This is a repository copy of Ensuring rigour and trustworthiness of qualitative research in
clinical pharmacy.
White Rose Research Online URL for this paper:
http://eprints.whiterose.ac.uk/109163/
Version: Accepted Version
Article:
Hadi, MA orcid.org/0000-0003-0108-7833 and Closs, SJ orcid.org/0000-0002-3257-5277
(2016) Ensuring rigour and trustworthiness of qualitative research in clinical pharmacy.
International Journal of Clinical Pharmacy, 38 (3). pp. 641-646. ISSN 2210-7703
https://doi.org/10.1007/s11096-015-0237-6
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Introduction:
1
Qualitative research is a diverse group of interpretative methods which aim to explore, 2
understand and explain people’s experiences using non-numerical data [1]. Although 3
still dominated by quantitative research methodology, the use of qualitative research 4
methodology in clinical and healthcare research has grown steadily in the past couple of 5
decades [2]. Qualitative research methodology typically involve interviewing and/or 6
observing people who are central to the research topic. The data produced are usually 7
(though not always) in the form of text, reporting what interviewees said and/or did. The 8
data are then analysed, often by the person who interviewed or observed, leading to the 9
likelihood of subjectivity and bias. Therefore, qualitative studies have often been 10
criticized for lacking rigour, transparency, justification of data collection and analysis 11
methods being used, and hence the integrity of findings [3]. 12
The issue of “judging the quality” in qualitative research has been one of the most 13
debated topics among methodologists and until recently there has been little consensus 14
on what constitutes a good and trustworthy qualitative study [4-9]. Rolfe postulates that 15
three opinions exist in the literature on how best to judge the quality of qualitative 16
research [4]. The first view, although not a popular one, advocates for the adoption and 17
application of positivist terminologies like validity and reliability to describe rigour in 18
qualitative research [5]. The second view (realist), the most popular view among 19
healthcare researchers, rejects the potential applicability of positivist reliability and 20
validity criteria because of differences in the theoretical and philosophical paradigms 21
underpinning quantitative and qualitative research [6,7,10]. This view therefore, 22
promotes the use of alternative terminologies such as dependability, credibility, 23
2
conformability and transferability instead of their quantitative equivalents reliability,
1
internal validity, objectivity and generalizability respectively to describe rigour 2
(trustworthiness) in qualitative research. Methodological techniques (explained in detail 3
later) such as the audit trail, member checking, negative case analysis, triangulation, 4
prolong engagement with participants and peer debriefing have also been proposed in 5
the literature to ensure dependability, credibility, and transferability in qualitative studies 6
(Refer to Table 1 for brief description of these terminologies) [6,7,10]. However, not all 7
these strategies are applicable in all types of qualitative studies [8,9]. The third and final 8
view held by some methodologists (interpretivist) have challenged the very idea of 9
having a single pre-determined criterion for evaluating the quality of diverse approaches 10
within qualitative research. Qualitative research encompasses a number of different 11
research methods underpinned by different research paradigms and theories thus 12
making single evaluative criteria impossible to develop and apply [4]. Methodologists 13
belonging to each of these paradigms have their arguments to support their positions. 14
The most important thing to note here is that the term paradigm refers to a discrete set 15
of beliefs and researchers are free to choose any paradigm (constructivist, realist, 16
feminist) but they need to be transparent about the choices that they have made 17
aligning with a specific paradigm and avoid mixing of paradigms. 18
Until recently there has been little guidance available for assessing the quality of 19
published qualitative research, but COREQ (Consolidated criteria for reporting 20
qualitative research) provides a 32 item checklist now widely used by medical and 21
health journals, to aid reviewers [11]. Subsequently two more checklists have been 22
developed based on wide ranging reviews, both producing a 21-item list, one for 23
3
qualitative studies [12] and another for qualitative research syntheses [13]. However,
1
while these papers identify standards for reporting, they do not go into the rationale for 2
selecting and undertaking strategies for ensuring rigour. 3
Unlike other healthcare disciplines, the subject of “quality” in qualitative research has 4
not been discussed much in the clinical pharmacy discipline. Perhaps this is because 5
the quality issue has been discussed extensively in other disciplines, allowing clinical 6
pharmacy researchers to rely on the available literature. Being predominantly trained 7
within a “positivist” paradigm, pharmacists may find debating this issue “out of their 8
comfort zone” or, simply, they may just not be interested. The aim of this paper is not to 9
propose another checklist to evaluate the quality of qualitative research but to highlight 10
the importance of rigour, present different philosophical standpoints on the issue of 11
quality in qualitative research and to discuss briefly key strategies to ensure 12
methodological rigour. Finally, an illustration of strategies reported by clinical pharmacy 13
researchers in a random sample of papers published recently to show how rigour in 14
qualitative research is presented. 15
Strategies to ensure trustworthiness 16
A number of strategies have been proposed to ensure trustworthiness of qualitative 17
findings. It has been suggested that at least two of these strategies should be used in 18
any particular qualitative study [14]. A brief description of commonly used strategies is 19
given below. 20
Triangulation 21
4
Triangulation is a widely used method to ensure credibility and conformability of
1
qualitative studies [14]. Triangulation involves using at least two related data sources, 2
data collection methods or researchers with the aim of reducing inherent bias 3
associated with a single source, method or researcher [5]. Triangulation should not be 4
seen as a tool to check the validity of data and labeling data as “true” or false” but to 5
ascertain the validity of the inferences derived from multiple data sources [15]. 6
Self-description/Reflexivity 7
Self-description and self-reflection is very important in qualitative research to 8
acknowledge and reduce researcher bias, a common criticism of qualitative research. 9
Self-reflection will enable qualitative researchers to discuss their position within the 10
study and how their personal beliefs and past training have influenced the research 11
findings [5, 15]. Qualitative researchers should be encouraged to make field notes and 12
maintain a reflective journal in order to recognize and make explicit any personal biases 13
[15]. Self-description promotes credibility and conformability of research findings 14
Member checking 15
Alternatively known as respondent validation, this is often described as the single most 16
important method to ensure a study’s credibility [7], and refers to checking of study 17
findings and conclusions by the respondents from whom the data (interview, 18
observation) were originally obtained [5]. The aim of member checking is to ensure 19
dependability and credibility of qualitative studies. However, some methodologists have 20
raised concerns about the usefulness of member checking as qualitative data do not 21
only consist of interview/observational data but also include field notes, the author’s 22