NPT can help inform, guide or structure your initial
research design, sampling and data
collection. You could think of it in a similar way
to one of Glaser and Strauss' (1) middle-range theories
like 'Awareness Contexts', in that NPT may inform the range of
situations or people you may want collect data from.
Introduction
Good qualitative research should be both flexible and adaptable.
When you initially start a project you will spend time clarifying
your research question, aims and objectives. These may or may
not have been influenced by NPT (see section - research focus and
questions). You may have quite a refined set of research
question or you may start with more general, generic, questions -
that you just want to map a specific implementation issue. As
with all qualitative research, whilst conducting your research you
should remain open to new avenues of understanding, to explore new,
albeit related questions and issues.
NPT can help with the development of a design for your research
in terms of your decisions about sampling, sites and data
collection methods. NPT does not tell you, in advance,
everyone who you will need to talk to, everyone you will need to
observe or everywhere you will need to go. In keeping with the
iterative nature of qualitative research such information will
emerge from your time in the field. However, NPT can help you
think through some potentially fruitful issues to research at the
outset and as things progress
In relation to sampling, NPT encourages
you to think about a large range of potential
actors. Following NPT, you should be thinking about
all those whose day-to-day routines, work or life is in someway
impacted upon by the new technology or way of working that your
research is exploring.
- By 'work', you could be referring to the work of conducting,
analysing, reviewing or delivering the results of a specific
diagnostic test as well as the work of being a patient in a
consultation room, living with a specific diagnosis, or being a
partner of someone who is ill.
- Centrally, NPT encourages you to focus beyond the 'usual
suspects' of healthcare research, for example beyond the health
professional or patient. You may want to focus on others who
are vital to the normalisation of a new technology or way of
working those that are less visible and often omitted from
implementation studies. For example receptionists, secretaries and
managers often coordinate specific administrative and research
tasks and actions that impact on clinical encounters between health
professionals and patients. Clinical and organisational support
staff, from lab technicians, to hospital porters and IT
technicians, often have to accommodate and realise aspects of new
technology or way of working.
You may not always be able to get direct access to all these
people, situations or places but at least you will be aware
that they are very relevant to the implementation work
and will be alert to the need to ask other participant
groups questions about them, to begin to think of the
distributed work involved in any technology or way of working.
In relation to sampling sites, NPT
encourages you to focus on, a large range of potential situations,
sites and contexts. Most implementation work does
not occur at a single point in time or at a single location.
Most implementation work is distributed across times and
places.
- Again, NPT encourages you to focus beyond the usual situations,
times and contexts of health care research. You may
need to focus on the more 'frontstage' of clinical work, where
patients, carers and health practitioners interact, as well as the
'backstage' of healthcare, the home, the office, the laboratory or
even the staff coffee room. You may need to focus on the
diffuse situations where the process is discussed or enacted.
From the management meetings where ideas are first raised, to the
corridors where these ideas are complained about or praised, to the
office where people attempt to work with the new processes.
- It is important to note that the same technology or way of
working will not always normalize in all the settings and
situations that it is introduced in. This is an ideal
research situation - a natural experiment - that enables you to
begin to understand the specific conditions normalization can occur
in, by comparing different sites.
When thinking about which people and sites to
sample, it may be useful at the start of the project to
list all the potential actors, situations, sites and contexts that
might involved in enacting the process. Just brainstorm the
potential trajectory of the technology or way of working, either
through developing lists or diagrams. As the project unfolds, and
you gain new findings and insights, regularly adjust you list or
diagram. Given the iterative nature of qualitative research,
it is good practice to return to this again and again, to both
inform your analysis (generally and using the NPT) and to develop
new ideas and avenues of thought [1].
- It is important to note that NPT does not direct you about
which type of sampling frame you should employ (e.g. typical case,
maximum variation, criterion, opportunistic etcetera) or tell you
when you have collected enough data. Clearly, as with all
qualitative research, you will be relying on some type of purposive
sampling or some combination of them.
When it comes to sampling, be as creative as you can be.
As noted above, don't just interview the usual suspects or observe
the usual situations. Your only constraints are based on what is
practical and feasible given the time, funding and access you have,
alongside what is ethically appropriate.
In relation to methods of data collection,
clearly you have a range of typical qualitative methods to draw on,
ranging from face-to-face or telephone interviews, focus groups and
non-participant observation.
- Given NPTs focus on process and action, you may also want to
consider other methods, like collecting audio or video-recordings
of key, process-rich interactions and situations. Or you may want
to consider collecting key documents, screen-shots of computer
programmes or photographs of objects, processes or technologies
that are central to the implementation work Given the
increasing prevalence of the media and the internet in healthcare,
often as source of knowledge for patients and their significant
others, you may also want to focus on that.
- NPT does not direct the specific methods or methodology you
should employ. Above all, you need to focus on what goes on,
so focus questions on practice, not ideals. If you get the chance,
consider life beyond the qualitative interview. Clearly they
are relatively time-effective but they can offer you a rather
generalised gloss of the work. If you get the chance to
observe, even fleetingly, how people enact aspects of the specific
technology or way or working, this will often offer you new
important insights.
Once you have decided on your data collection methods,
NPT can also inform the development of questions for
interviews or focus groups and direct specific aspects of your
observation.
- NPT is not prescriptive - for example it does not write your
interview questions but it can help guide some of the specific,
practical, choices you make.
- When it comes to developing your topic guide or specific
questions for interviews, you need to make sure you tailor the
specific ideas in the theory - be they the four
constructs or specific components you are interested in
exploring - to the specific phenomena you are studying. This means
you may generate a series of questions about coherence and
another series of questions about cognitive participation and so
on.
Do not expect your participants to speak in the language of the
theory. For example, do not expect them to understand an interview
question that asks uses theoretical terms like 'differentiation' or
'internalization'. You will need to translate
the intended meaning of each construct or component into clear and
simple language that is relevant to the technology or way of
working that is the focus of your implementation research. If your
interested in coherence, it may be enough to simply ask
them to describe what they thought when they first heard about it
or used it, how they felt it related to current work practices and
what the was the view of the unit they are working in.
- Your questions should not be straight translation from the
language of NPT. Instead you need to 'make NPT at home' within your
specific study context. For example, don't ask people
questions like "Can you tell me what you know about the
contextual integration for the implementation of language
interpreters in your general practice surgery?" You might
want to discuss things like 'local and national policy' or
'government document, decisions or guidelines'. It will take
time to tailor your questions to make them fit within your research
needs, alongside the language of participant, both when you
initially develop your topic guide and questions, and when you come
to review it after each interview or period of coding and
analysis.
If you are collecting data through observation, do not expect to
be able to witness specific constructs or components of NPT
unfolding before your eyes. At the start, as is typical with
most observation, you will see far too much and not be that sure
what to focus on, how to deal with the complexity of what you are
witnessing, just take notes. Again, you need to tailor the
ideas of NPT to the emerging findings from your observation.
Being aware of the four constructs or components of
NPT may encourage you to observe specific actions or ask you to ask
specific questions of the actions you observe
However, as with the use of any middle range theory, NPT
can only suggest specific issues that you might want to focus
on. In keeping with the principles of good quality
qualitative research you need to remember to follow the phenomena
you are studying and to be directed by your ongoing analysis.
For example, it might transpire, during your research that certain
NPT constructs are not relevant to the data you are collecting or,
indeed, that your data is indicative of important issues that are
not covered by NPT.
Things to consider
- NPT encourages you to design a project that enables you to
follow the process, to focus on a range of people, situations,
times and places that are involved in all aspects of enacting that
process.
- NPT asks you to be ambitious. However, do not overstretch
yourself, either practically or analytically. You can never
capture everything.
- NPT does not tell you, in advance, who to talk to, what to
observe or where to go. This is in part, emergent, this should
emerge from your time in the field.
- You always need to tailor and adapt the ideas of NPT to your
specific research project. It does not aim to be a theory
that will help you make sense of everything you and hear and see in
the field.
- NPT is not about individuals intentions and perceptions, it is
focused on helping you to making sense of collective, distributed,
patterns of work.
References
- Glaser, B.G. & Strauss,
A.L. (1965) Awareness of dying. Chicago: Aldine. Back to text
- Clarke, A. (2005)
Situational Analysis: Grounded Theory After The Postmodern
Turn Thousand Oaks, CA: Sage
Notes
[1] See
Clarke's (2) discussion of 'situational
maps'. Although she advocates them as an outcome of research,
it can be helpful to attempt them at the beginning of a project. Back to text
