. ¨Evaluating the contribution of ¨interpretative phenomenological analysis to health psychology ¨ ¨Jonathan A Smith ¨ ¨ ¨ Brno 1 Literature search ¨Databases and search terms ¨1996-2008 ¨Start unspecified:1st one- Smith(1996) Psych& Health ¨ ¨Rationale for search: high bar, refereed, trends ¨Reminder: tip of the iceberg ¨Hard copies obtained ¨Papers not reporting empirical studies removed- few 2 . ¨ ¨Total number empirical IPA papers from databases: 294 ¨ ¨ 3 The trend ¨ ¨ ¨ ¨ ¨ 4 From outside UK Papers 1 0 0 2 4 3 11 Year 02 03 04 05 06 07 08 5 IPA outside UK ¨Slower to take off ¨Mainly English speaking world ¨Heavily linguistically reliant ¨ ¨Trend increasing ¨Inquiries, training, postgraduates ¨2009 (up to Aug)12 non-UK papers, 25% of total ¨ ¨ 6 Subject areas ¨Biggest domain: health ¨Second biggest: mental health ¨ ¨Categorize each paper with one or two keywords ¨Wide range: e.g. genetics, music, sport, carers ¨ ¨Biggest category: patient’s illness experience ¨69 papers, 23% of whole IPA corpus ¨Strict criterion: primary symptoms physical not mental ¨Dementia, addictions, eating disorders not included 7 Illness experience ¨Perhaps not surprising it’s biggest category ¨IPA established itself first in health psychology ¨Concern with lived experience raison d’etre of IPA ¨ ¨For IPA, usually experience of existential import ¨Illness can play significant part in person’s life ¨ ¨Reviewed conditions with 4 or more papers ¨Total papers reviewed: 51 8 The conditions Illness cluster Number of papers Chronic pain 11 Neurological 10 Heart disease 8 Cancer 5 Chronic fatigue syndrome 5 Arthritis 4 Urinary problems 4 Dermatology 4 9 Quality & qualitative research ¨What type of criteria? ¨Do different methods need different criteria? ¨When judge validity? ¨Who does the judging? ¨ ¨My view ¨Important to judge quality of work ¨General principles operationalizing for specific methods ¨However explicit, always requires judgement ¨ ¨ 10 Assessing quality of IPA ¨Primary task to judge quality of published papers ¨Research already done, can’t be undone ¨But also some inference about research process ¨ 11 The assessment ¨Developed criteria to assess quality ¨With another IPA researcher, Virginia Eatough ¨ ¨Tested against 4 batches of 8-10 papers each time ¨Iterative development ¨Close agreement at end ¨ ¨Three categories: ¨Unacceptable Acceptable Good ¨ ¨ 12 Unacceptable ¨Not consistent with principles of IPA ¨Lacks detail of method ¨Poor evidence base- this is usually the problem ¨ ¨Large no descriptive themes from large no participants ¨Analysis is crude, lacks nuance ¨Insufficient extracts from participants to support themes ¨Each with short summary & 1or 2 extract without interp ¨No explanation how prevalence determined ¨ ¨Not trustworthy ¨ ¨ 13 Acceptable ¨Consistent with IPA theory; Transparency of method ¨Coherent, plausible analysis ¨ ¨Sufficient sampling from corpus for each theme ¨Ideal: prevalence, representativeness, variability ¨ ¨Safe: always by extracts from half corpus per theme ¨Borderline: enough data to show variability ¨ ¨Trade: prevalence, strength of data, interpret’n ¨Partial: enough quality for some themes or participants 14 Good ¨Must clearly meet all the criteria for acceptable ¨Corpus well sampled: clearly satisfies prevalence, representativeness, variability ¨ ¨Offers something extra, point to degree of excellence: ¨Well focused, learned in depth about specific thing ¨Strong data or interpretation or integration ¨Reader engaged and finds it enlightening ¨Actually usually find it has all of these! ¨ ¨Could recommend to novice as a good exemplar of IPA 15 The quality of IPA work ¨Good 15 30% ¨Acceptable 26 50 ¨Unacceptable 10 20 ¨ ¨Interpretation/explanation? ¨ ¨ ¨Within the acceptable: ¨Acceptable (safe) 16 ¨Acceptable (borderline) 10 ¨ 16 Quality by area G A U Pain 4 7 0 Neurology 2 7 1 Heart disease 3 1 4 CFS 3 2 0 Cancer 1 3 1 Dermatology 1 2 1 Arthritis 1 1 2 Urinary 0 3 1 15 26 10 17 Examples of Unacceptable ¨Experience of cancer ¨21 participants,14 themes ¨Each theme has short summary and 1 extract ¨No indication of prevalence or representativeness ¨ ¨Dealing with arthritis ¨7 participants ,10 themes ¨Each theme has short summary and 1 or 2 extracts ¨No indication of prevalence or representativeness ¨ ¨Not trustworthy 18 The Good ¨15 papers graded as good ¨ ¨11 in three high ranking heath psychology journals: ¨ Psychology & Health, Brit Journal of Health Psychology, Journal of Health Psychology ¨ ¨Show examples of three good papers ¨ 19 1. Impact of CFS on identity Dickson et al. (2008) Psychology & Health ¨Interviews with 14 people with CFS ¨Research question well framed, method described ¨Explicit criteria for inclusion of theme- in half the cases ¨Each theme illustrated with data from many cases ¨ ¨Important/interesting themes: ¨Identity crisis: agency and embodiment ¨Scepticism and the self ¨Acceptance, adjustment and coping ¨ 20 “Identity crisis: agency and embodiment” ¨Sustained, interpretative, insightful account of diminished self & loss of agency with very strong data ¨ ¨“I could have been robbed by a 5 year old child & I would have been too fatigued to do anything about it”(B) ¨ ¨“CFS is a dictator. It dictates my everyday life. It determines what I can and cannot do” (Anne) ¨ ¨“It was like a deathtrap. There was no life going on anymore” (Scott) 21 2. Technology in heart disease Chapman et al. (2007) Amer J of Critical Care ¨6 patients: ventricular assist device (VAD) for failing heart ¨Can be internal or external to the body ¨Presents vivid sustained analysis of patient reactions ¨All themes well evidenced ¨ ¨Important/interesting themes: ¨Shock on realizing dependence on machine ¨Adjustment ¨Need to trust the machine ¨ ¨ 22 Complexity of relationship with VAD ¨Difficult with: ¨“If that alarmed you’d have to change it. To think that that thing is keeping me alive is alarming”. (2) ¨Precariousness, emotional symbiosis ¨ ¨Difficult without: ¨“I was lying in bed & it was really quiet & I was scared to move away from people. I used to walk down the corridor & there was no ticking & I felt alone & I was scared”. (1) ¨Initial problems, became attached, now misses it (3P) ¨ ¨ ¨ 23 3. Ex-footballers & arthritis: making sense of loss Turner et al (2002) Journal of Health Psychology ¨ Int 12 ex-professional footballers with osteoarthritis ¨Closely woven, persuasive analysis with data from many participants to illustrate each of 3 themes ¨ ¨Interesting account of pressures to perform in professional sport- neglecting possible injury ¨Poignantly captures impact restricted mobility on men whose identity bound up with excellence in this domain ¨Men demonstrate mix of regret, stoicism & adaptation ¨Paper is subtly about masculinity- unifying theme ¨ 24 Writing a good IPA paper ¨Quality of interview data caps how good paper can be ¨Focus on particular aspect rather than broad sweep ¨ ¨Sufficient space for elaboration of each theme ¨Rigorous: prevalence, representativeness, variability ¨Extracts selected to show breadth/depth of theme ¨ ¨The analysis should be interpretative not just descriptive ¨Analysis is integrated ¨Good qualitative work always requires good writing 25 Summary ¨Increasing number of IPA papers being published ¨Wide range of topics ¨Health: largest domain ¨Illness experience: largest area ¨ ¨Instantiate criteria for judging quality ¨Quality of corpus: 50% acceptable, 30% good ¨Examples of good studies ¨Guidance on writing a good IPA paper ¨ 26 Future development of IPA ¨Increase proportion good papers: examples, training ¨ Book: JA Smith, P Flowers, M Larkin (2009) Interpretative Phenomenological Analysis:Theory, Method, Research. London: Sage. ¨ IPA Website: http://www.ipa.bbk.ac.uk/ ¨ ¨Develop corpus specific areas e.g. pain, heart disease ¨Review emerging generic constructs e.g. Identity ¨ ¨More good papers in medical journals ¨More integration: mixed methods ¨More work on preventative health behaviour 27 References ¨A Dickson et al. (2008) That was my old life: its almost like a past life now: loss and adjustment amongst people living with chronic fatigue syndrome. Psychology & Health, 23, 459-476. ¨E Chapman et al. (2007) Psychosocial issues for patients with ventricular assist devices: a qualitative pilot study. American Journal of Critical Care, 16, 72-81. ¨A Turner et al (2002) Play hurt, live hurt : living with and managing osteoarthritis from the perspective of ex-professional footballers. Journal of Health Psychology, 7, 285-301. ¨ ¨Smith JA (2011) Evaluating the contribution of Interpretative Phenomenological Analysis. Health Psychology Review, 5, 9-27 ¨ ¨ 28