Qualitative Research in Communication Disorders: An introduction for students and clinicians [1 ed.]

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Qualitative research in communication disorders

© 2019 J&R Press Ltd All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning or otherwise, except under the terms of the Copyright Designs and Patents Act 1988 or under the terms of a licence issued by the Copyright Licensing Agency Ltd, without the permission in writing of the Publisher. Requests to the Publisher should be addressed to J&R Press Ltd, Farley Heath Cottage, Albury, Guildford GU5 9EW, or emailed to [email protected] The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Cover design: Jim Wilkie Cover image by ‘clivewa’ (used under license from Shutterstock.com) Project management, typesetting and design: J&R Publishing Services Ltd, Guildford, Surrey, UK; www.jr-publishingservices.co.uk Indexed by Terry Halliday ([email protected])

Qualitative research in communication disorders An introduction for students and clinicians Rena Lyons and Lindy McAllister (Eds)

J&R Press Ltd

Contents Foreword by Professor James Law vii Prefacexi About the authors xv Section I Introduction 1 Introduction and overview of qualitative research1 Lindy McAllister and Rena Lyons Section II Qualitative research methodologies 2 Conversation Analysis and its use in communication disorders research35 Sarah Griffiths, Hilary Gardner and Rachel Bear 3 Critical discourse analysis and its use in communication disorders research59 Mary Pat O’Malley-Keighran 4 Discourse analysis and its use in communication disorders research75 Elizabeth Spencer and Lucy Bryant 5 Ethnography and its use in communication disorders research91 Tami Howe, Sarah Verdon, Catherine Easton and Martha Geiger 6 Grounded theory and its use in communication disorders research119 Clare Carroll and Deborah Harding 7 Narrative inquiry and its use in communication disorders research141 Rena Lyons, Chalotte Glintborg and Lindy McAllister 8 Participatory approaches in communication disorders research167 Ruth McMenamin and Carole Pound 9 Phenomenology and its use in communication disorders research193 Sophie MacKenzie, Lindy McAllister, Kyla Hudson, Linda Worrall, Bronwyn Davidson and Tami Howe 10 Q ualitative case study and it use in communication disorders research213 Samantha Siyambalapitiya, Tami Howe and Helen Hambly Section III Methods in qualitative research in communication disorders 11 Methods in qualitative research in communication disorders239 Rena Lyons and Lindy McAllister

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Section IV Ensuring rigour in qualitative research 12 Ensuring rigour in qualitative research267 Lindy McAllister and Rena Lyons Section V Illustrating methods in qualitative research 13 Using in-depth, semi-structured interviewing285 Lucette Lanyon, Deborah Hersh, Jane Bickford, Janet Baker, Charn Nang, Miranda Rose and Linda Worrall 14 Observational techniques313 Robyn o’Halloran, Abby Foster, Linda Worrall and Miranda Rose 15 Ethnographic techniques335 Carol Westby 16 The Voice Centred Relational Approach in communication disorders research351 Felicity Bright and Maxine Bevin Section VI Particular considerations 17 Ethics in qualitative research with people with communication disorders369 Nicole Müller, Rena Lyons and Julie Marshall 18 Innovative methods387 Rosalind Merrick, Sharynne McLeod and Clare Carroll 19 M  aintaining cultural integrity in Australian Aboriginal and Māori qualitative research in communication disorders407 Karen Brewer, Tara Lewis, Chelsea Bond, Elizabeth Armstrong, Anne Hill, Alison Nelson and Juli Coffin 20 Using qualitative research to explore professional practice435 Sue Roulstone, Marie Atherton, Bronwyn Davidson, Deborah Harding, Maja Kelić and Lindy McAllister 21 Qualitative evidence synthesis461 Robyn O’Halloran and Catherine Houghton Section VII Conclusions 22 Conclusions and future directions485 Rena Lyons and Lindy McAllister

Index493

Foreword Historically quantitative, positivistic approaches to research have predominated in the speech and language sciences. There are a variety of reasons for this, such as the way that research training is constructed in preliminary courses training people to become speech and language therapists, the editorial position of journals which have supported the academic development of the profession, and the historical proximity to medicine and, latterly, psychology. This is rather different from the research of other professional groups such as nurses, occupational therapists and teachers. These groups have often prioritized the experience of the individual, something which has become especially important in a world where patient satisfaction is at a premium and personalized care a priority. Quantitative methods are exceptionally good for asking certain sorts of questions about whether an intervention works, whether a diagnosis is accurate. But it has become increasingly clear that, while it can be seen as a necessary condition for testing the outcomes of an intervention, it is not a sufficient condition when it comes to evaluating the feasibility, acceptability or transferability of an intervention. It is not just about whether an intervention works but about how it works and for whom does it work and why, a fact captured in the UK Medical Research Council’s Guidance on complex interventions which underpins the development of most interventions1. We need properly conducted and well-structured interviews but also respondents who are well able to understand what they being asked and who can respond in a manner that is readily recognized by the reader. Inevitably, people with communication disabilities become a test both for how a consumer model of health and social care can work and for how best to get people to reflect on their needs. How do you gain the views of people who do not speak? In work we carried out in Primary Care in London, we asked people with a range of different disabilities about their experience of the transition from secondary to primary care (a key economic issue for any healthcare provider with a concern for the costs of a poorly-managed primary/ secondary interface). We heard, often shocking, stories about the way that

1 Craig, P.,  Dieppe, P.,  Macintyre, S.,  Michie, S.,  Nazareth, I.,  & Petticrew, M. (2013) Developing and evaluating complex interventions: The new Medical Research Council guidance. International Journal of Nursing Studies, 50(5), 587‒592. doi: 10.1016/j.ijnurstu.2012.09.010.

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many practitioners engaged with those with communication disabilities2. We heard stories of misdiagnosis and misunderstanding of needs, about practitioners too busy to listen carefully. In another study in Scotland, two general practitioners said that working with people with communication disabilities was like practising “vet medicine” because they could not tell you what was being said and had to rely exclusively on physical examination3. This type of information, so critical to informing service provision, is only really available from qualitative research. Historically speech and language therapists have often delivered services from their clinics separate from other services, but now it is much more common for them to be part of teams whether that be in hospices, hospitals, day care, or schools. The members of these teams have very different roles but all need to understand the individual and their communicative capacity. It is very difficult to ask of this sort of provision “does it work?” because it is, by its nature, so inherently complex. A more appropriate question is, what makes a team work effectively? And this leads us to notoriously slippery concepts such as collaboration and trust. At its root is the concept of social capital – the relationships between the different individuals and the only way to get at social capital is to adopt qualitative methods4. This type of research puts members of the team on the same page and makes them feel that it is something that they are collaborating in, or in modern parlance, ‘co-constructing’, rather than having it done to them. Of course, this interest in the qualitative paradigm is not new in communication disabilities research as witnessed by early papers in the UK5 and 2 Law, J., Bunning, K., Byng, S., Farrelly, S., & Heyman, B. (2005). Making sense in primary care: levelling the playing field for people with communication disabilities. Disability and Society, 20, 169‒185. 3 Law, J., Van der Gaag, A., & Symon, S. (2005). Improving communication in primary care: An examination of the feasibility of introducing Health Talk: Count me in in two primary care practices. Report to Forth Valley and Ayrshire and Arran Primary Care Trusts. Available from the first author c/o School of Education, Communication and Language Sciences, University of Newcastle, Newcastle-uponTyne NE1 7RU, e: [email protected] 4 McKean, C., Law, J., Laing, K., McCartney, E., Cockerill, M., Allon Smith, J., & Forbes, J.C. (2017). A qualitative case study in the social capital of co-professional collaborative co-practice for children with speech language and communication needs. International Journal of Language and Communication Disorders. DOI: 10.1111/1460-6984.12296 5 Eastwood, J. (1988). Qualitative research: An additional research methodology for speech pathology? International Journal of Language & Communication Disorders, 23, 171‒184. DOI:10.3109/13682828809019885

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the US6,7 but, despite its obvious value, it remains relatively underdeveloped. It needs advocates, and advocates who are at the top of their game. So I am delighted to be able to introduce Lyons and McAllister’s new book Qualitative Research in Communication Disorders: An Introductory Guide for Students and Clinicians. In the end, as the authors indicate, the distinction between qualitative and quantitative research is invidious because there is really just good quality and less good quality research, irrespective of the paradigm. In the end, it always boils down to how well theories are constructed, methods outlined, results reported, and conclusions drawn. There have been a panoply of texts outlining qualitative methods going back thirty or more years, but while they have reported on the methods they rarely engage with the complexity of eliciting the views of people whose primary difficulty is communication itself. This book addresses this issue directly, providing detail on how different qualitative approaches have been applied in the field of communication disorders. It will be an invaluable resource for students, practitioners, and researchers within the communication sciences but also for social and health scientists who have an interest in accessing the views of those who, by definition, find communication a challenge. James Law PhD Professor of Speech and Language Sciences Newcastle University, UK October 2018

6 Simmons-Mackie, N., Damico, J.S., & Damico, H.L. (1999) A qualitative study of feedback in aphasia treatment tags:  Aphasia,  feedback,  therapeutics,  qualitative research,  clinicians. American Journal of Speech-Language Pathology, 8, 218‒230. DOI:10.1044/1058-0360.0803.218 7 Damico, J.S. & Simmons-Mackie, N. (2003). Qualitative research and speech-language pathology: A tutorial for the clinical realm. American Journal of Speech-Language Pathology, 12, 131‒143. DOI:10.1044/1058-0360(2003/060)

Preface Rena The original idea for this book came about from conversations between Rena Lyons and Sharynne McLeod in August 2016. The Discipline of Speech and Language Therapy, NUI Galway, Ireland, was honoured to host Sharynne on a visit before the 30th IALP World Congress, which was held in Dublin for the first time that year. While Sharynne was in Galway, I took her on a sight-seeing tour of beautiful Connemara and we stopped for a coffee in Ballynahinch Castle. Over our drinks, we discussed qualitative research and the somewhat unique situation in our Discipline where almost everyone was a qualitative researcher, with experience in a range of approaches. We wanted to build on this experience and Sharynne suggested the possibility of an edited book on qualitative research in communication disorders. I was both excited and daunted by the idea but did not know where to start. I didn’t have a notebook so we improvised and jotted down ideas and possible chapter titles on a paper napkin! Sharynne suggested that Lindy McAllister would be the perfect match as a co-editor because of both her experience in editing books and as a qualitative researcher. I was aware of Lindy’s work but had never met her. Of course, Sharynne knew that Lindy would be attending the IALP Congress and she introduced us a few days later and the rest is history! Sharynne also introduced me to Rachael Wilkie at J&R Press. I am indebted to Sharynne for her encouragement, generosity, and support.

Lindy I was delighted when Sharynne introduced me to Rena with the suggestion we could write together. It’s not the first time I’ve co-authored a book with someone I had not previously worked with and knew that, with good planning, regular communication and a commitment to meeting deadlines, such an international collaboration could work well. As a late-stage career academic I was keen to foster the career development of those who would come after me, so supporting early career researchers and students to understand and use qualitative research was appealing. With two face-to-face sessions working

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together in Galway (one to plan, one to ‘wrap up’), hundreds of emails, and numerous skypes (where Rena would sometimes ask me to stop talking so she could hear the Australian birds in their early morning chorus outside my window!) we completed this book ahead of schedule. As co-editors, we are both passionate about qualitative research and its use in research of practice and communication disorders and have thoroughly enjoyed working together on this book. The field of communication disorders has its origins in the disciplines of medicine, linguistics, education, and psychology where the predominant research paradigm has been quantitative. Qualitative research has not traditionally been included in curricula educating speech and language therapists, so they may not feel that they have the knowledge or skills to use this methodology. In recent years there has been an increase in the number of qualitative studies published in communication disorders research. We know that many phenomena in the field of speech and language therapy practice and communication disorders are complex and that qualitative research provides an excellent paradigm for exploring these phenomena. There is increasing recognition that knowledge generated using qualitative research can complement that generated using quantitative methods. As qualitative researchers, we know that embarking on the use of this methodology can be daunting. As in many fields, people beginning to use qualitative research methods may be confused about the different approaches, different terms for what seem like similar concepts, and are often unclear in relation to how to actually ‘do’ the methods. What they read in published journal papers by necessity of word length glosses over the fine-grained detail of what was done, and why, in planning, data collection and data analysis. Our vision was that this book would be an introductory guide, which would be read in conjunction with other generic qualitative research textbooks, to support those beginning to use qualitative research specifically in the field of communication disorders. When we started planning the book, we brainstormed ideas and sent out ‘expression of interest’ emails to researchers who had published qualitative research in the field of speech and language therapy practice and/or communication disorders, inviting them to contribute and to suggest topics in qualitative research that they could write about. We were overwhelmed by the positive response from researchers in Ireland, the UK, Australia, New Zealand, Denmark, Croatia, South Africa, US and Canada! We used the data from the

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expressions of interest to develop a book proposal which we submitted to J&R Press. To our delight the book proposal was accepted. Given that this book is an introductory text, our goal was that it would be written in an accessible style with a practical focus. To achieve this accessible style and coherence, we provided chapter templates and chapter samples to authors. We invited authors who had experience using specific qualitative approaches to write chapters collaboratively. In this way, researchers from different parts of the world, who may not have already known each other, worked together on chapter drafts. We believe that this collaborative writing approach has enhanced the richness of the content and hopefully has fostered some new collaborations! One of the decisions we had to make as co-editors was in relation to terminology. For example, the term ‘speech and language therapist’ is used in Ireland and the UK, ‘speech-language therapist’ is used in New Zealand, ‘speech pathologist’ is used in Australia, and ‘speech-language pathologist’ is used in the US and Canada. Given that the book is published by J&R Press, a UK-based publisher, we made the decision to use the term speech and language therapist throughout the book to ensure consistency. We have structured this book into seven sections. The first section, entitled ‘Introduction’, as the name suggests provides an introduction to qualitative research and its use in the fields of speech and language therapy practice and communication disorders. The second section, entitled ‘Qualitative Research Methodologies’, has nine chapters, each of which covers one of the major qualitative research methodologies and which are presented alphabetically. Authors provide an overview of each qualitative approach, its use and application in both research in practice and communication disorders research, as well as top tips. Each chapter has case studies which clearly illustrate ways in which the authors applied and used the particular qualitative methodology. The third section, entitled ‘Methods in Qualitative Research in Communication Disorders’, provides an overview of aspects of the methods that are common across all of the qualitative methodologies. Section IV, entitled ‘Ensuring Rigour in Qualitative Research’, addresses ways in which researchers can apply strategies to strengthen rigour in qualitative studies. Section V, entitled ‘Illustrating Methods in Qualitative Research’, contains four chapters, each of which focuses on ways in which researchers have used specific methods in communication disorders research. Section VI is made up of five chapters which address ‘Particular Considerations’ when using qualitative research, such as dealing with ethical issues, innovative approaches, maintaining

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cultural integrity in Australian Aboriginal and Māori qualitative research in communication disorders, using qualitative research to explore practice, and qualitative synthesis. The final section focuses on a review of the content and reflection on future directions for qualitative research in communication disorders research. We have come a long way since that chat over coffee in Ballynahinch Castle! We have really enjoyed working on this book and we have learned so much along the journey. We have been humbled and inspired by the diversity and excellent quality of the chapter contributions. As co-editors, we are also very grateful to the chapter authors for writing so well collaboratively, sometimes with co-authors that they did not know, and for meeting our deadlines. This ensured that the process ran smoothly. It has also been a pleasure to work with Rachael and Jim at J&R Press. They have been so helpful and supportive along the way. We’d also like to acknowledge NUI Galway who awarded Rena a grant in aid of publication to support the detailed work of creating an index for the book. We are very impressed of the way in which speech and language therapy researchers are using qualitative methodologies in communication disorders research. We hope that this book will inspire speech and language therapy students and clinicians to engage in qualitative research.

About the authors Professor Elizabeth Armstrong, PhD, is Foundation Chair in Speech Pathology at Edith Cowan University in Perth. She has published widely in the area of aphasia and presents regularly at national and international speech pathology, linguistics, allied health and medical conferences. Aphasic discourse analysis, aphasia treatment studies, and cross-cultural practice constitute her areas of focus. Since 2010, Professor Armstrong has led a strong multidisciplinary team of Aboriginal and non-Aboriginal researchers exploring the experiences of Aboriginal brain injury survivors and their families using both qualitative and quantitative methodologies. This research aims to promote culturally secure rehabilitation services for Aboriginal people post brain injury, and to improve health outcomes of Aboriginal brain injury survivors. Marie Atherton, PhD candidate, is a lecturer in Speech Pathology at the Australian Catholic University, Melbourne Australia. She has had a diverse career path, practising as a clinical speech and language therapist for many years before working as an advisor to Speech Pathology Australia, the professional body representing speech pathologists in Australia, and then moving into academia. In 2010, Marie accepted a position in Vietnam to coordinate a 2-year speech and language therapy training programme for Vietnamese health professionals. Marie’s PhD was a longitudinal study employing qualitative and participatory research methods to explore the experiences of a group of these Vietnam graduates. She is due to complete her PhD in 2019. She continues to actively support the development of the speech and language therapy profession in Vietnam. Janet Baker, PhD, is Adjunct Associate Professor in Speech Pathology and Audiology, College of Nursing and  Health Sciences, Flinders University, Australia. She is a speech pathologist and family therapist with post-graduate qualifications in psychotherapy. Jan’s teaching, clinical work and research interests have been focused upon the aetiology and management of functional and psychogenic disorders, the professional voice, counselling for speech pathologists, and the processes involved in the therapeutic relationship. In her private practice, now newly based in Sydney, Jan offers services as Consultant in Voice and Supervision of Professional Practice for Speech Pathologists.

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Rachel Bear is a speech and language therapist who has worked for over 30 years in paediatrics in a primary care centre and mainstream school settings. Rachel works with children with a range of speech, language and communication needs, but her primary interest is in working with children with speech difficulties. Rachel is currently studying for a PhD at the University of Sheffield. Her research uses thematic analysis and conversation analysis to look at the ways we support parents of children with speech difficulties to carry out their homework tasks. Maxine Bevin, PhD, is a speech-language therapist working in private practice with adults with communication disability in New Zealand. Her interest is in qualitative research methodologies. Her doctoral research was in self and identity in people living with aphasia. She has also completed research exploring self and identity in community-based rehabilitation services for people with acquired brain injury. She is currently part of an evaluation team researching the outcomes of training programmes for the workforce working with vulnerable children. Jane Bickford, PhD, is a lecturer in the College of Nursing and Health Sciences at Flinders University, Adelaide, Australia. She has worked extensively as a speech pathologist in a range of clinical and community settings, with diverse populations in both Australia and the United Kingdom.  Inspired by her previous work in the area of head and neck cancer, Jane recently completed her PhD examining the psychosocial experiences of people who have a total laryngectomy. Through this research she developed expertise using grounded theory methodology. In 2017, she was awarded the Vice Chancellor’s Prize for Doctoral Thesis Excellence. She is currently using qualitative methods to research patient experiences of head and neck lymphoedema treatments, communicative participation outcomes after laryngectomy and user experiences of a co-designed programme to prevent occupational voice problems. Chelsea Bond, PhD, is a Munanjahli and South Sea Islander Australian and a Senior Research Fellow with the Poche Centre for Indigenous Health at The University of Queensland. Dr Bond has worked as an Aboriginal Health Worker and researcher in communities across south-east Queensland for the past 20 years and has a strong interest in urban Indigenous health promotion, culture, identity, and community development. Dr Bond’s career has focused on interpreting and privileging Indigenous experiences of the health system including critically examining the role of Aboriginal health workers, the

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narratives of Indigeneity produced within public health, and advocating for strength-based community development approaches to Indigenous health promotion practice. Dr Bond has a number of publications related to strength-based health promotion practice, Indigenous social capital, and the conceptualization of Aboriginality within public health. Dr Bond is a board member of Inala Wangarra and Screen Queensland, and a regular guest host of 98.9FM’s ‘Let’s Talk’ programme and co-host of popular weekly radio show and podcast ‘Wild Black Women’. Karen Brewer (Whakatōhea, Ngaiterangi), PhD, is a postdoctoral research fellow in Te Kupenga Hauora Māori (Department of Māori Health) at The University of Auckland. She completed a PhD in Speech Science in 2014, with a thesis titled ‘The experiences of Māori with aphasia, their whānau (family) members and speech-language therapists’. As a kaupapa Māori researcher Karen explores ways to improve cultural safety in the speech and language therapy profession and ensure equity of service delivery and outcomes for Māori. Felicity Bright, PhD, is a Senior Lecturer in Rehabilitation in the School of Clinical Sciences at Auckland University of Technology. She is a speech and language therapist with a particular interest in how clinicians work to enhance the patient’s experience in rehabilitation. She uses qualitative research methodologies to explore areas related to patient experience including patientprovider communication, hope, engagement, and therapeutic relationships. She teaches in the physiotherapy and postgraduate rehabilitation programmes, and supervises postgraduate students from a range of disciplines. Lucy Bryant, PhD, is a postdoctoral research associate at the Graduate School of Health, University of Technology Sydney, Australia and a Certified Practicing Speech Pathologist. She completed her PhD in Speech Pathology at the University of Newcastle Australia, investigating the implementation of discourse analysis in the clinical assessment of adults with aphasia. Lucy’s research focus on discourse analysis stems from an interest in assessment and intervention for people with aphasia, and in particular how people use language for functional communication. She also has an interest in how technology may be used to assist clinicians to perform analysis. Clare Carroll, PhD, is a registered speech and language therapist and a lecturer at National University of Ireland, Galway, Ireland. Clare has a wealth of clinical experience from working in the Irish Health Service and in private practice.

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She uses a range of qualitative methodologies to study interdisciplinary team working practices and to support the participation of children, young people with disabilities and their families in research and practice. Clare is passionate about services being informed by the people who use them, in particular understanding what is important to people with communication disabilities. Professor Julianne (Juli) Coffin, PhD, is an Aboriginal Western Australian who has traditional ties to her grandparent’s country in the Pilbara region (Nyangumarta). Juli was born in Ngala, Western Australia and has lived the majority of her life in the Pilbara. She is the proud mother of three children. Juli was educated in Australia through Edith Cowan University (Western Australia) and James Cook University (Queensland). Professor Coffin is a prominent Aboriginal researcher with research expertise in cultural security, education and research across diverse range chronic diseases, nutrition, contextualizing bullying, and health promotion. Professor Coffin has completed a degree in education, Masters in Public Health and Tropical Medicine (with distinction) and a PhD with an award in excellence. With a keen interest in Aboriginal languages and ways of learning Dr Coffin combines her education and cultural learnings to deliver the outstanding translation of research into practice that is always of an impeccable standard. She is highly regarded by her peers as being creative and innovative around some of the particularly controversial and complex areas in Aboriginal health and education. Bronwyn Davidson, PhD, is an Associate Professor at the University of Melbourne, Australia and a Fellow of Speech Pathology Australia. She completed her Bachelors Degree in Speech Pathology and her PhD at the University of Queensland. Bronwyn has extensive experience as a clinician, academic and researcher, especially in the fields of aphasiology and practice education. She holds a keen interest in participatory research and education that address services for people with communication disability in majority world countries. Catherine Easton, PhD, is a Senior Lecturer at Charles Sturt University, Australia and Certified Practicing Speech Pathology. She completed her Master of Speech Pathology at LaTrobe University after completing a PhD in linguistics, also at LaTrobe University. Catherine has an interest in research focusing on social justice in speech pathology, including regional, rural and remote practice, Australian Indigenous cultural competence development in higher education, and linguistic prejudice towards non-standard dialects. Catherine’s interest in ethnography has grown from exploring methodologies that facilitate multiple perspectives to be heard.

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Abby Foster, PhD, is a speech pathologist who has spent her career working with stroke survivors. She completed her doctoral studies in 2016 through The University of Queensland. After initially needing convincing to use qualitative research methods, she is now a self-proclaimed qualitative methods nerd. Her research and clinical interests lie in the acute management of post-stroke aphasia, the lived experience of acquired communication disability, and the intersection between speech pathology and social justice. Abby currently works as the manager and research/clinical lead for speech pathology at Victoria’s largest health network, Monash Health. She is also an adjunct lecturer in the School of Allied Health at La Trobe University. Hilary Gardner, DPhil, is a speech and language therapist with over 35 years in practice. She has combined a clinical career with research and lecturing posts at UK universities, most recently the University of Sheffield. Her own research utilizes predominantly qualitative methodology such as Conversation Analysis to consider adult‒child interactions, especially those involving speech and language therapy tasks. Hilary continues to support the development of collaborative approaches for those working with communication difficulties, especially within educational settings, through workshops and lectures at home and abroad.  Martha Geiger, PhD, is a senior lecturer at the Centre for Rehabilitation Studies in the Department of Global Health, Stellenbosch University, South Africa. A speech and language therapist by profession, she has specialized in interdisciplinary work to increase communicative participation of persons with severe to profound disabilities – usually with no speech at all. Her work includes teaching (e.g., applied research methods and ethics) and supervising postgraduate student studies. Past experience includes 12 years of communitybased rehabilitation and development work in neighbouring Botswana. Chalotte Glintborg, PhD, is Assistant Professor of Rehabilitation Psychology in the Faculty of Humanities at Aalborg University, Denmark. Her research has centred on exploring first person perspectives on the emotional consequences of living with disabilities, e.g., identity problems, distress, shame and depression, etc. She is involved in the development of Rehabilitation Psychology as a field in Denmark. She has used a variety of both qualitative and quantitative methods and the combination of the two in mixed methods studies. Sarah Griffiths, PhD, is a senior lecturer at Plymouth Marjon University and has over 28 years of experience as a speech and language therapist. She began

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her career working with adult clients in acute and outpatient settings before moving into higher education. Sarah teaches in the fields of adult acquired communication disorders and evidence-based practice and runs on-site clinics for people with Parkinson’s and support groups for their relatives. Sarah completed a PhD in Medical Studies in 2013 which focused on a conversation analytic study of everyday conversation management in Parkinson’s. She continues to research this area and has published several papers in this field. Helen Hambly, PhD, works as an analyst for ‘Children, Schools and Families’ at Cornwall Council, UK. She has a background in health psychology and health services research and has utilized a variety of qualitative and quantitative research methods in her work. She has a particular interest in methods for eliciting and understanding the perspectives of children with speech, language and communication needs, and their families, in the context of health and education support. She completed her PhD with the Bristol Speech and Language Therapy Research Unit and the University of the West of England, UK, using qualitative methods to explore everyday experiences of children with language impairment. Deborah Harding is Associate Professor and Director of Workforce Development for the School of Allied Health, Midwifery and Social Care in the Faculty of Health, Social Care and Education, Kingston and St George’s University of London. She is a UK-registered speech and language therapist and continues to work with speech and language therapists in a professional leadership role for St George’s University Hospital NHS Foundation Trust. Deborah delivers post-registration education for health and social care professionals with a focus on policy, quality improvement and service transformation. Deborah expects to have completed her PhD studies at the University of London in 2019. Her PhD studies are focused on supervision practices for Allied Health Professionals. Deborah Hersh, PhD, is Associate Professor in Speech Pathology at Edith Cowan University in Western Australia. She is a certified practising speech pathologist, and a Fellow of Speech Pathology Australia. Deborah has worked in the United Kingdom and Australia in a range of clinical, research and teaching contexts, publishing and presenting her research extensively. She uses a variety of qualitative approaches including grounded theory, interpretative phenomenological analysis, narrative inquiry and discourse analysis. Deborah’s research includes exploring the experiences of people with aphasia and their families in relation to assessment, goal setting, therapy, discharge, community aphasia groups and therapeutic relationships.

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Anne Hill, PhD, is a Senior Lecturer in speech pathology in the Faculty of Health and Behavioural Sciences at The University of Queensland, Australia. She is a speech and language therapist with extensive clinical experience and experience facilitating learning for students in practice placements. Anne’s research employs quantitative and qualitative methodologies and has a particular focus on models of clinical education which provide authentic and powerful learning experiences for students, such as simulation and placements in interprofessional and culturally and linguistically diverse environments. Catherine Houghton, PhD, is a lecturer in the School of Nursing and Midwifery in National University of Ireland Galway and co-chair of QUESTS (Qualitative Research in Trials Centre). Catherine is a registered general and children’s nurse and her research interests lie primarily in qualitative research methodologies including case study research and qualitative evidence synthesis (QES). Catherine has published on qualitative methods, analysis, rigour and ethics and QES studies on dementia, infant feeding and a Cochrane review on recruitment to trials. As co-chair of QUESTS, Catherine endeavours to promote and maximize the use of qualitative research in trials and primary trial methodological research. Catherine was recently awarded funding from the Irish Research Council for the purpose of developing a clearly articulated pathway between QES and trial methodology and further developing QES expertise in Ireland. Tami Howe, PhD, is currently an Assistant Professor in the School of Audiology and Speech Sciences at The University of British Columbia in Vancouver, Canada and was previously a faculty member at the University of Canterbury in Christchurch, New Zealand. She completed her doctoral and postdoctoral studies at The University of Queensland in Brisbane, Australia. Dr Howe has used a range of qualitative research methods to explore the insiders’ perspective on how adults with aphasia and their family members live with their communication disorder. She has also supervised numerous postgraduate students using both qualitative and mixed methods research approaches. Kyla Hudson is a member of the Centre for Clinical Research Excellence in Aphasia and the Communication Disability Centre at The University of Queensland, Australia. She has over 10 years’ experience as a speech language pathologist and her main research interests centre around quality of life for individuals with aphasia and their families. In her doctoral studies she used qualitative research methods to explore the meaning of successfully living with aphasia from the perspectives of people with aphasia, family members and

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speech language pathologists. She has supervised a number of PhD students using quantitative and qualitative research methods and has a keen interest in developing research methods that are inclusive and accessible for individuals with communication disorders. Maja Kelić, PhD, is a speech and language pathologist clinically working with school-age children with reading and language impairment at the SUVAG Polyclinic for the Rehabilitation of Listening and Speech, Zagreb, Croatia. She is involved in the ‘COST ACTION IS1406: Enhancing children’s oral language skills across Europe and beyond’ where she used qualitative research methods and knowledge elicitation to explore therapists’ decision-making process. She is actively participating in promoting the importance of speech and language therapy in the Croatian Association of Speech and Language Therapists and Croatian Dyslexia Association. Lucette Lanyon, PhD, is a lecturer and researcher in the School of Allied Health at La Trobe University, Australia. She is a speech pathologist with specialties in rehabilitation and long-term management for people with acquired brain injuries and progressive neurological diseases. Lucette has used qualitative research methods to explore a range of areas of speech-pathology practice including factors involved in research participant decision making, barriers and facilitators to community aphasia group engagement, and utilization of allied health assistants within speech pathology service provision. She has worked as a research mentor to numerous clinicians seeking to step into research. Lucette is co-founder of the online resource Aphasia Community which supports clinicians, people with aphasia, and their significant others to access up-to-date and relevant information regarding community aphasia groups. Tara Lewis is an Iman woman with connections to central Queensland. She is the Clinical Lead in Speech Pathology at the Institute for Urban Indigenous Health in Brisbane as well as a PhD candidate at The University of Queensland. She works alongside Aboriginal and Torres Strait Islander communicates to support culturally safe speech pathologist services in development paediatrics. Tara utilizes Indigenous research methodologies alongside western qualitative research methods in order to place Indigenous voices and aspirations at the centre of qualitative research. She is also the co-chair of the Speech Pathology Australia Aboriginal and Torres Strait Islander advisory committee where she is helping to implement Indigenous research methodologies across the profession. Rena Lyons, PhD, is a certified speech and language therapist and Senior Lecturer

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in the Discipline of Speech and Language Therapy, School of Health Science, College of Medicine, Nursing and Health Sciences, NUI Galway, Ireland. She has over 30 years of clinical, teaching, and research experience in speech and language therapy in Ireland. She has used qualitative methodologies to explore a range of research interests such as the lived experience of communication disability, parental perspectives, identity construction, the voice of children with developmental speech and language disorders, and the social model of disability. She is involved in the ‘COST ACTION IS1406: Enhancing children’s oral language skills across Europe and beyond’. Sophie MacKenzie, PhD, is Programme Director for the PGDip Speech and Language Therapy and the BSc (Hons) Speech and Language Therapy programmes at the University of Greenwich and Canterbury Christ Church University. She was a practising speech and language therapist for 20 years, working predominantly with clients with aphasia, dysphagia and cognitive communication disorders. She supervises both masters and PhD students, and has a particular interest in qualitative research methodologies. Julie Marshall, PhD, is a Reader (Associate Professor) in Communication Disability and Development at Manchester Metropolitan University in the UK. She is a speech and language therapist and has worked for over 30 years in the UK and in sub-Saharan Africa, helping to educate speech and language therapists and other professionals, carrying out research and clinical work, building research capacity and preparing allied health professionals to work in the Global South. Her research interests have been focused particularly on the development of services for people with communication disabilities in Majority World countries; attitudes towards, understanding of and responses to communication disability; evidence-based intervention and, more recently, supporting people with communication disabilities in humanitarian situations. Lindy McAllister, PhD, is Professor Emerita in the Faculty of Health Sciences at The University of Sydney, Australia. She is a speech and language therapist who has specialized in practice-based education across the allied health professions. In that capacity she has used a range of qualitative research methods to explore aspects of professional practice, supervision of students, students’ and clients’ experiences of practice-education placements. She has supervised numerous PhD students using both quantitative and qualitative research methods. She is involved in the development of the speech and language therapy profession in Majority World countries, especially in Vietnam.

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Sharynne McLeod, PhD, is Professor of Speech and Language Acquisition at Charles Sturt University, Australia. She is an elected Life Member of Speech Pathology Australia, Fellow of the American Speech-Language-Hearing Association, Vice President of the International Clinical Linguistics and Phonetics Association, founding chair of the International Expert Panel on Multilingual Children’s Speech, and past editor of the International Journal of Speech-Language Pathology. She has published 10 books and more than 150 book chapters and journal articles. Professor McLeod’s research focuses on multilingual children’s speech acquisition and children with speech sound disorders, particularly to ensure that children can participate fully in society. Ruth Mc Menamin, PhD, is a lecturer in Speech and Language Therapy and co-director of the MSc Advanced Healthcare Research and Practice at the National University of Ireland, Galway. Ruth has particular experience and expertise in involvement research with people with aphasia and community partners using qualitative participatory health research approaches. Ruth is a member of the International Collaboration of Participatory Health researchers, the Collaboration of Aphasia Trialists and the Public and Patient Involvement (PPI) Ignite team at NUI, Galway. In that capacity she uses participatory learning and action (PLA) research to involve people with aphasia (PWA), healthcare professionals and students as co-researchers in PPI activities, with publications in peer-reviewed journals and numerous international conference presentations. Ruth is responsible for supervising postgraduate MSc and PhD students and is committed to integrating civic values at the centre of her research and teaching. Rosalind Merrick, PhD, is a speech and language therapist in Sussex, UK. She specializes in work with children with speech, language and communication needs in mainstream schools. She has a background in primary education and is a chartered psychologist. She provides teacher education for the University College London Institute of Education. She has used qualitative methods to explore children’s perceptions of communication difficulty, clinical decision making and teachers’ views of children’s participation. Nicole Müller, DPhil, is Professor of Speech and Hearing Sciences at University College Cork, Ireland. She was born and grew up in Germany, and was educated in Germany, Ireland, and England. Before coming back to Ireland in 2017, she held academic positions in the UK, the USA, and Sweden. As a Fulbright scholar, she spent six months at NUI Galway, conducting a field

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study with bilingual nursing home residents. She has wide-ranging research and teaching interests, which include the effects of neurodegeneration and brain damage on communication and cognition, multilingualism, and clinical linguistics and phonetics. Charn Nang, PhD, is a lecturer and researcher in The School of Medical and Health Sciences at Edith Cowan University, Perth, Australia. She is a qualified speech language therapist who works clinically in the area of stuttering. Her research interests include stuttering, speech motor control development, evidence-based treatments for stuttering and cultural and linguistically diverse topics in speech pathology. Charn has used qualitative research methods to explore the experiences of people living with stuttering including women who stutter and migrants to Australia who stutter as well as to explore people who stutters’ experiences with treatment.  Alison Nelson, PhD, is the Director of Workforce Development at The Institute for Urban Indigenous Health in Brisbane. She holds an adjunct position as Associate Professor in the Faculty of Health and Behavioural Science at The University of Queensland. Alison has a background as an occupational therapist and has extensive research, teaching and practice experience working alongside urban Aboriginal and Torres Strait Islander people. Alison has completed both a research Master’s degree and PhD in the areas of service delivery and perceptions of health for urban Aboriginal and Torres Strait Islander children and young people, and she has published widely in these fields. Robyn O’Halloran, PhD, is a Senior Lecturer in Human Communication Sciences, La Trobe University and Research Lead in Speech Pathology at St Vincent’s Hospital, Melbourne, Australia. She is a speech and language therapist who has worked with adults with acquired neurogenic communication disorders in hospital and community health settings. She has supervised research by higher degree students using both quantitative and qualitative research methods. Her research interests include supporting healthcare providers to communicate effectively with patients who have communication disability in hospital. Mary-Pat O Malley-Keighran, PhD, is a lecturer in speech and language therapy at NUI Galway. She is a speech and language therapist with a special interest in working with multilingual families and in supporting speech and language therapists working with multilingual families. She is also interested

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in disseminating research in an accessible way to families and speech and language therapists through her award-winning website ‘Talk Nua’ (www.talknua. com). In her capacity as lecturer and speech and language therapist, she has used a range of quantitative and qualitative methods to investigate narrative as an ecologically valid language assessment approach for monolingual and multilingual children, children’s drawings as a way to understand children’s perspectives on their speech, and critical discourse analysis as a way of exploring representations of clients in range of contexts from report writing to Irish newspapers and radio. Carole Pound, PhD, is a speech and language therapist who has worked extensively with people with acquired neurodisability and their families and friends. She co-founded the charity Connect to develop innovative therapy and support services with and for people living with aphasia and her doctoral studies used participatory action research to explore the friendship experiences of adults with aphasia. As a researcher in the Centre for Qualitative Research at Bournemouth University, her current interests focus on working with service users, providers and organizations in health and social care contexts to understand and translate humanization theory to practice. Miranda Rose, PhD, is Professor of Speech Pathology in the School of Allied Health, La Trobe University, Australia. After a 20-year academic career in speech pathology education, Miranda moved into research-only positions focused on the development of effective interventions and management strategies for post-stoke aphasia. Miranda currently leads a nationally funded research centre in Aphasia Recovery and Rehabilitation at La Trobe University, including qualitative investigations and large randomized controlled trials of treatment efficacy and effectiveness. Sue Roulstone, PhD, is Emeritus Professor at the University of the West of England, Bristol and a member of the Bristol Speech & Language Therapy Research Unit. Sue has worked as a speech and language therapist, a manager, a researcher and an educator and was Chair of the UK Royal College of Speech & Language Therapists from 2004‒2006. Her research interests include child and family perspectives, professional judgement and evaluation of speech and language therapy. She has carried out a number of consultations with parents, children and young people using qualitative methods.

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Samantha Siyambalapitiya, PhD, is a speech pathologist and Senior Lecturer in the School of Allied Health Sciences at Griffith University, Australia and a member of the Menzies Health Institute Queensland. Samantha leads a programme of research investigating communication disability in individuals from culturally and linguistically diverse backgrounds, including bilingual speakers. She has employed both quantitative and qualitative research methods to explore this area. Elizabeth Spencer, PhD, is a qualified speech pathologist and lecturer in Speech Pathology at the University of Newcastle, Australia. She has a background in linguistics and specialist expertise in the areas of clinical discourse analysis. She currently teaches primarily in the area of child language. Her current research focuses on the application of linguistic analyses to explore the effects of ageing on language in the general population and also of adults with communication disorders and has supervised research at undergraduate and postgraduate levels in these areas. Sarah Verdon, PhD, is a Senior Lecturer and Research Fellow at Charles Sturt University, Australia. Her research focuses on the development of a culturally competent workforce and supporting the communication of children from diverse backgrounds. She is co-chair of The International Expert Panel on Multilingual Children’s Speech and oversaw the development the Speech Pathology Australia national position paper and clinical guidelines for ‘working in a culturally and linguistically diverse society’. Carol Westby, PhD, is a consultant for Bilingual Multicultural Services, Inc. in Albuquerque, NM. She is an ASHA Board Certified SLP Specialist in Child Language. She has employed qualitative methodologies in the development and evaluation of early intervention programmes and language/literacy programmes for school-age students from culturally/linguistically diverse populations and support systems for first generation university students. She has published and presented nationally and internationally on narrative and expository language development and facilitation, theory of mind, metacognition/ executive function, language-literacy relationships, and issues in assessment and intervention with culturally/ linguistically diverse populations. She has directed masters’ theses and doctoral dissertations that have used qualitative methodologies, particularly ethnography.

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Linda Worrall, PhD, is a Professor of Speech Pathology, Co-Director of the Communication Disability Centre and Postgraduate Coordinator at The University of Queensland, Brisbane, Australia. She completed her undergraduate degree in speech pathology at The University of Queensland but then completed her PhD in the Stroke Research Unit in Nottingham, UK. She has practised as a speech pathologist both in Australia and the UK and founded the Australian Aphasia Association, the consumer-led organization, in 2000. She has published over 200 peer-reviewed journal articles, 26 book chapters, and six books; graduated 24 PhD candidates and has had continuous nationally competitive research funding during her academic career. From 2009‒2014, she led the NHMRC-funded Australia-wide Centre for Clinical Research Excellence in Aphasia Rehabilitation.

Section I Introduction

1 I ntroduction and overview of qualitative research Lindy McAllister and Rena Lyons Goals and layout of the book Most speech and language therapists (SLTs) undertake research subjects as part of their degrees, and some will complete research projects as students. Clinicians increasingly have a research role built into their job descriptions. Until recently, SLTs were educated primarily (or only) in quantitative (statistical) approaches to research and the majority of our research literature presented quantitative studies. Qualitative research is being used more frequently by SLTs and research funding bodies are increasingly seeking research proposals using mixed methods, that is, designs that combine quantitative and qualitative approaches, to better answer research questions. The body of literature in the field of communication disorders where researchers have used qualitative research has grown considerably in the last decade, and there are new books on the topic of qualitative research in communication disorders (e.g., Ball, Müller, & Nelson, 2014). Qualitative research is now more frequently covered in pre-registration degree curricula for speech and language therapy students. However, students and clinicians remain under-confident in their use of qualitative research. There are many reasons for this; depth of education in qualitative research is one reason. There may not be sufficient time devoted to explicating qualitative research methods and giving students time to practise and develop skills in qualitative data collection and analysis. Developing an understanding of qualitative research is also confused by the plethora of terms used in qualitative research, often without clear explanation and illustrations of use. Some students do not feel confident in their knowledge of statistics and may see qualitative research as a way of avoiding statistical analysis. However, Creswell (2007) reminds us that qualitative research involves indepth exploration of a problem and this type of research requires time and resources and should not be seen as an easier option than a quantitative study.

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We are SLTs who are passionate about qualitative research and have experience both using and teaching qualitative research in the field of communication disorders and speech and language therapy practice. We use the term ‘communication disorders’ in this book as a broad term that includes both the communication impairment and barriers to participation. We deliberately focus on the use of qualitative research in the field of communication disorders rather than dysphagia because very few qualitative studies have been published in dysphagia to date. This book aims to demystify qualitative research and reduce confusion about terms used in discussing and writing about qualitative research methodologies and methods. We aim to provide speech and language therapy students and clinicians with an overview of qualitative research, the different methodologies and methods within it, and how it can be used to answer important questions in clinical and professional practice in speech and language therapy. There are particular issues which researchers need to consider when carrying out qualitative research with people with communication disorders given that many data collection and analysis methods are based on generating and analyzing talk. Our goal is to provide rich examples of how qualitative research has been used in the field of communication disorders so that readers develop understanding of the methods used and gain confidence in how to go about designing qualitative research studies, selecting methodologies, collecting and analyzing data, and writing up findings from qualitative research. But Braun and Clarke (2013) remind us that while it is important to learn about qualitative research, the actual doing of qualitative research is an essential part of the learning process. We start by explaining what qualitative research is, locating qualitative research within the array of research paradigms, highlighting the similarities and differences between qualitative research and quantitative research, and providing an overview of the major methodologies (also referred to as approaches or traditions) within the qualitative research paradigm. Later chapters (Chapters 2‒10), written by experienced and internationally published SLTs, provide more detailed discussions and examples of the different qualitative research approaches or methodologies, with examples of use in their research. Chapter 11 provides an overview of common methods used to collect and analyze data in qualitative research. Chapter 12 discusses the various techniques used to ensure scientific rigour in qualitative research. In subsequent chapters (13‒16), SLTs illustrate methods they have used to recruit participants, collect data, analyze and write up their data. These chapters contain worked examples of data, analysis and writing to reveal the detail too often excluded from qualitative

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3

research journal publications due to word length. We include chapters (17‒21) on ethical and cultural considerations in engaging with research participants1 in qualitative research as well as innovative approaches in qualitative research. In Chapter 21 there is a discussion on the emerging area of synthesizing data from qualitative research studies. Finally, in Chapter 22 we make concluding remarks and discuss future directions for qualitative research in the field of communication disorders.

What is qualitative research? The starting point for any research project is the research question or what it is that you want to find out. This will guide you to the most appropriate methodology and methods to answer your question. For example, if a researcher wanted to explore parental experiences of ‘what’ it is like to live with a child with a developmental language disorder and ‘how’ parents sought help for their child, one of the options available to answer these questions is qualitative research. According to Braun and Clarke (2013) the most basic definition of qualitative research is that “it uses words as data, collected and analysed in different ways. Quantitative research, in contrast, uses numbers [their emphasis] as data and analyses them using statistical techniques” (p.3). There is debate about whether qualitative researchers should provide quantitative data (e.g., the number of times that a theme appeared across participants). Qualitative researchers may decide to provide a frequency count but this may be used to complement a deep analysis and is not the primary goal of a qualitative research design (Lewis, 2016). Qualitative research is particularly useful for answering ‘what’ and ‘how’ questions and can be viewed as an umbrella term for a range of methodologies such as conversation analysis, critical discourse analysis, discourse analysis, ethnography, grounded theory, narrative inquiry, participatory research, phenomenology, and qualitative case study. All of these methodologies have been used in communication disorders research and are discussed in this book. In this section we provide an overview of research paradigms and then of the methodologies and methods available within the qualitative research paradigm. It is in the discussion of research paradigms and qualitative research methodologies where much of the confusion and uncertainty experienced by students and SLTs about qualitative research arises. There can be confusion 1 We use this term but are aware of other terms used in the literature such as patients, clients, and consumers.

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about the overlapping nature of the concepts and ways in which terms are used to describe research. For example, the term ‘paradigm’ may be used by one author to represent the ontological and epistemological aspects of research design and by another writer as a method of data collection. Our goal is to overview this as clearly and succinctly as possible but some understanding of the terminology of research is required – so bear with us. A paradigm provides an overarching framework for the research and different research paradigms carry with them certain assumptions about the nature of reality (ontology) and the nature of knowledge (epistemology), which in turn suggest appropriate methodologies for generating knowledge. Creswell (2007) reminds us that philosophical assumptions may come from the researchers’ worldviews, a set of beliefs, and theoretical positions. It is important that researchers make these philosophical assumptions explicit when writing up the study. Over time there have been changes in how people view paradigms. For example, in the past some argued that there were three paradigms (quantitative, qualitative and critical theory paradigms) which “stem from the philosophical stances of positivism, idealism and realism, respectively” (Higgs & Titchen, 1995, p.132). Critical theory is an overarching term that covers a number of qualitative research traditions such as participatory, feminist or emancipatory research (see, for example, Kincheloe & McLaren, 2005). Researchers working in a critical theory paradigm assume that reality is shaped by the surrounding social, political, cultural, and economic values that people operate in. Critical qualitative researchers “question the conceptual and theoretical bases of knowledge and method, to ask questions that go beyond prevailing assumptions and understandings, and to acknowledge the role of power and social position in health-related phenomena. The notion includes self-critique, a critical posture vis-à-vis qualitative inquiry itself ” (University of Toronto: http://www.ccqhr.utoronto.ca/what-is-critical-qualitative-research). In the current literature, critical theory is not generally viewed as a distinct paradigm but a critical lens can be brought to any methodology. In the past, some scholars saw action research as distinct from other research paradigms (for example, Kemmis & McTaggart, 1988) in that it “combines inquiry with action as a means of stimulating and supporting change and as a way of assessing the impact of that change” (Burns, 2007, p.11); that is, the purpose of the inquiry is to bring about change and learning through systematic reflection on the topic that is the focus of the study. However, Kagan, Burton and Siddiquee (2017) view action research as an approach to inquiry whereby researchers attempt to “combine understanding, or development of a theory, with action

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and change through a participatory process, whilst remaining grounded in experience” (p.55) and is part of the qualitative research paradigm. Kemmis and McTaggart themselves now accept the view that action research fits under the participatory research umbrella (Kemmis, McTaggart, & Nixon, 2014). We have included a chapter on participatory research (Chapter 8) which covers a range of methodologies such as participatory learning and action research in which stakeholders are collaborators with researchers. In the interest of clarity we will focus our discussion here on the two main paradigms discussed in the current literature: quantitative and qualitative research. SLTs have long used the quantitative research paradigm (also known as the positivist, empirico-analytic paradigm, and often referred to using the term ‘statistical research’), but are now increasingly using the qualitative paradigm (also known as the interpretive paradigm or as interpretive research or interpretive inquiry), which includes some linguistic research such as discourse analysis and conversational analysis. It is important to understand that a researcher’s views on ontology and epistemology should lead to the selection of particular methodologies and methods so that there is coherence within the research design (Braun & Clarke, 2013). Confusingly, in your readings you will come across the term

Box 1.1 Definitions of terms paradigm, methodology and methods.

• Paradigm: A paradigm represents “the entire constellation of beliefs,

values, techniques, and so on shared by the members of a given (scientific) community” (Kuhn, 1970, p.175). Guba (1990, p.17) described a paradigm as a “basic set of beliefs that guides action”. For example, qualitative research is a distinct paradigm.

• Methodology:

Methodology refers to the choices we make in relation to ontology and epistemology and how we will explore the phenomenon of interest (Silverman, 2013). For example, we refer to grounded theory and narrative inquiry as methodologies. In this book we use the terms ‘approach’ and ‘methodology’ synonymously.

• Methods:

Methods refer to the specific research techniques (Silverman, 2013). For example, interviews are a method for data collection and thematic analysis is a method for data analysis.

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methodology used in different ways by different authors. For example, the term methodology may be used for broad definitions (e.g., qualitative research) or narrow definitions (e.g., discourse analysis) (Silverman, 2013). Furthermore, O’Brien, Harris, Beckman, Reed and Cook (2014) used the term ‘approaches’ to refer the names of methodologies (e.g., ethnography) and ‘methodologies’ to refer to data collection methods (e.g., interviews or focus groups). With a view to providing clarity we are using the terms paradigm, methodology, and methods as illustrated in Figure 1.1.

Similarities and differences between qualitative and quantitative research paradigms It is important to understand the similarities and differences between the two major research paradigms of quantitative and qualitative research. This is important because qualitative research has been criticized and researchers have been referred to as “journalists or soft scientists. The work of qualitative researchers is termed unscientific, or only exploratory or subjective” (Denzin & Lincoln, 2005, p.8). Lewis (2016, p.8) argues that these criticisms “demonstrate a lack of understanding about both the nature of qualitative research and the differences between subjectivity and objectivity”. Both qualitative and quantitative research paradigms share similarities. For example, both paradigms are ‘scientific’ and produce empirical evidence. However, there are some significant ontological and epistemological differences between the paradigms which need to be understood, as they influence the sorts of questions that can be asked and answered, methodologies and methods chosen, and interpretation and presentation of data and findings. Figure 1.1 summarizes the major ontological and epistemological distinctions between qualitative and quantitative research as we discuss them here. Guba and Lincoln (1994) described the ontological assumptions (about the nature of reality) of the qualitative paradigm as relativist in nature, meaning that multiple realities exist, with individuals constructing their own meanings and interpretations of their experiences. Qualitative approaches acknowledge that meaning is relative to individuals (not assumed as absolute and measurable as in the quantitative paradigm), and that multiple realities mean there are multiple ways of looking at and experiencing the world. Qualitative research assumes “a relativist ontology (there are multiple realities), a subjectivist epistemology (knower and respondent cocreate understandings) and a

Theory

QUANTITATIVE RESEARCH

RESEARCH PARADIGM

QUALITATIVE RESEARCH

Single, objective reality

PHILOSOPHICAL PERSPECTIVE

Multiple realities

Test, verify, describe (discrete variables)

Research purpose

Explain, interpret, describe (phenomena)

Descriptive Relational Comparative

Methodology

Phenomenology Ethnography Grounded theory Qualitative case study Participatory research Narrative inquiry Discourse analysis Conversation analysis Critical discourse analysis

Randomized controls Clinical trials Single case designs Surveys

Methods

Observation Interviews Focus groups Review of artefacts Review of documents

Numerical, descriptive

Research data

Words, images

Visual display Statistical analysis

Data analysis

Constant comparative analysis Thematic analysis Discourse analysis Framework analysis

Confirmed, revised, emergent or grounded theory

Figure 1.1 A model of qualitative and quantitative approaches to research (after Higgs, 1998). (Used with relevant permissions.)

Definition

The study of structure, functions and meanings of symbol systems (such as language) which was developed by the Chicago school (Oxford University Press, 2009). The process of interaction to understand meaning in people’s lives (Minichiello & Kottler, 2010). According to Blumer (1969) there are three core principles in this theory: the meaning people assign to their interactions with others; the language we use to negotiate meaning through symbols; and the thinking processes that negotiate the interpretation of symbols (as described by (Minichiello & Kottler, 2010).

The processes through which social realities are constructed and sustained (Holstein & Gubrium, 2008b in Silverman, 2013, p.107). The multiple and varied subjective meanings of experiences which are negotiated socially and historically and formed through interactions with others (Creswell, 2007). In social constructionism there is an emphasis on the constructivist aspects of knowledge such as a focus on ‘what’ and ‘how’ questions (Silverman, 2013). Social constructionism is rooted in symbolic interactionism and phenomenology.

A theory about how people learn – where they ask questions and find answers via exploration and assessment of what they already know (Oxford University Press, 2009).

The research processes in qualitative research are often described as hermeneutical and dialectical (Guba & Lincoln, 1994). Hermeneutics refers to the activity of interpretation (Schwandt, 1994). Participants’ understandings of their lived experiences or their social constructions are interpreted by researchers using hermeneutic techniques and are “compared and contrasted through a dialectal interchange” (Guba & Lincoln, 1994, p.111) between participant and researcher.

Philosophical traditions and theoretical constructs

Symbolic interactionism

Social constructionism

Social constructivism

Hermeneutics

Table 1.1 Philosophical underpinnings of qualitative research and seminal scholars.

Ricoeur (1980), Derrida (1993), Schwandt (1990,1994), Heidegger (1962, 1982), Gadamer (1976)

Husserl (1973), Schutz (1967) Ricoeur (1980), Vygotsky (1987), Searle (1995), Berger and Luckman (1971)

Blumer (1969), George Herbert Mead (1925)

Seminal scholars

Systemic functional linguistics is theory of language use (Müller, Mok, & Keegan, 2014). Language has two functions, i.e., constructing experience and enacting social processes (Halliday & Matthiessen, 1999). Provides a framework for the “detailed analysis of the linguistic resources involved in the creation of meaning” (Müller, Mok, & Keegan, 2014, p.168).

Critical theory is a school of thought that stresses the reflective assessment and critique of society and culture by applying knowledge from the social sciences and the humanities. (Wikipedia accessed 27 July 2018). Many disciplines have a critical strand (e.g., critical disability studies, critical education). Readers should also be aware of the distinct tradition of Critical Theory, which arose in the 1930s in the Frankfurt School.

Systemic functional linguistics

Critical theory

Halliday & Hasan (1980), Eggins (2004)

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naturalistic (in the natural world) set of methodological procedures” (Denzin & Lincoln, 2005, p.24). In your reading about qualitative research you will come across a number of philosophical traditions and theoretical constructs which underpin qualitative research. It is beyond the scope of this book to discuss these in depth but it is important that you position your research within the context of these philosophical and theoretical underpinnings. We provide a brief overview of the key philosophical constructs and seminal scholars in Table 1.1. The ontologies and epistemologies underpinning qualitative research are in stark contrast to those of research in the quantitative paradigm, which assumes that researchers are capable of controlling and measuring a phenomenon (called in that paradigm a ‘variable’) “without influencing it or being influenced by it” (Guba & Lincoln, 1994, p.110). Quantitative researchers assume that measurement is undertaken by a value-free, detached researcher, rigorously following prescribed procedures that eliminate contamination of data, and that this allows replicability of results. In contrast, in the qualitative paradigm, knowledge is not seen as ‘fixed’ or ‘true’, unchangeably determined through experiments, but rather as created in interactions among people (socially constructed); in the case of research, between researcher and research participants. Qualitative researchers seek to describe, explain, interpret, and understand the meaning of social phenomena as experienced by individuals in their context. “Research with people, rather than on people” is the goal of qualitative research (Dickson, 1995, p.415). Hence, the people who participate in qualitative research are known as informants, participants, or research collaborators, not ‘subjects’ as in some quantitative research. Indeed, Graue and Walsh (1998) argue that the term data generation is preferable to data collection because data collection suggests that the data is out there to be collected whereas data are generated in and through interactions between researchers and participants. The ontological and epistemological assumptions upon which qualitative research is based lead to considerations about methods quite distinct from those of the quantitative paradigm. In relation to sampling strategies, qualitative researchers do not seek large samples from which generalizations can be drawn; rather they seek detailed knowledge and understanding of the lived experience of a typically small number of participants. The data in qualitative research consist of texts, newspapers, documents, interviews, naturally occurring talk (without the intervention of the researcher), life stories, observational data, visual data (see Silverman, 2013 for an overview). These data contrast with

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the data collected in quantitative studies which are typically numbers-based. The place of theory also differs in the two paradigms. In quantitative research, a priori theory is tested, often in the form of hypothesis testing. In contrast, qualitative research seeks to discover and describe theories that emerge from the data; theory is derived by inductive analysis and is grounded in the data. All theory emerging from qualitative research can be said to be ‘grounded’. The term ‘grounded theory’ applies to a particular methodology and approach to data analysis and theory generation described by Glaser and Strauss (1967) and Strauss and Corbin (1990) (see Chapter 6). Deductive approaches to data analysis can also be used where researchers may draw on concepts from the literature when conducting data analysis while also remaining open to new themes (Minichiello, Aroni, & Hays, 2008). To better understand the differences between these two research approaches it may be helpful to consider two papers in the speech and language therapy research literature, both apparently about the same topic ‒ the perceptions of parents about their experiences of speech and language therapy programmes, but using different research paradigms which reflect different views about the kinds of data that best address their questions. Crais, Poston and Free (2006), working within the quantitative paradigm, used an established rating instrument to examine agreement between parents and professionals on whether family-centered practices were implemented during assessments and which practices were viewed as important to include in future assessments. The features of interest were established a priori within the rating tool, and

Box 1.2 Characteristics of qualitative research (Creswell, 2007).

• It is conducted in natural settings • Researchers are viewed as key instruments • Multiple sources of data may be used • Inductive data analysis is used • There is a focus on participants’ meanings • The design is viewed as emergent • Interpretive inquiry is used

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the analysis compared parents’ and professionals’ ratings using numerical data and statistical analyses. Kummerer, Lopez-Reyna and Hughes (2007) positioned their study within the qualitative paradigm and their aim was to explore the perceptions of immigrant Mexican mothers with regard to their children’s communication disability and their experiences of speech and language therapy services. They used semi-structured interviews and field notes of informal conversations with parents; the data were therefore verbal. The researchers adopted a grounded theory methodology, using constant comparative analysis to identify themes in the mothers’ data. In summary, the key characteristics of qualitative research are presented in Box 1.2.

Arguments for using a qualitative approach in communication disorders research Qualitative research can complement quantitative research to enhance our understanding of communication disorders as well as speech and language therapy practice for four reasons. First, communication as a human right is enshrined in Article 19 of the Universal Declaration of Human Rights which states that everyone has the right to freedom of opinion and expression (United Nations, 1948). People with communication disabilities have been excluded from research because of assumptions that they would be unable to participate due to their communication disabilities. If we take a human rights perspective, then it is incumbent upon us to include people with communication disabilities in research, to give them a voice and, more importantly, to listen to their voice. A special edition of the International Journal of Speech-Language Pathology celebrated the 70th anniversary of the Universal Declaration of Human Rights and authors discussed communication as a human right and focused on four themes: “(1) communication rights for all people; (2) communication rights of people with communication disabilities; (3) communication rights of children; and (4) communication rights relating to language” (McLeod, 2018, p.5). Qualitative methodologies can be used to explore the first-hand experiences of people with communication disabilities, their communication partners and those who work with them, which may in turn shape the services we provide. Second, one of the frameworks that has informed assessment and intervention in the field of communication disorders has been the International Classification of Functioning, Disability, and Health (ICF; World Health Organisation, 2001). The ICF provides a holistic biopsychosocial framework

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and consists of three lists of codes: one list of body structure and function; one list for activities and participation; and a list of codes relating to personal and environmental factors that may impact on functioning. Many of the tests available to speech and language therapists focus on the impairment rather than activities and participation or personal and environmental factors. Qualitative methodologies provide rich opportunities to explore the lives and experiences of people with communication disorders as well as their communication partners in context. These data can complement data from traditional tests by providing ecologically valid information on what it is like to live with a communication disability and the types of supports which are required to improve quality of life. Third, evidence-based practice (EBP) underpins speech and language therapy practice and has been defined as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996, p.71). When using EBP, the clinician integrates three different kinds of evidence: external evidence from systematic research, clinical expertise, and patient values and preferences. When SLTs think about evidence-based practice, they may focus on one of these pillars (i.e., external evidence from rigorous quantitative studies). Qualitative research provides opportunities to explore the other two pillars of EBP. For example, if we want to explore how clinicians implement evidence or make decisions in practice, qualitative methodologies are useful to uncover their reasoning and decision making (see Chapter 20). Qualitative research can also enhance our understanding of patient preferences and values. For example, Greenhalgh (2016) argued that narrative inquiry, a type of qualitative methodology, can complement traditional quantitative approaches and enhance our understanding about the cultural contexts of health. Qualitative methodologies can be used to understand lived experiences and lifestyle choices which in turn can inform interventions which are aimed at influencing these experiences and choices (Greenhalgh, 2016). Qualitative research is also recommended in the early stages of designing complex intervention trials to enhance credibility and the impacts of interventions (Morgan et al., 2016). Fourth, there have been calls to promote patient and public involvement (PPI) in healthcare and research with the goal of improving the health and experiences of patients, families, and the wider public (Ocloo & Matthews, 2016). Involvement in this context refers to activities that are done ‘with’ rather than ‘on’ patients. In PPI there is a partnership between patients, the public, and

Figure 1.2 Qualitative Research Level of Alignment Wheel (QR-LAW)TM (Bradbury-Jones et al., 2017). Reproduced with permission from Taylor and Francis.

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healthcare professionals and patients can be involved in all aspects of research and healthcare from design to implementation and dissemination. Ocloo and Matthews (2016) discussed some of the benefits of PPI including: “improving patient choice, self-care and shared decision-making (SDM) contributing to research partnerships and changes to service delivery and patient outcomes” (p.627). Qualitative methodologies can be used to promote PPI (e.g., involving participants in all aspects of the research process) (see Chapter 8).

Research methodologies within the qualitative research paradigm Several methodologies or approaches in the qualitative paradigm have particular applicability to communication disorders research. They include participatory research, phenomenology and hermeneutics, narrative inquiry, ethnography, grounded theory, qualitative case studies, and methodologies where talk and text are analyzed. Silverman (2013, p.138) stated that “your choice of method should reflect both your research topic and your overall research strategy as your methodology shapes which methods are used and how each method is used”. Furthermore, each of these methodologies has specific epistemological and ontological underpinnings as well as particular approaches to sampling, data collection, and analysis. Bradbury-Jones et al. (2017) claimed that some researchers may only use some aspects of a methodology rather than the full package and there can be a mismatch between what researchers say they do (e.g., they may state that they used grounded theory) and what they actually do (e.g., they may not have used all of the specific methods associated with grounded theory). BradburyJones et al. (2017) designed a Qualitative Research Level of Alignment Wheel (QR-LAW)TM (see Figure 1.2) which provides information on the major methodologies in qualitative research (they use the term ‘orientations’) and the methods (they use the term ‘techniques’) associated with these methodologies to enable researchers to align methodologies and methods. Their intention is not to draw rigid boundaries between methodologies but rather to enable researchers to be cognisant of and account for their decisions if they combine or borrow from different methodologies and methods. Bradbury-Jones et al. (2017) also include a methodology called ‘generic qualitative’ research. Generic qualitative research has been defined as research that “is not guided by an explicit or established set of philosophic assumptions in the form of one of the known qualitative methodologies” (Caelli, Ray, & Mill, 2003, p.2).

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Caelli et al. (2003) argue that researchers who use generic qualitative research should address four parameters to enhance the credibility of their research: “the theoretical positioning of the researcher, the congruence between methodology and methods; the strategies to establish rigour; and the analytical lens through which the data are examined” (p.5). In the following section, we provide a brief overview of what each of the major methodologies entails. In Chapters 2‒10 more detailed descriptions of these methodologies are provided with exemplars of the decision-making processes used by researchers regarding methodologies and methods in the field of communication disorders.

Analyzing text and talk In many qualitative approaches the method of data collection is interviews (see Chapter 13). However, if the researcher is interested in exploring interactions between people (e.g., interactions between SLTs and clients) or in repair strategies used when communication breakdown occurs in aphasia or dementia, the data could be naturally-occurring talk rather than interview data. Three major approaches to analyzing text and talk are conversation analysis, critical discourse analysis and discourse analysis. Conversation analysis was developed by Sacks, Schlegloff and Jefferson (1974) to explore “the structure and process of social interactions” (Peräkylä, 2005, p.875) (see Chapter 2). For example, Griffiths, Barnes, Britten and Wilkinson (2011) used conversation analysis to explore repair strategies in conversations between people with Parkinson’s Disease and familiar conversation partners. Discourse analysis is used across a number of disciplines such as linguistics and psychology where it is referred to as discursive psychology. Discourse analysis refers to “many different approaches of investigation of written texts (and of spoken discourse as well)” (Peräkylä, 2005, p.871). There are different approaches to discourse analysis. In critical discourse analysis, researchers analyze ways in which power and inequalities are represented and constructed in text (see Chapter 3). This approach has been used in the field of communication disorders. For example, O’Malley-Keighran (2016) used critical discourse analysis to explore representations of clients in exemplar texts in textbooks and Ferguson and Armstrong (2004) analyzed SLTs’ documentation presenting challenges for the profession regarding relationships with our ‘patients’. In linguistics, discourse analysis refers to research that explores “the features of

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text that maintain coherence in units longer than the sentence” (Peräkylä & Ruusuvuori, 2011, p.871) (see Chapter 4).

Ethnography Ethnography focuses on understanding a culture or way of life of a group from the perspective of its members. Early ethnographers such as Margaret Mead (see, for example, 1963) studied so-called ‘exotic cultures’ in the Pacific, Asia, South America or Africa. Recent ethnographic work has been informed by the work of Spradley (1979), Werner (1999), and Rice and Ezzy (1999), among many other writers. Data collected through observation, field notes, interviews, artefacts, mapping of relationships and places of importance are analyzed to identify ways in which people categorize meanings inherent in their culture. Prolonged immersion in the field, interacting with and observing participants, allows understanding and description from an ‘insider’ or ‘emic’ perspective (Fetterman, 1989). The result of ethnographic research is a detailed description of the way of life of a group. A few ethnographic studies have been conducted in the field of communication disorders (e.g., Parr, 2007; Wickenden, 2011; see Table 1.2). This methodology has potential to help us to understand the everyday experiences of people with communication disorders as well as elucidating routine practices in speech and language therapy which may be taken for granted (see Chapters 5 and 15).

Grounded theory Glaser and Strauss (1967) coined the term ‘grounded theory’ to describe an inductive process of identifying themes and analytic categories in data. As described by Glaser and Strauss (1967) and later Strauss and Corbin (1990), the theory uses a structured approach to coding. Researchers bring their ‘theoretical sensitivity’, that is, knowledge of the field and phenomenon under investigation, which allows them to be aware of subtleties in the data and likely concepts and categories to be found in the data. Particular coding strategies are used to identify categories of data, and causal, relational, and consequential types of relationships among categories of data. Semantics and the similarities of analytic procedures in interpretive research have led to confusion about what is meant by grounded theory and theory grounded in data. All theory emerging from the analysis of interpretive data

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is grounded in data, and the steps of grounded theory analysis are similar to those used in many approaches to interpretive data analysis. Analysis involves multiple interactions of coding and categorization of data using what is known as ‘constant comparative analysis’; that is, constantly moving between sections of one text or across different texts, comparing codes or categories to identify commonalities and differences. Early emergent theory is tested in the analysis of subsequent data, and data collection continues until saturation is achieved (Hammersley & Atkinson, 1983); that is, until no new concepts or categories emerge from the data. Analytic memos are written while data are analyzed to assist with describing the processes actually used in analysis and interpretation. Grounded theory has not been widely used in communication disorders research. In recent years, researchers have used grounded theory to explore experiences of people with communication disabilities (Hynan, Goldbart, & Murray, 2015) and reflective practice in speech and language therapy (Caty, Kinsella, & Doyle, 2016) (see Table 1.2 and Chapter 6).

Narrative inquiry An interpretive approach widely used in education research is narrative inquiry (Clandinin & Connelly, 1994; Connelly & Clandinin, 1990), which seeks to illuminate personal practical knowledge through the elicitation and analysis of stories from participants about their life experiences. Humans are essentially ‘storied beings’ (Polkinghorne, 1995) and there are at least two ways in which narrative inquiry can be conducted: through the analysis of narratives, which yields typologies or categories; or through narrative analysis, which uses “actions, events or happenings ... to produce stories such as ... a historical account, a life story, a case study or a storied episode of a person’s life” (Polkinghorne, 1995, p.15). Narrative inquiry has been used in communication disorders research; for example Lyons and Roulstone (2017) used narrative inquiry to examine identity in children with speech and language disorders (see Table 1.2 and Chapter 7).

Participatory research Participatory research has been defined as a methodology which “focuses on a process of sequential reflection and action, carried out with and by local people rather than on them” (Cornwall & Jewkes, 1995, p.1667). According to Kemmis and McTaggart (2005, p.560) there are distinguishing characteristics

Semi-structured in-depth interviews and participantInterpretative generated photographs and artefacts with 25 people with phenomenological analysis aphasia. following a four-step process 5‒6 semi-structured interviews with 11 children with speech and language disorders and the aim was to generating storied accounts of everyday experiences.

To explore participants’ insider (emic) experiences of (1) aphasia and (2) a Conversation Partner Programme.

The aim of this study was to Interpretive explore, from the perspectives of phenomenology people with aphasia, the meaning of living successfully with aphasia.

Narrative Inquiry To explore the identities which children with speech and language disorders presented in their narratives and to investigate their evaluations of these identities with a view to understanding the values they attach to labels.

To track the day-to-day life and Ethnography experiences of people with severe aphasia, and to document levels of social inclusion and exclusion as in everyday settings.

Brown, Worrall, Davidson, and Howe (2010)

Lyons & Roulstone (2017)

Parr (2007)

Participatory Learning and Action (PLA)

Thematic analysis that included analysis of plot structure and evaluative language.

The analysis was guided by the principles of thematic analysis with co-analysis of data with participants.

Visited participants on three occasions for up to 3 hours. Thematic analysis Some participant observations where she observed with little interaction and some where she participated in the situation, e.g., joining a swimming class or carrying in shopping. Extracts from her ethnographic field notes were included.

Flexible brainstorming and card sort tasks.

Appraisal analysis

McMenamin et al., (2015)

Critical Discourse Sample reports texts from the speech and language Analysis and therapy educational literature that aim to demonstrate Systemic ‘best practice’ in relation to ‘professional’ report writing. Functional Linguistics

Methods of data analysis

An exploration of ways in which clients’ speech, language, communication, and feeding, eating, drinking and swallowing (FEDS) abilities are evaluated in diagnostic report writing exemplars.

Methods of data collection

O’Malley-Keighran (2016)

Methodology

Research questions/Aims

Researchers

Table 1.2 Mapping of research questions to paradigms, methodology and methods: Examples from communication disorders research.

To identify and advance understanding about how experienced speech and language therapists engage in reflective practice to develop their knowledge of head and neck cancer rehabilitation.

To explain the processes involved in collaborative relationships in early intervention services from the multiple perspectives of all those involved in the team.

To explore children’s, parents’, peers’ and professionals’ experiences of children’s language impairment.

To examine naturally-occurring instances of problems with intelligibility that resulted in multiple attempts at repair in order to consider repair initiation strategies that might restrict or enhance participation.

Caty et al. (2016)

Carroll and Sixsmith (2016)

Hambly (2014)

Griffiths, Barnes, Britten, & Wilkinson (2011)

Arts-based methods with children with language impairment. Interviews with the children’s parents, teachers, learning support assistants, speech and language therapists and siblings and/or friends.

Interpretive phenomenological analysis (IPA) and case study

Video-recordings of informal conversations with people with Parkinson’s Disease in their home setting involving familiar conversation partners.

Interviews with parents and professionals from an early intervention team and participatory methods with five young children with developmental disabilities e.g., talking mats, babycam.

Grounded theory and case study

Conversation analysis

In-depth, semi-structured interviews were conducted with 12 SLPs working in head and neck cancer rehabilitation.

Interviews with young people who used AAC, with heads of technology and a quality assurance manager, internet blog and policy documents.

Participant observation and extended narrative conversations with 9 key young people, in a variety of contexts over an 18-month period.

Grounded theory

To explore ways in which young Constructivist people with a diagnosis of cerebral Grounded palsy who use augmentative and Therapy alternative communication (AAC) perceive using the Internet and social media.

Hynan, Goldbart, & Murray (2015)

Ethnography

To explore identity and the lifeworlds of teenagers who use AAC.

Wickenden (2011)

Conversation analysis techniques to explore repair initiators.

Thematic analysis

Grounded theory methods of data analysis.

Grounded theory methods (e.g., constant comparison and memo-ing).

Initial, focused and theoretical coding supported by memo writing.

Thematic analysis

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of participatory research: “shared ownership of research projects, community based analysis of social problems, and orientation towards community action”. There are different types of participatory research: for example, Participatory Action Research (PAR), Participatory Rural Appraisal (PRA), Participatory Health Research (PHR), and Participatory Learning and Action (PLA). O’Kane (2000) argued that participatory research approaches do not rely heavily on reading or writing skills but on visual materials and the active generation of ideas. For example, McMenamin, Tierney and McFarlane (2015) used Participatory Learning and Action (PLA) to explore insider experiences of aphasia and a conversation partner programme which involved people with aphasia as co-researchers (see Table 2.1 and Chapter 8).

Phenomenology and hermeneutics The literature around phenomenology can be confusing, as the term is used to refer to both a philosophical foundation for the qualitative research paradigm and an interpretive research methodology in its own right. Early phenomenologists such as Heidegger (1962, 1982) and Husserl (1973) focused on understanding and describing individuals’ constructions of their world views and the ‘essence’ of the experience of everyday situations and contexts from participants’ viewpoints. The emphasis was on uncovering the meanings of the phenomenon under investigation for participants. The task of phenomenology, as described by van Manen (1990, p.9), is to ask, “What is this or that kind of experience like?” and to systematically uncover, through reflection and dialogue, the internal meaning structures of a lived experience, be it an activity or role undertaken in life or the experience of the ‘lifeworld existential’ of lived body, space, time and relation. These uncovered structures of the meaning of lived experience are then described with depth and richness. Van Manen (1990) argues that these descriptions should resonate with our sense of lived life. They should evoke in readers the “phenomenological nod” (van Manen 1990, p.27) in recognition that this experience so richly described is one that they too could have had. Descriptions of this type inevitably involve an element of interpretation, as there are no such things as “uninterpreted phenomena ... the (phenomenological) ‘facts’ of lived experience are always already meaningfully (hermeneutically) experienced. Moreover, even the ‘facts’ of lived experience need to be captured in language (the human science text) and this is inevitably an interpretive process” (van Manen, 1990, pp.180–181). Participants’ understandings of

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their lived experiences or their social constructions are interpreted by the researcher using hermeneutic techniques and are “compared and contrasted through a dialectal interchange” (Guba & Lincoln, 1994, p.111) between the participant and the researcher. Most researchers today using phenomenology would agree they were using hermeneutic phenomenology, defined by van Manen (1990, p.180) thus: Hermeneutic phenomenology tries to be attentive to both terms of its methodology: it is a descriptive (phenomenological) methodology because it wants to be attentive to how things appear, it wants to let things speak for themselves; it is an interpretive (hermeneutic) methodology because it claims that there are no such things as uninterpreted phenomena. Phenomenology has been used in research in communication disorders. For example, Brown, Worrall, Davidson and Howe (2010) used phenomenology to explore the meaning of living successfully with aphasia (see Table 1.2).

Qualitative case studies Another term that may be confusing is ‘case study’ because case study designs are used in both qualitative and quantitative research but in different ways. In single case study design research (SCD) a quantitative paradigm is used and researchers measure behaviours of interest, chart these measurements and, in some cases, subject the data to statistical analysis (for example, see Thompson, 2006, for ways in which SCD has been used in aphasia research). SCD is a powerful research approach that can help us understand individual variation in responses to intervention. Early trials of the Lidcombe programme for preschool children who stutter started from a series of SCD (Onslow, Costa, & Rue, 1990) that suggested the programme might be effective and warranted larger-scale clinical trials. Qualitative case studies are distinct from the better-known medical case studies that appear in journals or are used in teaching, which may or may not be quantitative but nonetheless lack emphasis on how the individual(s) under study experience the phenomenon in question. In qualitative research, the case is a ‘bounded unit’; bounded in time (such as a 3-month period) or place (such as a workplace or particular geographical location). Qualitative case studies have as their focus individuals, groups, or institutions. Case

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Table 1.3 Checklist for thinking about qualitative research (adapted from Braun & Clarke, 2013, p.43). Question

Notes for my research project

What do I want to know? Why do I want to know it? What assumptions am I making about research and knowledge (what are my theoretical and methodological positions)? What type of data would best answer these questions? What type of data will I use to tell me what I want to know? How much data will I need? How will I collect my data? If my research involves participants: Who do I need to collect data from? How will I access and recruit those participants? How will I analyze my data in order to answer my questions? What particular ethical issues do I need to consider? Are there any pragmatic or practical factors that I need to take into account?”

studies can be theory-directed (developed to test or refine existing theory) or theory-generating (conducted to assist in the development of substantive theory) (Grbich, 2003). Case studies can also be intrinsic, when the focus is on understanding an individual case, or instrumental, when the focus is on understanding an issue or refining a theory (Stake, 1995); in the latter, the case might be a school, a service, or a profession. Sorin-Peters (2004) presented an argument for the use of qualitative case study methodology in communication disorders research, illustrating the approach with a case study of the psychosocial

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Top tips (adapted from Silverman, 2013, p.39)

• Begin in familiar territory • Find a theoretical orientation • Narrow down your topic • Do not try to re-invent the wheel • Keep writing • Begin data analysis early • Think critically about the data • Use your supervisor • Use other resources and opportunities • Do not expect a steady learning curve • Keep a research diary • Do not reproach yourself about setbacks • Treat field relations as data • Understand that there is no perfect model of research design

consequences of living with aphasia. The value of case studies lies in their breadth, depth, and richness of detail, and holistic presentation of aspects of the life of an individual or of a situation. As with single case design methods, multiple case studies of a phenomenon can be invaluable in developing or refining theory. Some qualitative researchers have combined the case study approach with other approaches. For example, Carroll and Sixsmith (2016) used case study and grounded theory to explore experiences of collaboration in early intervention, and Hambly (2014) combined case study and interpretive phenomenology to explore developmental language disorder from multiple perspectives (see Table 1.2 and Chapter 10). Therefore, case studies can be qualitative (e.g., Sorin-Peters, 2004; Yin, 2013) and, increasingly, case studies combine qualitative and quantitative components.

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Having provided an overview of methodologies, Table 1.2 illustrates ways in which these methodologies have been used in the field of communication disorders.

What would help you to decide to use a qualitative paradigm? So far, we have provided a brief overview of the different approaches that can be used within the qualitative paradigm. We will be providing further detail on these approaches in Chapters 2‒10. If you are considering qualitative research it might be helpful to work through a checklist to help you to plan your research (see Table 1.3).

Conclusion In this chapter, we provided an overview of research paradigms used in communication disorders research and speech and language therapy practice, and explained some of the key concepts and terminology used in qualitative research. Understanding the philosophical bases of quantitative and qualitative research paradigms and how they differ will hopefully help you avoid confusion as you move through the chapters in the book, learning about the major qualitative research methodologies and the key research methods used in qualitative research. The major methodologies in qualitative research are presented in more depth in Chapters 2‒10, along with case studies that illustrate how the methodologies have been used. These interpretive methodologies could be used more extensively to investigate the assumptions, beliefs, values, theories, and models of practice or the meanings of communication disorders for the people concerned. We hope that you do not feel overwhelmed at this stage and if you are thinking about doing qualitative research there is some useful advice in Box 1.1.

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Müller, N., Mok, Z., & Keegan, L. (2014). Systemic functional linguistics and qualitative research in clinical applied linguistics. In M. Ball, N. Müller, & R. Nelson (Eds), Handbook of Qualitative Research in Communication Disorders (pp.149‒170). London: Psychology Press. O’Brien, B., Harris, I., Beckman, M., Reed, S., & Cook, D. (2014). Standards for reporting qualitative research: A synthesis of recommendations. Academic Medicine, 89, 1245‒1251. Ocloo, J. & Matthews, R. (2016). From tokenism to empowerment: Progressing patient and public involvement in healthcare improvement. British Medical Journal Quality and Safety, 25, 626‒632. O’Kane, C. (2000). The development of participatory techniques: Facilitating children’s views about decisions which affect them. In P. Christensen & A. James (Eds), Research with Children (pp.136‒159). Abingdon, UK: RoutledgeFalmer. O’Malley-Keighran, M.P. (2016). ‘Presenting complaints’: Professional discourse and evaluation in speech and language therapy report writing exemplars. Journal of Interactional Research in Communication Disorders, 7(2), 213‒242. Onslow, M., Costa, L., & Rue, S. (1990). Direct early intervention with stuttering: Some preliminary data. Journal of Speech and Hearing Disorders, 55, 405‒416. Oxford University Press. (2009). Glossary of key terms. Retrieved on 27th July 2018 from http:// lib.oup.com.au/he/media_journalism/weerakkody/weerakkody_research_glossary.pdf Parr, S. (2007). Living with severe aphasia: Tracking social exclusion. Aphasiology, 21(1), 98‒123. Peräkylä, A. (2005). Analyzing talk and text. In N. Denzin & Y. Lincoln (Eds), The Sage Handbook of Qualitative Research (pp.869‒886). London: Sage. Peräkylä, A. & Ruusuvuori, J. (2011). Analyzing talk and text. In N. Denzin & Y. Lincoln (Eds). The Sage Handbook of Qualitative Research, 4th ed. (pp.529‒524). London: Sage. Polkinghorne, D. (1995). Narrative configuration in qualitative analysis. In J. Amos Hatch & R. Wisniewski (Eds), Life History and Narrative (pp.5‒24). London: Falmer Press. Rice, P. & Ezzy, D. (1999). Qualitative Research Methods: A Health Focus. South Melbourne, Australia: Oxford University Press Ricoeur, P. (1980). Narrative time. Critical Inquiry, 7(1), 169‒190. Sackett, D., Rosenberg, W., Gray, J., Haynes, R., & Richardson, W. (1996). Evidence-based medicine: What is is and what it isn’t. British Medical Journal, 312, 71—72. Sacks, H., Schegloff, E.A. & Jefferson, G. (1974). A simplest systematics for the organization of turn taking for conversation. Language, 50, 696‒735. Schutz, A. (1967). The Phenomenology of the Social World. Evanston, IL: Northwestern University Press. Schwandt, T.R. (1990). Paths to inquiry in the social disciplines: Scientific, constructivist, and critical theory methodologies. The Paradigm Dialog, 258‒276.

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Schwandt, T. (1994). Constructivist, interpretivist approaches to human inquiry. In N. Denzin & Y. Lincoln (Eds), The Sage Handbook of Qualitative Research (pp.118‒137). Thousand Oaks, CA: Sage. Searle, J. (1995). The Construction of Social Reality. London: Penguin. Silverman, D. (2013). Doing Qualitative Research, 4th ed. London: Sage. Sorin-Peters, R. (2004). Discussion - The case for qualitative case study methodology in aphasia: An introduction. Aphasiology, 18(10), 937‒949. Spradley, J. (1979). The Ethnographic Interview. Fort Worth, TX: Harcourt, Brace, Jovanovich. Stake, R.E. (1995). The Art of Case Study Research. London: Sage. Strauss, A. & Corbin, J. (1990). Basics of Qualitative Research. London: Sage. Thompson, C. (2006). Single subject controlled experiments in aphasia: The science and the state of the science. Aphasiology, 39(4), 266‒291. United Nations (1948). Universal Declaration of Human Rights. Retrieved on 10th August 2018 from http://un.org/en/universal-declaration-human-rights/ University of Toronto. (no date). What is critical qualitative research? Centre for Critical Qualitative Research. University of Toronto. Retrieved on 14th October 2017 from http://www.ccqhr.utoronto.ca/what-is-critical-qualitative-research van Manen, M. (1990). Researching Lived Experience: Human Science for an Action Sensitive Pedagogy. London, Ontario: The University of Western Ontario. Vygotsky, L.S. (1987). The Collected Works of L.S. Vygotsky: Vol 1 Problems of General Psychology. New York: Plenum. Wickenden, M. (2011). Talking to teenagers: Using anthropological methods to explore identity and the lifeworlds of young people who use AAC. Communication Disorders Quarterly, 32(3), 11‒163. World Health Organisation (WHO) (2001). International Classification of Functioning, Disability, and Health. Geneva: World Health Organisation. Yin, R. (2013). Case Study Research: Design and Methods, 5th ed. London: Sage.

Section II Qualitative research methodologies

2 C onversation Analysis and its use in communication disorders research Sarah Griffiths, Hilary Gardner and Rachel Bear What is Conversation Analysis? Conversation Analysis (CA) is a rigorous empirical approach to examining the sequential organization of talk-in-interaction. Its origins lie in the work of the sociologist Harvey Sacks and his colleagues Emanuel Schegloff and Gail Jefferson in the 1960s and 1970s (Sacks, Schegloff, & Jefferson, 1974). Sacks became interested in working with real conversational data, starting with analysis of phone calls to a suicide prevention centre in San Francisco. Later he moved his attention to everyday talk in his seminal lecture series (Sacks, 1995). At the time, prominent linguists such as Noam Chomsky (https://en.wikipedia. org/wiki/Noam_Chomsky) believed conversation was too disorganized and chaotic to be worthy of in-depth structural analysis. Yet Sacks showed that we orientate (largely unconsciously) to orderly and meaningful conversation ‘rules’. CA is a technical discipline used to investigate competencies underlying ordinary conversation. There is a commitment to using recordings (preferably video) of naturally-occurring interactions, rather than other data collection methods such as taking field notes. This avoids ‘interpretive filtering’ (Speer & Hutchby, 2003). Unexpected, counter-intuitive events happen in real conversations that are unlikely to be accurately represented by researchers reflecting on events or working with invented examples (Sidnell, 2010). Recordings are transcribed in detail, accounting for features of talk such as prosody, simultaneous talk and silence. Transcriptions often capture nonvocal features including gesture, eye gaze, body movement, and the use of artefacts like augmentative and alternative communication (AAC) systems. Alongside the video/audio recordings, transcripts are studied for recurrent

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patterns, examining what social actions people seem to be carrying out and how these are achieved (Sidnell, 2010). Discourse analysis is a broad approach; an umbrella term for examining what people do with talk and text (Antaki, 2008). CA is one type of discourse analysis, focusing specifically on talk-in-interaction. It is concerned with how participants understand and respond to each other in each turn at talk. Analysis relies on the ‘next turn proof procedure’ (Hutchby & Wooffitt, 2008). This means speakers display in their sequentially ‘next’ turns an understanding of what action the prior turn was doing. The focus is on the properties of talk oriented to by the participants, proved by their ‘next turns’ instead of properties of talk based on prior assumptions of the analyst.

How does CA fit within a qualitative research paradigm? CA is typically described as a qualitative method (Taylor, 2001) but does not compare easily with other qualitative methods. Although in CA conversation is seen as socially constructed, there are distinctions between its methods and those usually associated with social constructivist approaches drawing on phenomenology; these do not aim to capture a single truth but offer inevitably partial interpretations. In contrast, CA strives for detached observation. The discovered patterns are often demonstrated as highly generalizable across conversations and even across cultures. Unlike the positivist viewpoint, however, generalizability in CA refers to patterns shown to be normative and expected rather than inevitable (Wooffitt, 2001). For example, when declining invitations, speakers typically structure their turns in predictable ways, including accounting for the rejection, e.g., ‘I’m busy tonight’ (Atkinson & Drew, 1979). Adherence to this rule, that we seem to know and use, is not inevitable. There will be speakers who break from convention. A rhetoric of both positivism and social constructivism in CA has led to confusion about the position of CA as a research paradigm (Svennevig & Skovholt, 2005). On the one hand, CA incorporates the language of pure inductive science, in which there is a single objective reality. On the other hand, ideas about social reality being an interactional achievement are central. This fits a social-constructivist view of the world: “When people talk, they are simultaneously and reflexively talking their relationships, organisations, and whole institutions into action or into ‘being’” (Boden, 1994, p.14). Svennevig and Skovholt (2005) settle on the view of CA as one version of

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social constructivism, with reality viewed as an orderly construct, but created by participants in instances of interaction. In CA, the practices and procedures of social action, to which participants are normatively orientated, are stable and are not dependent on the motivational, psychological and sociological characteristic of participants (Heritage, 1995). Rather, conversational practices are the medium through which these characteristics manifest themselves.

How might CA be used in communication disability research? CA has been used to reveal patterns within interaction that differ from the ‘norm’, to identify whether observed phenomena are treated as problematic by participants and whether successful compensatory strategies are adopted. Clinical CA studies began emerging in the early 1990s, initially in aphasiology (e.g., Milroy & Perkins, 1992), providing a new perspective within the communication disorders field previously dominated by neuroscience and psycholinguistics. Since the 1990s, CA has been used to research a range of communication disorders. See O’Reilly and colleagues (2017), for instance, for a collection of studies exploring social interaction in autism spectrum disorders. Conversation analysts attend to how all parties collaborate in conversations rather than focusing on the individual with the ‘impairment’. CA has been used to examine how disruptions to speech and language affect the usual turn-taking system and how interactants collaborate to repair difficulties in hearing and understanding. The CA terms ‘turn-taking’ and ‘repair’ will therefore be explained.

Turn-taking in everyday conversation Sacks et al. (1974) described the rules governing turn-taking and turn construction in everyday conversation which result in the minimization of gaps and overlaps. They describe how a current speaker may select or ‘choose’ who will be the next speaker through various means such as addressing that speaker directly using eye gaze or through implication. If the current speaker does not select a next speaker, a person may self-select. Whoever starts speaking first becomes the new current speaker. If no-one is selected or self-selects as the next speaker, the current speaker may or may not continue speaking. Single turns of talk can be constructed from one or more units, labelled ‘Turn-constructional units’ (TCUs); recognizably potentially complete units

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of talk. TCUs can comprise a variety of grammatical units: words, phrases, clauses and sentences. Recipients of talk base judgements of whether a turn is nearing completion on such features as semantic context and intonation. A one-word utterance like ‘Saturday’ may be heard as complete if occurring in response to ‘What day are you leaving?’ but not yet complete in response to ‘What’s the weather forecast this weekend?’ TCUs are ‘projectable’; in other words, a recipient might predict what it will take to complete the unit of talk currently under way. As a TCU nears completion, a transition relevance place (TRP), a space in which it becomes appropriate for another to start talking, opens up. For instance, as the utterance ‘Saturday’ in response to ‘What day are you leaving?’ nears completion, a TRP opens up and a next speaker might start gearing up to take a turn. However, if no potential next speaker begins talking in that TRP, the current speaker might extend their current turn by adding another TCU, e.g., ‘Saturday. I’ll get the train’.

Repair in everyday conversation ‘Repair’ describes a range of practices available to speakers for resolving troubles with speaking (e.g., false starts, word retrieval problems and hesitations), hearing, understanding (Schegloff, Jefferson, & Sacks, 1977), or acceptability (Schegloff, 2007). In CA, a problematic segment of talk is a ‘trouble source’ or ‘repairable’. When the need for repair arises, unless this is ignored, a repair sequence typically unfolds in two stages. First, repair initiation occurs, whereby the need for repair is initiated by the trouble source speaker (self-initiation of repair) or another speaker (other-initiation of repair). Second, there is a repair outcome: a “solution or abandonment of the problem” (Schegloff, 2000, p.207). The solution can be carried out by ‘self ’ or ‘other’. An example of each type of repair sequence follows. A and B denote different speakers.

Self-initiated self-repair A: I watched that wildlife programme last night about the um…um…oh you know…sharks!

Self-initiated other-repair A: I watched that wildlife programme last night about the um…um…oh dear

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B: Sharks. A: Yes! That’s the one.

Other-initiated self-repair A: Can you pass me the book please? B: The book? A: I mean the magazine.

Other-initiated other-repair A: Did you have a nice holiday? B: It wasn’t a holiday it was a sabbatical. As conversationalists, our preference is also for progression in talk. ‘Adjacency’ is an important feature of the turn-taking system in that one element moves on to a hearably-next-one with nothing intervening (Schegloff, 2007). Repair is a powerful mechanism that can replace or defer what was to come next in the sequence. In adult conversation there is a general preference towards selfrepair (Schegloff et al., 1977). Other-repair can be interpreted as addressing lapses in competence. When a trouble source arises, it may be that conversationalists are able to adhere to the principle of progressivity by not giving any overt attention to repair (Heritage, 2007). However, repair may be essential for achieving joint understanding, which itself enables progression. Other-initiation (OI) of repair is therefore generally avoided, unless absolutely necessary for the advancement of the sequence under way (Sidnell, 2010). Wilkinson (2013) discusses a range of benefits derived from using CA to research communication disorders. For example, the ‘next turn proof procedure’ makes the approach particularly useful for examining troubles arising in talk where participants have difficulty communicating. The preference for progressivity means that a delay or absence in utterances that are projected as ‘due’ is noticeable and accountably relevant. The general rule of ‘adjacency’ results in ‘first pair parts’ (FPPs) such as questions or invitations being routinely followed by ‘second pair parts’ (SPPs) such as answers and acceptances (Schegloff, 2007). If SPPs are absent or delayed the speaker is opened up to negative inferences regarding ability or willingness to provide a relevant next turn. Also, as a speaker’s turn is ongoing, listeners ordinarily monitor for a possible TRP. If a selected next speaker does not take up a turn without delay,

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and a delay of more than one second is treated as relevant (Jefferson, 1988), this is noticeable and accountable. A communication disorder, with its associated linguistic or phonetic limitations, provides challenges for speakers to adhere to these constraints and expectations inherent in the turn-taking system (Wilkinson, 2013). Therefore, repair is a pervasive feature of communication disordered conversations. Most CA communication disability studies reveal what happens when progression is impeded by repair and how conversationalists collaborate to resolve the trouble source or avoid disruption. For example, Griffiths, Barnes, Britten and Wilkinson (2012) found that speakers with Parkinson’s Disease (PD), likely due to delayed initiation of speech, long pauses and cognitive difficulties, are vulnerable to being overlapped in talk, which can lead to the need for repair. Alternately, this leads to the PD speakers’ turns being effectively deleted from the interaction, which poses a threat to participation. CA can also uncover competencies in methods used by participants to compensate and adapt to challenges thrown up by communication disability. For instance, Wilkinson, Beeke and Maxim (2003), using a CA approach, found speakers with fluent aphasia often construct turns using grammatical structures different from those they might have used before the aphasia. One example is ‘fronting’, whereby instead of canonical word order (subject verb object), a noun phrase is followed by a proposition relating to that noun phrase. A man with aphasia, GB, and his partner are discussing different kitchen knives they prefer to use. GB says, ‘My little ... you don’t like’ (a noun phrase followed by a pause and then a proposition relating to the noun phrase). In this way the person with aphasia is able to produce a relatively complex contribution to the interaction without need for repair. Radford and Mahon (2010) analyzed interactions between teachers and children with specific language or hearing impairment. They focused on the role of nonverbal communication in language learning through storybook sharing, including how gesture is used to facilitate turn-taking. The children were shown to gesture in overlap with the teacher’s verbal utterance in order to secure the next turn. They might also sustain gestures (e.g., continue to move fingers as if playing the flute) to ‘hold’ a turn and prevent the teacher from taking the next turn. In this study, CA was used to highlight interactional competencies that might not otherwise be recognized when viewing children from a deficit perspective. There are numerous further examples of CA uncovering unexpected competencies, across a range of client groups. Some notable examples are:

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Bloch and Wilkinson (2013), Bloch and Beeke (2008), and Stribling, Rae and Dickerson (2007). The use of CA in cross-cultural communication disability research is an exciting emerging field. Mohammed Zain, Muskett and Gardner (2017) studied recordings of a Malay-speaking child with his mother. The authors examined the child’s repetitive use of ‘apa tu’ (‘what is that?’) and compared this to existing studies of English-speaking children with ASD. Their comparative analysis showed that CA has potential to identify universal features of atypical human interaction. They suggest CA may be a useful tool for practitioners in the assessment of individuals with ASD from diverse linguistic backgrounds. CA findings have informed the development of several published assessment and intervention tools (Lock, Wilkinson, & Bryan, 2001; Perkins, Whitworth, Perkins, & Lesser, 1997), and most recently, the online resource ‘Better Conversations with Aphasia’ (Beeke, Sirman, Beckley, Maxim, Edwards, Swinburn, & Best, 2013).

What methods can you use in Conversation Analysis? Data collection In CA, it is important to try and capture interaction that is as naturalistic as possible. Video data are generally preferred when researching conversation in communication disorders, unless phone conversations are the interactions of interest. It is particularly relevant to capture nonvocal behaviours and how they are used in interaction, often as a valuable resource where vocal methods are limited (Wilkinson, 2014). Mondana (2013) provides detailed practical advice regarding data collection methods. As with any method involving videoing, there is a risk that participants will become unduly influenced by the camera’s presence. Common practice is to train participants to record themselves without the analyst present. Conversation partners (CPs) may try to steer conversations to demonstrate particular difficulties. However, this can be minimized by explaining what is required, i.e., representation of what would typically happen (Wilkinson, 2014). A conversation analyst will need to consider the amount of data required to address the specific research aims. It is important to collect enough to enable participants to get used to the camera (sometimes the early segments of recordings are not used for this reason). It might be appropriate to capture

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a range of interactants in a variety of different contexts. If so, methods of obtaining informed consent will need to be planned. The researcher should bear in mind that, in CA, transcription is close and detailed, therefore timeconsuming. Depending on the nature of the data, it can take up to 20 hours to transcribe one hour of interaction (Wiggins & Potter, 2017). CA can be used in combination with other data collection methods to provide triangulation. Wilkinson, Bryan, Lock and Sage (2010), for instance, used a mix of CA, interviewing and quantitative methods to evaluate the success of a conversation-focused intervention for a couple where one partner had aphasia.

Data transcription and analysis CA transcription and analysis are concerned with representing and examining the minutiae of what happens in talk, moment by moment. This requires practice and the development of technical skills. Therefore, it is a good idea to enrol on an introductory CA course or enlist support and supervision of experienced CA researchers (see Hepburn & Bolden, 2013, for a detailed discussion of transcription issues). The first author of this chapter carried out CA research into everyday conversations between people with PD and their familiar CPs, in the home setting (Griffiths, 2013). What follows is an illustration of the process undertaken during transcription and analysis of her video data. Familiarization with the data took place, through repeated viewings, and she carried out initial verbatim transcription of the entire data set. Following this stage, a full CA transcription of sections of the data took place, using the Jefferson (2004) system of transcription (see Appendix 2.1) which takes account of prosodic features, simultaneous talk and (where of interest) nonverbal features. At first, sections of data were chosen for CA transcription because they were in some way interesting. Through transcription, it was possible to attend to details not necessarily apparent to the ordinary listener. Transcription works as a major ‘noticing device’ (Ten Have, 2007). Recordings were replayed many times and transcripts refined, both materials worked with simultaneously until it was possible to capture “nuances of intonation and breath and pacing because these can turn out to be consequential for the way in which talk is heard by its recipients, for the way they respond to it and thus for the way it is organized” (Sidnell, 2010, p.23). Data transcription and analysis took place using Transana software (Woods & Fassnacht, 2008). This allows a researcher to work with large amounts of

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video data, use CA transcription conventions, measure pause durations and organize clips into meaningful categories and collections. There are alternative software programs, such as ELAN (Sloetjes & Wittenburg, 2008), developed by the Max Planck Institute for Psycholinguistics. As more and more close transcription took place, each transcript was scrutinized for remarkable phenomena that could be described as disturbances to the systematic rules governing conversation or as competencies in everyday talk. Early on, potential analytic foci in the study of people with PD included ‘repair’, ‘pausing’ ‘overlap’ and ‘humour’. In deciding which phenomenon to focus on first, Sidnell (2012) recommends going for the ‘low hanging fruit’; the feature easily identifiable and appearing most commonly across a range of contexts and environments. That low hanging fruit was undoubtedly ‘repair’. All instances of phenomena associated with repair, for instance ‘otherinitiation of repair’, within and across participants, were collected and examined (Ten Have, 2007). Distinctive and shared features were noted. Patterns of consistency in terms of turn design and positioning in the sequence were identified. Instances that appeared to differ from the emerging pattern in terms of design or positioning (deviant cases) were examined for what they could reveal about the integrity of the ongoing analysis or the interactional consequences for the participants of deviation from a rule. Deviation in this case meant avoiding initiating repair by glossing over the problem and changing the topic. Analysis of collections involved tracking back and forth between in-depth consideration of individual instances and the view across multiple cases focusing on their generic properties (Sidnell, 2012).

Methodological rigour in CA There are specific methods used in CA to ensure rigour in terms of credibility, dependability, confirmability and transferability (Guba & Lincoln, 1994). These will now be explored.

Credibility Member validation can be used to address the accuracy of findings in describing social phenomena. A researcher might take findings back to original participants for comment. In the Griffiths (2013) study, original participants commented on a written summary of overall findings. However, Griffiths felt that some within-case findings had potential to lead to sensitivity and blame. She therefore

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presented findings to groups of people who belonged to the same category as the research participants; people with PD and relatives. She used clinical simulation actors to create dramatized examples of findings, thus protecting the anonymity of original participants. The aim was to test recognition of the identified phenomena. A CA study can be judged credible if it presents “such faithful descriptions of interpretations of a human experience that the people having that experience would immediately recognize it from those descriptions or interpretations as their own” (Sandelowski, 1986, p.28). Of all the findings, the fact that speakers with PD can often be ‘talked over’ seemed to especially resonate with the groups. The credibility of CA findings is also strengthened by the presentation of transcribed data extracts in the write-up. This is an inherent characteristic of CA methodology, placing readers in the same position as the researcher, allowing conclusions drawn to be checked back against the evidence; a form of validation (Wetherall, 2001). Also, credibility is enhanced by describing deviant cases, inconsistencies and diversity (Potter & Wetherall, 1987). Existing CA work, specifically relevant to each particular finding, is explored in order to situate findings within the field and to build on or challenge such findings. This contributes to the coherence of the presented arguments (Wetherall, 2001). For instance, Griffiths et al. (2012), in exploring overlap, examined literature on how overlap plays out in ordinary conversations as well as in other communication disorders.

Dependability and confirmability It is common practice in CA for researchers to present findings and insights for others to critically inspect (Ten Have, 2007). “As a practice and discipline, CA is rooted in local communities of practitioners…” and this “…provides an audience for trying out observations” (Sidnell, 2010, p.29). This is usually done in ‘data sessions’, whereby researchers present video or audio data extracts, along with transcripts, to a group of other CA researchers. Repeated viewing/listening within the group can lead to proffering of observations and constructive criticism regarding ongoing analysis and how well this is grounded in the data rather than being impressionistic (Ten Have, 2007). As with other qualitative methods, reflexivity enhances the credibility of the research. An analytic diary can be used to record reflections and ideas throughout the process. It is usual for CA researchers to reflect openly on their own abilities to remain unbiased and on the potential effects of their

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background and experience in shaping the research (Roberts, Preist, & Traynor, 2006). For instance, there can be difficulties associated with being a clinician-researcher. Participants’ decisions over when and what to video could be subject to bias due to their understanding of the researcher as a clinician, despite careful instructions to video ‘what would normally happen’. The clinician-researcher may have strong expectations regarding findings based on clinical expertise, but it is important to work at achieving analytic distance. Griffiths expected that there would be little variation in intonation of speakers with PD, due to hypokinetic dysarthria. The objectivity inherent in CA challenged this preconception; she had to transcribe what she heard, and what she heard was lots of variation in intonation.

Transferability How far can CA findings be applied to other contexts or groups? Claims made typically vary in strength. Findings have been presented as generic rules of conversation or, less optimistically, possible actions that might occur in specific settings. Svennevig and Skovholt (2005) view the first extreme as too specific and overly ambitious and the second as overly cautious, arguing that CA should know its limits but that even small-scale studies can aim for transferability of findings across data sets, activities and social relationships. Dissemination of findings through peer-reviewed journals can lead to ‘particularizability’ (Stake, 2010); for example, when findings resonate with speech and language therapists (SLTs) thinking about their own experiences with clients. “It is the reader who has to ask, what is there in this study that I can apply to my own situation and what clearly does not apply” (Patton, 1980, p.34). Stronger claims of transferability accumulate over time through aggregation, as further studies reveal similar patterns (Svennevig & Skovholt, 2005). Once findings are replicated, quantitative methods may become useful and appropriate to determine frequency of occurrence and compare population groups.

Case studies In this section, we present case studies illustrating how we used conversation analysis.

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Case study 1 ‘Disjunct turns’: A within-case phenomenon in conversations of speakers with PD Sarah Griffiths This case study is based on research already discussed, exploring everyday conversations for people with PD, a hitherto unpublished case from a larger PhD study (Griffiths, 2013). Associated studies are Griffiths et al. (2011, 2012, 2015). Video data comprised 10 hours of informal conversations between 13 people with PD and their CPs. The following describes analysis of one phone conversation recorded by Lily (speaker with PD) (pseudonyms are used). Her conversations include long pauses, likely due to speech initiation difficulties. A within-case pattern was identified whereby Lily sometimes produces turns that seem disjunct from the previous speaker’s turn. Lily and her husband, Sahir, have called Margy, Sahir’s daughter. Analysis depended on tracking how the topic developed and changed over the sequence. In Extract One, line 1, Margy initiates the topic of a trip the couple are planning to visit family member Julia. Extract One 1. Margy: Sahir tells me that you could very well be going there for 2. Christ↓mas 3. Lily: (0.6) ↑puh-poss↓ibly

4. Sahir: ↓°mm [mm] ↑yeah° 5. Margy:

[mm]:

6. Sahir: °↑yeah° 7. Lily: [uh] Lily’s minimal response (line 3) seems incomplete and, following this, the topic seems at risk of decay. At line 7 Lily may have been about to launch into a topic progressing turn. Margy starts up in overlap at line 8 and wins the floor. Margy’s tag question ‘doesn’t it?’, line 8, acts to elicit a fuller response from Lily, who does not attempt to complete the turn started at line 7. She takes up the new topic of the weather (line 9).

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After further talk on weather between Margy and Sahir (not shown), Margy pursues the topic at lines 21‒22 (Extract Two). This again receives a minimal response from Lily (line 23). Extract Two 21. Margy: mm. it might be i- might be cos you’re so close to the water. like 22. we are in Hemmington we don’t get ↓snow 23. Lily: that’s ↓good 24. (0.8) 25. Margy: Ye:ah. ↑well I dunno. sometimes I think if it’s gonna be cold and 26. miserable that snow is (um) quite pri↓ddy ↑hahahaha 27. Lily: but we can ↑wear ↓warm clothes

Margy continues to pursue the topic of the weather (lines 25‒26) and this time Lily responds more elaborately. However, the discourse marker ‘but’ (line 27) indicates disagreement and therefore seems disjunct from the previous turn, with which she appears to be in agreement. A possible explanation is that Lily still aims to progress the original topic of whether or not she and Sahir will go on their trip, i.e., ‘but we can wear warm clothes if we do go.’ The pause at line 28 could indicate trouble for Margy in understanding this slightly disjunct turn before she steps in with an agreement turn. Later on (Extract Three) Margy initiates a new topic (line 34). Extract Three 34. Margy: tell me about yer new chai:r ma ↓dar↑ling what’s all ↑that

35. a↓bout 36. L  ily: .ptk.hh (0.7) iz°da° (2.2) ptk.°god° (0.8) hh we’re ↑probably 37. going to a ho↓tel 38. (1.2)

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Lily struggles to get going but initiates a further new topic (lines 36‒37), disjunct from the previous turn, appearing to reject Margy’s proposed topic. Lines 36‒37 could be Lily taking the opportunity, given the conversational floor, to pursue her own agenda, reintroducing the topic raised at line 1: the proposed trip to Julia’s. The lack of fit with ongoing talk at lines 36‒37 causes problems, as evidenced by Margy’s pause at line 38. Margy does, however, display her own role as receiver of news at line 39. Lily then overlaps Margy’s turn at line 40 at a transition relevance place. She extends her previous turn by adding the location of the hotel. It would be reasonable to assume that the pause at line 38 did not reflect turn completion but that Lily was gearing up to extend her turn, as evidenced by line 40. It just so happened that intervening talk occurred before she managed to produce the extension. Another example of talk intervening during an extended turn comes later in Extract Four. Extract Four 64. Margy: I love you to ↓bits I wanted to thank you for your wonderful 65. ↓presents 66. (0.8) 67. Lily:

I’m [↑glad.]

68. Margy: [you] take it easy and enjoy your new chai:r 69. (1.1) 70. Lily: it makes you feel (0.9) that you can affo:rd ↓something doesn’t it

At line 64 Margy refers to monetary gifts Lily sent to Margy. At line 67 Lily starts to comment on this but Margy overlaps, perhaps not hearing Lily’s startup, to reintroduce the topic of the chair. After a pause (line 69) Lily extends the turn she started at line 67, pursuing the gifts topic (line 70). Again, what has occurred is an extended turn produced by Lily but with intervening talk from another. The pause at line 71 indicates that, to Margy, Lily’s turn at line 70 appears disjunct from the ongoing topic (the chair). Margy either reaches an understanding, having had time to process Lily’s turn, or glosses over the need for repair at line 72.

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There are several potential causes of this within-case disjunct turns pattern of disjunct turns. Lily might simply be rejecting a current topic. Alternatively, due to speech initiation difficulties: (i) she previously missed an opportunity to develop a now closed topic and makes a move to reopen that topic, or (ii) her extended turns, before completed, are subject to incursions by other speakers. Other CA research has shown that turns-at-talk using graphical resources (handwriting or using AAC devices) are vulnerable to ‘incursion’ by other speakers before completion (Wilkinson, Bloch, & Clarke, 2011). Similarly, the speech initiation difficulties and consequent long pauses characteristic of Lily’s contributions make her turns vulnerable to incursion. Disjunct turns could be over-interpreted as a manifestation of the cognitive difficulties often associated with PD, leading to negative judgements regarding competence. Although Lily’s CPs acted to gloss over potential trouble caused by her disjunct turns, it is easy to imagine a pattern of repair initiation following such turns, with the aim of helping speakers keep on topic. This could impact on participation by preventing speakers with PD from pursuing their own agendas.

Case study 2 Adult-child interaction in a speech clinic Rachel Bear and Hilary Gardner A series of projects have explored speech and language therapy as a form of ‘institutional talk’ in which professional identity is talked into being (Richards & Seedhouse, 2005). This case study considers adult-child interaction within therapy tasks, where the children have speech disorders. The data include cohorts of SLTs and those who are supporting therapy such as mothers (Bear 2016; Gardner 2004), SLT students and teaching assistants (Gardner, 2006). Extracts One and Two are from work by Gardner (2006). Extracts Three and Four are from unpublished data (Bear, 2016). The data variably illustrate that a range of supportive turns used by clinicians may be absent or may be deployed differently by other adults. In the extracts below, sequenced turns are seen to move the child through repair with varying consequences. While direct ‘other repair’ will provide a clear model for a child to imitate, forms of invitation to self-repair set up the opportunity for the child to do corrective work independently. In the first extract (Gardner, 2006) a student SLT is asking a child (pseudonym ‘Chas’) to read his name, as a therapy task involving production of final [s]. Each child attempt is met with a pause and

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then two open class repair initiators (Drew, 1997) at lines 8 and 10, turns that do not display whether the listener has heard or understood any part of the utterance. These turns offer no interpretation to the child of his try at target nor do they offer any phonetic or other information as to the precise source of the error. The child appears to have little capacity to repair his output or does not realize the need to change. A request for repair such as ‘pardon’ may be a typical occurrence in natural conversation. However, within intervention the lack of specific information on the source of the error is a missed learning opportunity and can create a negative episode for both participants. The examples below display interactional ‘phenomena’ that are evidenced across two cohorts of data. Extract One: Second-year student and ‘Chas’ in an educational setting with supervisor SLT observing. Chas:

Sim:



(.5) ((student maintains gaze at child & point at word))

Chas:

↓Sim.



(.) ((student maintains gaze at child & point at word))

Chas:

Shim.

(.) Chas:

Si[m.

Student: [What’s that you were saying? (.5) Chas:

( )

Student: Sorry? (1.0) Chas:

Sim, sim

In a later instance from the same dyad, the student has learned to use a wider range of responses that support the child’s next turn. The task requires phrase level competence with an embedded final ‘s’ sound. The child (line 2) imitates the presented model but cannot execute the target /s/. The student uses a form of request for self-repair, presenting the child’s error back to him at

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51

line 3 (‘hou:’) and additionally supports the child by lengthening the locus of omission. The resulting repair at line 4 is successful and is evaluated as such. Extract Two: Session 3, student SLT and Chas Student: It’s house in the middle. Chas:

hou in the migger

Student: I heard hou: in the middle there. Chas:

House: in the migger.

Student: Good, that was better

(.)

↓okay.

Open class repair initiators, like those used unsuccessfully in Extract One, can help the child (pseudonym ‘Aaron’) to address the error where they already have some competence with the therapy target and can make a repair independently. In Extract Three the mother requests repair nonverbally using a fixed expression of confusion. At line 7 this results in a repeat of the error ‘key’ (response should be ‘tea’). However, the mother does not change her tactic and holds her silent gaze at the child (line 8). Aaron self-repairs from ‘key’ to the correct ‘tea’ displaying mastery of the expected response (line 9). His mother then checks that he is clear on the distinction and invites a repeat (line 10). He then isolates the word ‘tea’ with effortful production.



((Mother shows a picture of a key))

(1.0) Aaron

key



(2.0) ((Mother puts down a tea picture))

Aaron

↓key ((Aaron looks at mother laughing))

Mother

(1.0) ((confused expression))

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Aaron key Mother

(4.0) ((still looking confused))

Aaron

k- tea

Mother

which one do you think it is?

Aaron teah   Mother

that’s it.

Data analysis shows SLTs typically make judgements of competence on a turnby-turn basis, moving up and down the level of support, based on the child’s try. The teaching assistant or parent who is supporting the intervention may also display such interactional sensitivity or may need support to develop it. In Extract Four, Aaron’s mother is showing him pictures to name for phrase level [f]. Aaron (line 3) produces the target [f] at the beginning of the utterance rather than as a word-initial sound embedded in the phrase. His mother at line 4 then uses a request for self-repair which provides some phonetic information with supporting iconic gesture. Aaron has already shown that he knows [f] is required, the error being that of sequential placement which he reiterates. In line 6 his mother uses an open class repair initiator that offers no further support. The error is repeated (line 7) and his mother next uses a model (line 8) saying the shorter phrase ‘fat tummy’. Aaron imitates this successfully and the task is completed with a measure of positive success, albeit at a level of imitated rather than spontaneous output as was initially targeted. Extract Four: Clinical setting with mother carrying out a task with Aaron. Clinician is observing. Mother: oh my dear, who’s that, like grandad. ((shows Aaron picture)) Aaron: (A laughs & sustains labiodental posture))

a [f:iʔ daʔ dumi] (big fat tummy) he’s got a f: ((Moves hands out indicating large tummy))

Mother: Aaron: Mother:

a [f:id dat tumi] has a what, sorry? ((leans in to A))

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Aaron:a [fid dat= dumi] Mother: Aaron:

fat tummy.

fat dummy.

Mother:

↓that’s better.

It has been argued (Gardner 2006) that the implementation of a training programme, evidenced from rigorous CA analysis, which focuses on task interaction can enhance the delivery of speech and language therapy tasks by other adults. Top tips

• CA is a useful methodology for examining what actually happens

in interaction for people with communication disabilities. It is not necessarily easy for people to recall or describe what is going wrong with their conversations or the strategies that seem to work. CA is a way of identifying these factors empirically. It can reveal how people collaborate in conversation, rather than focusing on the individual with the impairment.

• CA can be used to evaluate change following intervention (e.g., Case study 2 showed change in a supporting adult’s turn taking. Although CA is primarily a research methodology rather than an intervention, the findings from CA studies can inform the development of evidence-based interventions.

• Video is the preferred data collection method when carrying out a

CA study, especially in communication disorders research where it is valuable to examine the use of nonvocal communication resources.

• Transcription is necessarily detailed and can be time-consuming. It is

recommended that novice CA researchers enrol on an introductory training course or seek support and supervision from researchers experienced in the methodology.

• Transcription

should be seen as the first stage of analysis in that it helps the researcher to get close to the data and make initial observations of potentially interesting features.

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• Software such as Transana and ELAN is available to support data

transcription. These packages include methods for working alongside video clips, CA transcription symbols and tools for measuring features like pause length.

• Join

a local group of researchers who are interested in using CA in a range of disciplines, to support you in your data collection, transcription and analysis. This might mean contacting your local university to enquire about such research groups. You might consider setting one up yourself.

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Appendix 2.1 Conversation Analysis transcription conventions (Jefferson, 2004). Symbol

Explanation

(0.8)

Numbers in parentheses = length of silence in tenths of a second

[

Start of overlapping talk

]

End of overlapping talk

.

Falling intonation

,

Rising intonation, suggesting continuation.

?

Rising intonation. Questioning inflection, but not necessarily a question

word

Underlining = stress/emphasis

°°

Degree signs = talk between these is markedly quieter than the surrounding talk

­

Up arrow = sharp intonation rise

¯

Down arrow = sharp intonation fall

.hh

Audible in-breath

(( ))

Double parentheses enclose description of environment or nonverbal behaviour

()

Empty parentheses enclose unintelligible talk

(word)

Words in parentheses indicate transcriber’s ‘best guess’ utterance

>