Which qualitative research type studies the lives of individuals to provide stories about their lives?

Narrative inquiry, a relatively new qualitative methodology, is the study of experience understood narratively. It is a way of thinking about, and studying, experience. Narrative inquirers think narratively about experience throughout inquiry. Narrative inquiry follows a recursive, reflexive process of moving from field (with starting points in telling or living of stories) to field texts (data) to interim and final research texts. Commonplaces of temporality, sociality, and place create a conceptual framework within which different kinds of field texts and different analyses can be used. Narrative inquiry highlights ethical matters as well as shapes new theoretical understandings of people’s experiences.

3.06.3.3 Narrative Analysis

Narrative analysis, also referred to as narrative inquiry, is based on the premise that people experience and understand their lives in storied forms, connecting events in a manner similar to a story with a beginning, middle, and end point representing a person's past, present, and future (Josselson, 2011; Sarbin, 1986). Furthermore, individual stories are embedded in other stories including those of a society, culture, family, or any other story intersecting with a person's lived experiences. Relatedly, the stories that people tell about their lives represent their meaning-making of lived experiences, that is, how they connect and integrate experiences based on both individual factors (e.g., age, gender, culture) and impactful external factors (e.g., sociocultural contexts; Cissé et al., 2018; Josselson, 2011). Narrative analysis is particularly suitable for the study of interrelated factors and their impact on psychological phenomena (e.g., the impact of childhood adversity and chronic stress on depression).

Narrative analysis distinguishes itself from other qualitative methods by its focus on narrated experiences representing either a whole life story or aspects of it (Josselson, 2011). The analysis of how people think and talk about their experiences provides the researcher with rich and detailed information about how individuals understand their lives (i.e., meaning-making; Josselson, 2011). Noteworthy, when using this approach, the researcher distinguishes narrative truth from historical or objective truth. That is, the focus is on constructed accounts of experiences - i.e., how people subjectively experience, view, and understand life events - not factual records of what really or truly happened (Josselson, 2011).

Because narrative analysis is a mixed genre grounded in various theoretical schools - i.e., hermeneutics, phenomenology, ethnography, and literary analysis - this approach is flexible and does not require the researcher to follow a strict method of data analysis (Josselson, 2011). Rather, narrative analysis emphasizes “doing what is necessary to capture the lived experience of people in terms of their own meaning-making and to theorize about it in insightful ways” (Josselson, 2011, p. 225). Moreover, following Schleiermacher's idea of the hermeneutic circle, narrative analysis often consists in a content-focused analysis geared toward gaining an understanding of how “the whole illuminates the parts, which in turn create the whole” (Josselson, 2011, p. 226). Accordingly, sections or parts of a participant's narrative are interpreted with respect to other parts. Similar to other qualitative approaches, findings generated by a narrative analysis are typically presented in the form of a descriptive narrative of the participant(s)' lived experiences and meaning-making of these in relation to the phenomenon of interest.

Hall (2011) provides an ideal example of the flexible and multidisciplinary nature of narrative analysis. In a study of trauma recovery narratives among women who survived childhood maltreatment (n = 44), Hall (2011) used multiple sources of evidence and combined several qualitative methods to fit research aims. In collaboration with an interdisciplinary team, Hall (2011) conducted multiple-time individual interviews, case studies, and surveys. In addition, the study reflected an action-oriented approach grounded in constructivist and feminist theories, as illustrated by the following comment: “I took an advocacy stance in favor of participants' interests, as is commensurate with a critical feminist standpoint” (Hall, 2011, p. 3). Data analysis consisted in constructing a narrative of participants' trauma recovery process, using various levels of analysis that focused on key relationships, life trajectories, self-strategies, and perceptual changes. Results consisted in a comprehensive narrative of participants' life stories and meaning-making of lived experiences related to trauma and recovery.

Interpreting the Data

When data are tentatively coded, they are then sorted into themes (in grounded theory), thick descriptions (in many kinds of ethnography and case study), essences (in phenomenology), and narrative threads or plotlines (in narrative inquiry). The process is a highly interpretive one, guided by what the researcher sees as emerging from the data. As noted earlier, the subjective role of the researcher is central to the process. There are various ways that researcher subjectivity can be accounted for, including a process of bracketing, creating an audit trail that other researchers can follow to verify interpretations, and having other researchers code and interpret some of the data to create interrater reliability. Other ways to verify the coding and interpretive processes include member checking, whereby codes and interpretations are checked with the involved participants for accuracy. Still other processes involve triangulation, whereby multiple kinds of data or data from multiple sources are cross-verified for adequacy of coding and interpretation. However, in narrative inquiry, which is a relational form of qualitative analysis, interim interpretations are also negotiated with participants in order to ensure that an interpretation resonant with participants is being created. Interpretation of data is frequently a messy process. Sometimes as data are interpreted, researchers realize that more data are needed before an adequate interpretation can be made. In these cases, researchers need to return to the field to gather more data from participants. The process is rarely linear; researchers move from living in the field and collecting field texts to coding and interpreting field texts and writing research texts. Issues of participant voice are central to data interpretation and to all attempts to compose an understanding of human experience.

Relationships with Other Qualitative Approaches

Life-history research is one of several qualitative research approaches that fit under the larger category of narrative research. Along with life history, narrative research includes such approaches as life-story research, oral history, biography, personal experience methods, and narrative inquiry. As a narrative approach, life history shares the following characteristics that distinguish narrative from other forms of qualitative inquiry:

Focus on individual stories – understanding individual lives through individual stories is central to the processes and products of life history and narrative research.

Personal nature of research processes – researchers and participants must work closely together to come to a shared understanding of the participants’ stories.

Practical orientation – because of their goal of capturing real lives as lived, research outcomes make it possible to connect understandings to the everyday world.

Emphasis on subjectivity – more than other qualitative methodologies, life history and narrative go beyond scientific and empiricist standards, relying on the authentic voices of participants to generate confidence in research findings (Hatch and Wisniewski, 1995).

These characteristics mean that life history and narrative approaches fit within some qualitative research paradigms and not others. Because of their emphasis on subjectivity and co-constructed understandings, life history and narrative do not align with characteristics of the postpositivist research paradigm, which assumes that approximations of reality can be discovered through rigorous data collection and analysis procedures. There is a better fit for life history and narrative within constructivist, critical/feminist, or post-structuralist paradigms, which assume different relationships between researchers and participants, different connections between sociopolitical positionings and research, and different possibilities for representing the complexities of postmodern life. Excellent life-history and narrative research has been done within the assumptions of each of the constructivist, critical/feminist, and post-structuralist paradigms (Hatch, 2002).

Life history is a kind of narrative research, but it is distinct from other narrative approaches. All life histories are narratives; but not all narratives are life histories. All narrative research is focused on collecting individual stories, but what distinguishes life-history work is its broad purpose. Life-history research goes beyond personal accounts and individual interpretations and examines those accounts and interpretations within an array of social, historical, and cultural contexts. While other narrative approaches seek to make meaning of individual experiences, life-history work draws on individual experiences to make sense of broader social phenomena (Cole and Knowles, 2001).

3 The researcher–participant relationship

Narrative inquiry is a complex and dynamic methodology. The researcher and the participant constantly negotiate the meaning of the stories by providing validation checks throughout the collection and analysis [18]. The researcher develops a deep understanding of the diverse contexts that are embedded within the participant's life as the researcher collects stories, negotiates relationships and transactions, and explores new ways of collaborating with the participant to actively involve him/her in the research process [2]. Active collaboration with the participant is necessary throughout the narrative inquiry process. Researchers need to continually discuss the participant's stories with the participant, and reflect on his/her personal, social, and political background. This process shapes how the researcher re-stories the account within the framework.

Nurse researchers engaged in narrative inquiry research need to recognize and embrace the subjective reality inherent in the process. Researchers are bound by this method to acknowledge their subjectivity and permit a full examination of the effect of their subjectivity on the research project and its report.

Understanding how individuals acquire knowledge and use their experiences to develop approaches of inquiry assists the reader in evaluating differing research paradigms. It is important to realize that no single research paradigm will answer all of the questions that are important to nursing. Nursing and health care delivery are complex occupations and hence one must recognize that multiple methodologies can be useful in answering the myriad of questions that are pertinent to nurse researchers. However, by focusing attention on the participants' and the researchers' inner voices, narrative inquiry provides an opportunity to come to a better understanding of what it means to be human and what health means to people. Narrative inquiry does not rest with the researchers' preconceived ideas of what constitutes health or wellness, but explores these concepts within the researcher–participant relationship.

7.2 Qualitative research

The sixteen qualitative studies were diverse in the settings and methodological approaches. In Australia, Reed and Rowe23 used narrative inquiry to explore midwifery practice during physiological birth by interviewing 10 midwives. Davis and Homer24 conducted descriptive research wherein 12 midwives working concurrently in primary and secondary birth models were interviewed. Research conducted by Davis and Walker25 explored how midwifery practice is constructed by case-loading midwives in New Zealand through interviews with 48 midwives and examining reference documents. Studies conducted in the United States (US) all used a phenomenological approach. Kennedy26 explored the essence of nurse-midwifery care by interviewing 6 women about their experience of the same.

In the US, doctoral research by Hunter4 is the only study to date, that has specifically sought to explore the phenomenon of midwives being ‘with woman’. Hunter used a hermeneutic approach to analyse poetry written by 18 midwives who had referred to providing labour and birth care. Still in the US, Doherty27 interviewed 10 nurse-midwives to explore their professional experiences and factors influencing the decision to enter the profession. In the United Kingdom (UK), McCourt28 used an observational approach to study how 40 women in either conventional or case-loading models of care were supported to make decisions in their antenatal booking visits. Doctoral research conducted by Barker29 used a phenomenological approach to describe the experiences of 7 midwives providing emotional support to new mothers. Lawton and Robinson30 also used descriptive phenomenology to explore the experiences of five midwives who were helping women struggling to breastfeed.

The remaining research was conducted in Scandinavian countries. Thorstensson, et al.31 adopted a descriptive approach and used a combination of observation and interview with 7 ‘triads’ (a Swedish midwife, woman and partner) to explore how professional support was offered by midwives during labour. A phenomenological approach was used by Berg et al.32 to describe the labour and birth encounters with midwives of 18 Norwegian women. Aune and Amundsen33 interviewed 10 Norwegian midwives to explore factors influencing their decision to provide continuous presence in childbirth. A ‘phenomenology of practice’ approach was the basis for research conducted by Jepsen et al.34 which used observation and interviews with Danish couples in a case load model after birthing. Finally, Lundgren and Berg35 undertook secondary data analysis of 8 Swedish qualitative studies to explore the central concepts in the midwife/woman relationship.

2.3 Eligibility criteria

Studies were included if they met the following criteria: 1) used a qualitative research design (e.g., phenomenology, grounded theory, ethnography, narrative inquiry, interviews, observations); 2) focused on the experiences of unpaid caregivers (i.e., family members or friends) providing the majority of care within a home setting to a community dwelling adult age 60 years and over with urinary and/or fecal incontinence; 3) provided synthesized themes or statements with exemplar quotes on informal caregiver perceptions, experiences, and self-reported consequences related to the provision of incontinence care; and 4) were full-text, peer-reviewed articles or dissertations or theses published in English. Studies were excluded if they: 1) used mixed methods designs whereby qualitative data could not be extracted; 2) combined responses from both paid and unpaid caregivers, making it difficult to elucidate the experience of informal caregivers; 3) combined responses of informal caregivers and care recipients; 4) targeted care recipients with terminal illness, cancer treatment within the last six months, congenital intellectual disability, affective disorder, spinal cord injury, and seizure disorder as these conditions have different physiologic mechanisms of incontinence that require different approaches for management and pose unique challenges for caregivers; and 4) included informal caregivers of older adults living in long-term care facilities or receiving hospice care.

3.1 Description of studies

After the screening process, 25 studies met the inclusion criteria. Most studies were undertaken in India (n = 10)30–39 or the United States (n = 8).40–47 Twelve of the studies were randomized controlled trials, 32,34–39,45,48–51 one quasi-experimental, 42 nine employed single group pre-post designs (before-after), 30,31,33,43,46,47,52–54 two were qualitative (narrative inquiry41 and phenomenology44), and one employed mixed methods (a pilot RCT and reflective writing). 40 The majority of studies focused on medical (9/25) 30,32,34,35,39,43,46,53,54 and nursing (4/25) 33,36,41,49 students. One study focused on speech and language pathology students 40 and another three on dental interns. 31,38,47 The remaining studies focused on practicing HHPs (nurses = 6; 37,44,48,50–52 dental hygienists = 1; 42 mental healthcare providers = 1; 45).

There were 1778 participants across all 25 studies, with 73 % overall female; 8/25 studies 32,36,37,40,48–50,52 engaged exclusively female participants and only five studies reported an even gender distribution. 30,35,38,39,43 The attrition rates ranged from none to 26 %. Fourteen studies focused on young adults under the age of 30. 30–36,38–41,49,53,54

Analysis

The way analysis is undertaken must, like the methods used, align with the ontological and epistemological position. The continuum described in the sections dedicated to ontology and epistemology is mirrored in qualitative analysis, with critical realist research commonly utilising highly structured code based analysis, and what is termed the discursive and more subjective types of analysis undertaken in interpretivist and constructivist research. For some qualitative research methods such as narrative inquiry the terminology reflects the building of an account of the data rather than ‘analysis’ as such. Table 3 sets out some of the main ways in which qualitative data can be analysed.

Table 3. Distinguishing qualitative analyses.

Somewhat confusingly, there are methods of conducting qualitative research which contain the term ‘analysis’ in their title but which are more than analytic tools. Two examples of this are Interpretive Phenomenological Analysis (IPA) which is used in applied psychology, especially health psychology and wellbeing research. IPA focuses on the individual and their experience of a specific event or events, sometimes termed their lifeworld. In IPA, the researcher brings into mind, then sets aside, their own ideas in order to understand the essence of another person. A second example is Concept Analysis; a methodology used to understand and give meaning and clarification to concepts that are vague or ambiguous, the aim being to give theoretical and operational definitions of a concept. For a recent example in radiography see Taylor et al. (2017).32

Positivist and some critical realist analyses, then, tend to quantify and produce objective or semi-objective measures with varying degrees of confidence and certainty as to the truth or veracity of a theory or idea, whilst constructionist and interpretivist analyses create concepts and generate new ideas and theories which can either be adopted or taken further for testing and evaluation.

2 Results

After removing duplicates, four studies remained eligible for review. Methodologically the studies were dissimilar, using retrospective analysis, qualitative inquiry, a quasi-experimental design, and a randomized controlled trial, making comparisons by study design difficult. Though the studies typically included participants with a cancer diagnosis, and often involved inpatient palliative care, age varied significantly. As some studies stratified specifically by participant age, this review was structured similarly. Table 1 summarizes the findings of the studies reviewed.

Table 1. Result summary.