by the authors. Quality refers to the extent to which there is congruence between the Husserlian phenomenological approach and the content of Husserlian phenomenological research studies. These stipulative definitions are intended to preclude the need to cite the scientific literature as there is no need to demonstrate their ‘validity’ or ‘acceptability’ by the communities of scholars. These definitions are not based on consensus across qualitative research communities; rather, they are presented as useful stipulative definitions that underpin the protocol and serve to avoid confusion regarding the use of the terms in the specific context of this systematic review. Background Phenomenology is a philosophical movement.1 A movement is characterised by the fact that there is no unified set of doctrine to which all participants agree. There is only a broad approach that tends to be shared. This systematic review focuses on Husserlian phenomenology. Given the methodological nature of the systematic review, the most important section of the systematic review report will be the thorough examination of the congruence between the Husserlian phenomenological approach and the content of Husserlian phenomenological research studies included in the review. Therefore, a comprehensive discussion of Husserlian phenomenology will be presented in the systematic review report. The objective of Husserlian phenomenology is the direct investigation of phenomena as consciously experienced from the first-person perspective.1–6 Husserlian phenomenology is a descriptive approach and the approach is directed towards discovering essences of meaning.1–6 Husserlian phenomenology represents an approach to examining what properties are essential. Husserlian phenomenology is not a factual approach. There is no interest to describe the properties of a particular example. Concrete particular examples are examined in Husserlian phenomenology only as examples in the effort to find what is essential. The approach aims to provide description of phenomena as free as possible from presuppositions.1–6 No causal explanations are considered nor are theories.1 The focus is on clarification not on causal explanation. Phenomenology is concerned with experiences. Descriptive phenomenological clarification of the essentials is based only on the examination of how things are given in our experience. The understanding of Husserlian phenomenology for the purposes of this review will draw on the direct study of English translations of Edmund Husserl's own published works and also on commentaries from internationally recognized phenomenological scholars and Husserlian phenomenological scholars.1–37 This systematic review draws from the structured framework provided in the six ‘essential uses of phenomenology’ and the seven ‘steps of the phenomenological method’ as described by Herbert Spiegelberg.1,7 This framework is especially useful for understanding Husserlian phenomenology and for providing an explicit and clear structure for the synthesis component of the review. Spiegelberg describes six ‘essential uses of phenomenology’: descriptive phenomenology, essential phenomenology, phenomenology of appearances, constitutive phenomenology, reductive phenomenology and hermeneutic phenomenology. 1(p 57-70) The seven ‘steps of the phenomenological method’ as presented by Spiegelberg are the following: investigating particular phenomena; investigating general essences; apprehending essential relationships among essences; watching modes of appearing; watching the constitution of phenomena in consciousness; suspending belief in the existence of the phenomena; interpreting the meaning of the phenomena.7(p 681-715) Given the methodological nature of the systematic review a comprehensive discussion of the Spiegelberg's structured framework will be presented in the systematic review report. Descriptive phenomenology refers to description of particular phenomena based on exploration and analysis of what is immediately given as is given as free as possible from presuppositions. As phenomenology is the attempt to find the essential structures of the phenomena and the essential relationships within and among them, specific concrete examples are used only in order to facilitate insight into essences. Each specific statement about essences and about essential relations among such essences is based on free variation in the imagination. On the basis of free variation it is determined what is essential and what is accidental. Phenomenology of appearances focuses attention on the ways in which phenomena appear. This phenomenology of appearances cultivates attention to different perspectives making it possible to explore a thing from a different perspective. Constitutive phenomenology represents the attention to the process in which the phenomena take shape in consciousness; it is the examination of the dynamic transition from first impressions to a full picture. Reductive phenomenology is implicitly present in all other steps of the phenomenological approach. It refers to the bracketing of the natural world; the suspension of beliefs in the reality of the phenomena. Hermeneutic phenomenology (which is not explicitly used nor rejected by Husserl) seeks access to meanings of the phenomena which are not directly perceived. Phenomenology is not only a philosophy but also a qualitative research methodology used around the world in very diverse fields such as nursing, medicine and health research in general.38–47 Preliminary examination of the existing phenomenological health research literature reveals that there is a significant proportion of this literature claiming to be Husserlian phenomenological research. Some of these studies explore patients' experiences. Other studies explore nurses', healthcare providers' or family members' experiences. Some studies examine the experiences of learning, or experiences of communication or interactions. As a methodological systematic review, only a small sample of existing studies will be considered to serve as a paradigm “case” of the use of the Husserlian phenomenological approach within the broad field of health. In recent years the evidence-based health care movement has increasingly recognised the importance of evidence from qualitative research and especially the evidence related to patients' lived experiences.48–51 Based on an assessment of the existing literature (specifically the trend observed in the last years) it would appear that there is no evidence that Husserlian phenomenological research will not be used in the future as a mainstream approach in health research studies. There is an impressive diversity of phenomena explored in phenomenological research in health studies: from mothers' experiences of postpartum care, to experiences of eating after esophagectomy; from experience of youth with hemoglobinopathy to lived experience of patients with rheumatoid arthritis or pregnant women's experience of the decision-making process related to completing or terminating pregnancy; and from perianesthesia experience from the patient's perspective to the experiences of older people on discharge from hospital following assessment by the public health nurse to name a few.52–70 Qualitative researchers have increasingly become concerned about the way phenomenology is conducted in health, the most articulate and the most aggressive in their critiques (specifically on nursing phenomenology) being Crotty, Yegdich and Paley.38,71–73 Given the methodological nature of the systematic review these critiques will be examined in detail in the systematic review report. These critiques refer to the meaning of fundamental concepts or approaches used in Husserlian phenomenology such as intentionality, experience, the phenomenological reduction, bracketing, natural attitude, and the essential structure of a phenomena to name but a few. Michael Crotty claims that there are two phenomenologies.38 One is the phenomenology of the phenomenological movement emerged from the works of Edmund Husserl. The other is a ‘new phenomenology’. Crotty's strong claim is that the ‘new phenomenology’ used in nursing research is a different phenomenology that uses the vocabulary of phenomenology but the meanings attached to the fundamental concepts are different.38 According to Crotty the ‘new phenomenology’ is compatible with the epistemological perspective that phenomenology explicitly refutes. John Paley claims that nursing researchers misunderstand the concepts of phenomenological reduction, phenomena and essence and therefore the version of Husserl's phenomenology as presented in these research studies is not consistent with the original Husserlian phenomenology.72 In 2000 Tania Yegdich published an article claiming inconsistencies between Husserl's phenomenology and nursing interpretation of this phenomenological approach.71 Similarly, Paley alleges in another article that there are discrepancies between the philosophical claims presented by nursing phenomenologists in what nurses call ‘phenomenology’ and ‘nurse-phenomenology’ research practice.73 A preliminary search of the Joanna Briggs Institute's Library of Systematic Reviews, the Cochrane Library of Systematic Reviews, Medline, CINAHL and Mednar did not identify any existing research synthesis on the specific topic proposed for this systematic review. A recent systematic review by Norlyk and Harder investigates only peer-reviewed empirical phenomenological nursing studies and the objectives of the review, the focus of interest, the methodological approach, the inclusion criteria, the search strategy, the critical appraisal tools and data extraction tool are different from those proposed in this review.74 In the review by Norlyk and Harder the objective was to systematically review the presentations of phenomenology as a research approach (regardless of phenomenological approach) and to discuss possible peer review scientific criteria for publication of phenomenological research studies; inclusion criteria specified published empirical studies from peer-reviewed journals (within the timeframe from January 2006 to June 2007) with nurse researchers listed as first or corresponding author. Inclusion criteria The focus of this methodological systematic review is the quality of existing Husserlian phenomenological research studies in the health sciences. As a methodological systematic review, only studies that focus on adult patients' experiences of preventive, screening, diagnosis, treatment or rehabilitation interventions/procedures will be considered to serve as a paradigm “case” of the use of the Husserlian phenomenological approach within the broad field of health. Types of participants and phenomena of interest mentioned in inclusion criteria are used not to define clinical aspects of interest but to specify the limits of the paradigm “case”. Types of participants This review will consider studies that include adults (aged 18 years old or older), regardless of gender or ethnicity, cognitive abilities or impairments/dysfunctions, principal diagnosis and co-morbidities, severity or stage of the disease or co-morbidities, who receive preventive, screening, diagnostic, treatment or rehabilitation interventions regardless of healthcare setting and type and specifics of interventions/procedures. Phenomena of interest This review will consider studies that investigate patients' experiences of any preventive, screening, diagnosis, treatment or rehabilitation interventions/procedures. Only studies with the experiences from the patient's perspective will be considered for inclusion in the review. Studies with experiences from health professionals' perspectives, or family members' perspectives, or others' perspectives (not the patients' perspective) will be excluded from the review. Types of studies All existing primary qualitative research studies that are explicitly grounded in the work of Husserl according to the explicit statement or description by their authors will be considered for inclusion in the review. Studies that utilise the Giorgi or Collaizi approach (or any similar phenomenological descriptive approach) and that are explicitly grounded in the work of Edmund Husserl according to the explicit statement or description by their authors will be considered for inclusion in the review.39, 75–79 All studies using (according to the explicit statement or description by their authors) an existential phenomenological approach or a hermeneutical phenomenological approach (for example, such as the Van Manen approach) will be excluded from the review.39 Search strategy The search strategy aims to find both published and unpublished studies. The search will be limited to English language publications from 1960 to current date (year 2012). The most recent critique of phenomenological health research emerged in the period 1996-2005 and the search timeframe for the systematic review will be from 1960 to 2012 to explore the literature published before, during and after the 1996-2005 debate. A three-step search strategy will be utilised in this review. An initial limited search of MEDLINE and CINAHL will be undertaken followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe article. A second search using all identified keywords and index terms will then be undertaken across all included databases. Thirdly, the reference list of all identified reports and articles will be searched for additional studies. The databases to be searched include: Medline, CINAHL, Scopus, PsychInfo, British Nursing Index, Academic Search Premier, and Health Source Nursing/Academic Edition. The search for unpublished studies will include: Mednar and organisations involved in phenomenological research. A specific search for phenomenological theses and dissertations will be performed through ProQuest Dissertations & Theses Database and Dissertations Abstracts Online. Journal-specific searches will be performed on some journals including (but not limited to): Social Science in Medicine,Qualitative Health Research; Journal of Phenomenological Psychology; The Indo-Pacific Journal of Phenomenology; Phenomenology & Practice; Phenomenology and the Cognitive Sciences; Research in Phenomenology. Initial keywords to be used will be: phenomenology; phenomenological; Husserlian phenomenology; Husserl; Giorgi; Collaizi; descriptive phenomenology; phenomenological description; experience; patients' experiences; clients' experiences; lived experiences; adults. Assessment of methodological quality Papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardised critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) (Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer. For this systematic review the secondary reviewer will be involved only in this stage of the review process, specifically the critical appraisal of retrieved papers using the generic critical appraisal tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). Given that the objective of the systematic review is to synthesize the evidence on the quality of the existing studies no studies will be excluded after critical appraisal. This critical appraisal performed during the stage of assessment of methodological quality should not be confused with the methodological critique of the included studies that will be performed during the data synthesis stage of the review. Methodological critique is not the same as critical appraisal. Critical appraisal performed during the stage of assessment of methodological quality is a first order assessment. Critical appraisal is based on the 10 standardised critical appraisal questions from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. The goal is to assess the methodological validity as considered in the qualitative research. Data collection Data will be extracted from papers included in the review using the standardised data extraction tool from Joanna Briggs Institute Qualitative Assessment and Review Instrument JBI-QARI (Appendix II). Only data as reported in studies will be used, there will be no attempt to contact the authors for missing or unclear data. The data extracted will include specific details about philosophical perspective, the objectives of the research, the research questions, the phenomena of interest, the methodology, the sampling procedures, the data collection methods, the data analysis methods, and the reporting of results and conclusions and implications or recommendations for practice or research. All these details are necessary for the methodological critique of the included studies that will be performed during the data synthesis stage of the review. Data synthesis Because of the review focus on quality, it is anticipated that the synthesis of the results will be presented in narrative form. The narrative summary of the results of the methodological critique of the included studies will be presented in the results section of the systematic review report. Methodological critique will be guided by the Husserlian phenomenological approach.1–37 The narrative synthesis of the results of the methodological critique will be specifically guided by the Spiegelberg' structured framework provided in the six ‘essential uses of phenomenology’ and the seven ‘steps of the phenomenological method’.1,7 Methodological critique of the included studies will be performed during the data synthesis stage of the review. The purpose of the methodological critique of included studies is the examination of their congruence with the central tenets of Husserlian phenomenological approach (unlike the process of critical appraisal, where the focus is on the generic aspects of validity as considered in the qualitative research). The assessment of the congruence will be performed by carefully reading and re-reading the full text of all included articles and examining compatibility between the Husserlian phenomenological approach and the content of Husserlian phenomenological research studies, for example: consistency between the Husserlian phenomenological approach and the stated phenomenological philosophical perspective as stated, reported or described by the authors; consistency between the Husserlian phenomenological approach and the research objectives/questions as stated by the authors; and consistency between the Husserlian phenomenological approach and the data collection methods as stated, reported or described by the authors. Figure 1 is an attempt to graphically represent the relationship between a Husserlian phenomenological approach ‘plane’ and a Husserlian phenomenological research studies ‘plane’. Methodological critique is about the correspondence, accord or harmony between the elements of one ‘plane’ and a different ‘plane’. In their critiques on nursing phenomenology Crotty, Yegdich and Paley make the claim that there is no consistency between the two ‘planes’. This review will focus on the assessment of compatibility or agreement between concepts and approaches from the Husserlian phenomenological approach ‘plane’ and the elements included in the Husserlian phenomenological research studies ‘plane’. The graphical representation is used to make it visually clear that critical appraisal is located in one ‘plane’ of enquiry and the methodological critique is located in the ‘space’ between two different ‘planes’.Figure 1: . Graphical representation of the relationship between a Husserlian phenomenological approach ‘plane’ and Husserlian phenomenological research studies ‘plane’ (original graphical representation by primary reviewer)Conflicts of interest No conflict of interest. Acknowledgements This systematic review will be performed as part of the requirements of the High Degree by Research (HDR) program, Master of Clinical Science (MClinSc) in Evidence-Based Health Care (EBHC), Joanna Briggs Institute, Faculty of Health Sciences, University of Adelaide, Australia. Principal supervisor: Professor Alan Pearson AM Co-supervisor: Dr Suzie Robertson-Malt RN, BHSc (Hons) PhD The secondary reviewer, Dr Melanie Attard, will be involved only in the critical appraisal of retrieved papers using the generic critical appraisal tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). I would like to express my appreciation for her involvement in this systematic review.