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Introduction

When carrying out research, the methods you select should be based upon the question you are trying to answer, there is no ‘wrong’ or ‘right’ method but it is something that should be carefully considered and you should be able to justify your approach.

This may be based on what you are looking to find out, the capacity in which you are working, the data you are collecting and the sample of people that will be involved (directly or indirectly). 

This section includes an introduction to some of the key research methods and issues around methodology relevant to speech and language therapy research, such as qualitative research and Patient & Public Involvement.

Sometimes you may be undertaking a project (e.g. an audit or service evaluation) which is not technically classified as ‘research’ but you may still employ ‘research methods’ as described here. 

We will be adding to this section in the future. If you have any further ideas of what should be included, or if you would like to contribute to writing some content on Research Methods, please contact us

Patient and Public Involvement (PPI) in Research

What does PPI mean?

INVOLVE defines public involvement in research as “research being carried out ‘with’ or ‘by’ members of the public, rather than ‘to’, ‘about’, or ‘for’ them” (2018).

PPI activities may include:

  • Working with research funders or priority-setting partnerships, to prioritise research questions
  • Developing and reviewing materials for research projects
  • Being part of a project steering group
  • Being consulted about a particular aspect of a study
  • Leading a stage of the research project

The approach and level of involvement will depend on activities people would like to be involved with and the nature of the research project. It is good practice to involve patients and the public throughout the project (INVOLVE, 2018).

Involving service-users can help to improve the quality of care and outcomes for patients. Public involvement is particularly challenging for people with communication difficulties, and SLTs can play a key role in facilitating this involvement. (Palmer et al. 2013).

SLTs are encouraged to think about:

  • Why you want to involve people
  • Who should be involved
  • How you can involve them

PPI examples:

‘All we want to say’ was a project looking at life in Ireland for people with intellectual disabilities.

NIHR CLAHRC South Yorkshire have videos demonstrating PPI within a number of research projects, including the CACTUS aphasia research group.

The RCSLT are carrying out a research priorities project in a number of key clinical areas, with a focus on PPI.

Useful PPI resources:

The NIHR has information about how patients and the public can get involved in research.

The National Standards for Public Involvement in Research aim to improve the quality and consistency of public involvement in research. The RCSLT was selected as a ‘test bed’ site for these standards as part of our Research Priorities project.

INVOLVE is an organisation that supports public and patient involvement in NHS, public health and social care research. It is funded by the NIHR.

Bulletin April 2014 - Chris Welburn’s first hand account of being involved in shaping aphasia research as a person with aphasia.

'Involving People’ gives information for researchers and patients in Wales.

‘People in Research’ provides information about carrying out research with (not ‘for’ or ‘to’) members of the public.

The King’s Fund experience-based co-design toolkit gives a way to improve the patient experience of services. It also helps service-providers run and assess their own patient-centred care projects.

The National Institute for Health and Care Excellence PPI guidance.

Research ethics

Research ethics describes the underlying principles of undertaking ethical research. Two main perspectives inform ethical research. First is the need to provide the greatest benefit for the greatest number of people and second is the need to avoid doing harm to participants, researchers and others.

These principles must underpin your intended research activity. Your reasoning must also include consideration of the possible consequences of different courses of action.

Research governance is the broad range of regulations, principles and standards of good practice that exist to achieve and continuously improve research quality across all aspects of health and social care. These standards are in place to ensure that research activities meet the ethical principles described.

If you work within the NHS, your Trust will have mechanisms in place to ensure that all research undertaken by its staff, with its patients or on its premises meets required standards. Before considering any research you must contact your Trust's R&D department to be sure that you are aware of requirements and procedures.

If you do not work within the NHS please seek advice before planning any research activity from a University/Higher Education Institution or from the Research and Development Team at the RCSLT contact Amit Kulkarni.

Research, an audit or service evaluation?

It can be difficult to identify whether the study you are proposing is research, audit or an evaluation of your service. All these activities may involve patients or their data and may require the use of surveys or interviews. However, ethical review is only mandatory for research.

Research can be defined as “the attempt to derive generalisable new knowledge by addressing clearly defined questions with systematic and rigorous methods.” (DH 2005). This definition emphasises that the research process aims to find out, by means of a systematic approach, what happens when a clinical approach or intervention is changed or explored.

A quantitative or qualitative approach may be used to answer the research question, but the findings should be generalisable, or at least transferable to a wider population than the sample or local service.

Clinical audit is a process that directly assesses services against a standard that has already been set and provides a quality assurance mechanism for practice. Although patient contact may be involved in audit activity and data collection methods, such as surveys, may be used, the process of audit does not produce generalisable knowledge. However, it aims to assess whether current practice meets required standards in the setting concerned.

Service-evaluation is undertaken to identify information about a service, such as its cost and benefits, strengths and weaknesses. The process of evaluation may involve a range of data collection methods to record activities. It's often undertaken in response to identified local needs and is likely to involve a number of departments within an organisation.

Where to find out more

Audit, Evaluation, or Research? this decision tool will help you decide.

The Health Research Authority (HRA) Approval is the process for the NHS in England that brings together the assessment of governance and legal compliance.

The Integrated Research Application System is a single system for applying for permissions and approvals for health, social care and community care research in the UK.

Chartered Society of Physiotherapists have information on research governance and ethics, including guides to when approval is needed and how to get ethical approval.

Qualitative Research

Introduction to Qualitative Research

Research questions which need qualitative methods will ask about the experiences, circumstances, perspectives, reasoning or histories of people in particular social contexts (situations or events).

In contrast, quantitative research addresses questions regarding effectiveness, causality, incidence and prevalence, diagnosis and screening (Greenhalgh 2010).

A research question may involve both quantitative and qualitative aspects, which may need multiple methods or mixed methodology.

Qualitative research, as defined by Srivastava & Thomson (2009), is:

“an inquiry process of understanding based on distinct and methodological traditions of inquiry that explore a social or a human problem. The researcher builds a complex, holistic picture, analyses words, reports detailed views of informants and conducts the study in a natural setting.” (p 73)

Qualitative research focuses on the beliefs, experiences and interpretations of participants, addressing psychosocial questions. The frameworks for qualitative research questions aim at interpreting, understanding and explaining a wider phenomenon, “What” “How” and “Why” questions.

It encourages participants to:

“Use the richness of their own words to explore and describe their experiences in relation to the research question” Markham, van Laar, Gibbard & Dean (2009, p 749)

As discussed by Silverman (2000) the methods used by qualitative researchers:

“exemplify a common belief that they can provide a deeper understanding of social phenomena than can be obtained from purely quantitative data” (p 8).

Within qualitative research an “inductive approach” is usually taken. This begins with empirical data and works towards the development of more abstract ideas and principles, This is in contrast to the deductive approach of quantitative research when a detailed literature review will be completed and a hypothesis formed from existing theories. In practice a balance needs to be struck; it is important to have a good sense of the substantive issues that the research topic involves, as well as being clear about the literature base on which they are founded.

Research is all about making thoughtful and strategic choices. A high-quality study design depends on the coherence of your:Practical goals (what do you want to achieve?), your intellectual goals (what do you need to understand that might help you achieve it?)

  • Conceptual framework you are working within (What is already known about the problem? What do you think is going on?)
  • Research questions (What do you want to learn from this study?)
  • Research methods (What will you actually do to answer your research questions and with whom, how, where and when?)
  • Awareness of how you might be wrong and strategies to address this (see also ‘reflexivity’)

(Adapted from Maxwell, 2013)

Qualitative research varies in the extent to which ‘theory’ is explicitly part of the research design. Bradbury-Jones et al (2014) propose a 5-point typology on the levels of theoretical visibility, which may be helpful in making choices about your own study.

While these web pages discuss primary (empirical) qualitative research studies, qualitative methods are also appropriate when research questions need a ‘qualitative synthesis’ of a group of reported qualitative studies. The most commonly-used method of interpretive qualitative synthesis, is meta-ethnography.

Qualitative research traditions

The practice of qualitative research is very diverse. Within the qualitative paradigm there are different traditions, each with a different philosophical base. This means the chosen approach will influence the way the researcher collects and analyses data. The three most common traditions are summarised below.

Research tradition

Disciplinary origin

Aims

Ethnography

Anthropology / Sociology

Understanding of social world of people studied through immersion into their community to provide detailed descriptions.

Provides a detailed description of the setting or individuals.

Phenomenology

Philosophy / Sociology

Understanding the constructs people use in everyday life to make sense of their world.

Uncovering meanings contained within conversations or text. Analysis of significant statements and the generation of "meaning units" to develop an "essence" description.

Grounded theory

Sociology / social psychology

Aims to generate a theory that is "grounded in" or formed from the data and is based on inductive reasoning.

Selecting a sample

Qualitative research uses purposive sampling; the characteristics of the population are the basis of selection. Purposive sampling allows the researcher to carefully and critically choose the cases to be involved in interviews and focus groups, etc. This is because they have relevant opinions and interpretations to the topic of interest. The sample is not intended to be statistically representative, as it is in quantitative research. Types of purposive sampling may include:

  • Typical – case chosen because thought to be like the majority.
  • Snowballing or chain sampling - this involves asking people who have already been interviewed to identify others who they know would fit the selection criteria. This is particularly useful for potentially small or dispersed populations.
  • Maximum variation – identifies the diverse characteristics of the population and then samples people that match these characteristics.
  • Convenience sampling – the cases that can be studies most easily, cheaply or quickly. For this reason, it is the least credible method.

Read more information on purposive sampling choices in qualitative research

Qualitative samples are usually small in size, with the number varying depending on the purpose of the research and the resources available to you.

Rather than fixing on a sample size at the beginning of the process, it may be appropriate to your research design to sample iteratively. This means making choices as you go along about who or where you need to go to next depending on the data you already have). It may also mean that you stop collecting data when you are confident you have sufficient amount of the type that will enable you to answer your research questions.

Data collection

This section is intended to show a range of choices that you might consider depending on your purpose. Each has strengths and limitations which you need to take into account:

  • Interviews: Unstructured, Semi-structured, Structured
  • Focus groups
  • Dairies and records of activities
  • Observations
  • Delphi technique

Interviews

One of the most widely-used methods is the interview used to obtain information about behaviours or experiences, opinions or beliefs, feelings, knowledge and demographic information. The interview allows for a focused, detailed investigation of a person’s perspective on a given topic or experience. Depending on your purpose and strategy, interviews may be:

Unstructured

  • The researcher asks the respondent a general question regarding the area of interest and asks them to tell their own story

Semi-structured

  • The interviewer has a slightly more focused agenda than in an unstructured interview. Questions are phrased to allow the participants to tell the story in their own way. An interview guide is used to ensure information is gathered on areas of relevance to the research question

Structured

  • An interview in which the questions are predetermined and asked to all subjects. Closed questions are used with limited response choices

Focus groups

  • A frequently employed research method is the focus group. This utilises the interaction of group dynamics to generate data and prompt participants to describe their own experiences, views and priorities. A clear structure and ground rules are essential and it is beneficial to have a facilitator

Diaries and records of activities

  • Maintaining a diary can encourage participants to focus on daily activities and reflections that he or she values. The diary may be written, audio recorded or shared via a telephone/ computer medium. The information provided by a diary may be combined with face-to-face follow-up interview. Dalemans et al. (2010) explored how people with aphasia perceive their participation in society and the factors that influence their social activities. Diaries were kept by participants for a two-week period. An important advantage of writing a diary for the person with aphasia is the reduction of time-pressure: a significant issue for the communication impaired. To facilitate the process, a series of stickers representing different activities was used

Observation

  • Observation allows for behaviours and interactions to be recorded as they occur. This method was employed in a study by O’Halloran, Worrall & Hickson (2011) which sought to:

“Identify the environmental factors that either create barriers and/or facilitate communication between patients and their healthcare providers in an acute hospital stroke unit.” (p30)

Delphi technique

  • This method of data collection offers the opportunity to survey a group of experts who otherwise might be difficult to convene. Its aim is to establish as objectively as possible, consensus on a complex problem. It typically involves interaction via email and other technological methods. It includes at least two rounds of experts answering questions and giving justification for their answers and providing the opportunity between rounds for changes and revisions. It is an iterative process and results of the first round of questions, when summarised provide the basis for the second round of questions. Results from the second round of questions feed into the third and normally final round.

Data analysis

Creswell (2003) identifies a number of steps which are usually, but not always followed to analyse qualitative data:

  • Organise and prepare data for analysis, transcribe interviews, focus-group discussions
  • Read and re-read the data, to obtain a general sense of the information obtained
  • Categorise and code the data, also referred to as indexing the data
  • Generate a small number of “themes” which will form the heading in the results section of the study
  • Organise the data in the qualitative narrative; this will be influenced by the theoretical approach taken by the researcher
  • Interpretation of the data and the lessons learnt

The method of analysis you choose will depend on your purpose. Examples of some used in qualitative research include:

Thematic Analysis

Braun and Clarke (2006) define thematic analysis as “a method for identifying, analysing, and reporting patterns (themes) within data. It minimally organises and describes your data set in (rich) detail. However, it also often goes further than this, and interprets various aspects of the research topic.

They provide guidance on how to do thematic analysis, using a six-phase process:

  • Familiarising yourself with your data.
  • Generating initial codes.
  • Searching for themes.
  • Reviewing themes,defining and refining themes.
  • Producing the report.

The free companion website for Braun and Clarke’s book ‘Successful Qualitative Research: A Practical Guide for Beginners’ (2013) has a number of resources to support you through the entire research process.

Ethics and reflexivity

Ethics

Qualitative research involves prolonged contact with people in social situations. This means ethical challenges are inevitable and it is important to anticipate, recognise and be responsive to them as the research unfolds. The National Centre for Research Methods has a free 30 minute video presentation: What are qualitative research ethics? by Rose Wiles.

Researcher reflexivity

Research data do not speak for themselves. The findings of research are generated in particular ways, for particular purposes and are always shaped by choices made by the researcher. Reflexivity is an attitude that involves ongoing questioning of yourself and your research and how they may be influencing each other. It stands for conscious and consistent efforts to view the subject-matter from different angles, strongly avoiding the a priori privileging of a favoured one (Alvesson, 2011, p.106). The role of researcher reflexivity is discussed further in Medico Santiago-Delefosse (2014).

Resources and references

Web resources

Journals

Articles

Bailey, J. (2008). First steps in qualitative data analysis: transcribing. Family Practice. 25 (2), 127-131.

Bradbury-Jones, C., Taylor, J. and Herber, O. (2014) How theory is used and articulated in qualitative research: development of a new typology. Social Science & Medicine. 120, 135- 141.

Braun, V. & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3 (2), 77-101.

Farmer, T., Robinson, K., Elliott, S. J., & Eyles, J. (2006). Developing and implementing a triangulation protocol for qualitative health research. Qualitative Health Research. 16, 377- 394.

Hodges, B. D., Kuper, A., & Reeves, S. (2008). Discourse analysis. British Medical Journal. 337.

Malterud, K. (2001). The art and science of clinical knowledge: evidence beyond measures and numbers. Lancet. 358(9279), 397-400.

Medico, D. & Santiago-Delefosse, M. (2014). From reflexivity to resonances: Accounting for interpretation phenomena in qualitative research. Qualitative Research in Psychology. 11(4), 350-364.

O’Cathain A., Murphy, E. & Nicholl, J. (2010). Three techniques for integrating data in mixed methods studies. British Medical Journal. 341 :c4587.

Shaw, S.E. & Bailey, J. (2009). Discourse analysis: what is it and why is it relevant to family practice? Family Practice. 26(5), 413–419.

Simmons-Mackie, N. & Damico, J. S. (1999). Qualitative methods in aphasia research: ethnography. Aphasiology. 13, 681-687.

Simmons-Mackie, N. & Lynch, K. E. (2013). Qualitative research in aphasia: A review of the literature. Aphasiology. 27 (11), 1281-1301.

Skeat, J. & Perry, A. (2008). Grounded theory as a method for research in speech and language therapy. International Journal of Language and Communication Disorders. 43(2), 95-109.

Smith, J. A. (2004). Reflecting on the development of interpretative phenomenological analysis and its contribution to qualitative research in psychology. Qualitative Research in Psychology. 1(1), 39-54.

Sousa, D. (2013). Validation in qualitative research: general aspects and specificities of the descriptive phenomenological method. Qualitative Research in Psychology. 11(2), 211-227

Tracy, S. J. (2010). Qualitative quality: eight “big-tent” criteria for excellent qualitative research. Qualitative Inquiry. 16(10), 837-850.

Books

Alvesson, M. (2011) Interpreting interviews. London: SAGE.

Ball, M. J., Müller, N. & Nelson, R. L. (2014). Handbook of qualitative research in communication disorders. Hove: Psychology Press.

Braun, V. & Clarke, V. (2013). Successful qualitative research: A practical guide for beginners. London: Sage.

Charmaz, K. (2014). Constructing grounded theory. (2nd Ed). London: Sage.

Corbin, J. M. & Strauss, A. (2008). Basics of qualitative research: Techniques and procedures for developing grounded theory. London: Sage.

Creswell, J. 2003. Research design: qualitative, quantitative, and mixed methods approaches. (2nd Ed). California: Sage.

Dollaghan, C. A. (2007). The handbook for evidence based practice in communication disorders. Baltimore, MD: Brookes Publishing Co.

Flick, U. (2014). An introduction to qualitative research. (5th ed). London: Sage.

Greenhalgh T (2010). How to read a paper: the basis of evidence based medicine. (4th ed). Oxford: BMJ Books.

Mason, J. (2002). Qualitative researching. (2nd Ed). London: Sage.

Maxwell, J. (2013) Qualitative research design: an interactive approach. (3rd ed). Los Angeles: SAGE.

Ritchie, J., Lewis, J., McNaughton Nicholls, C. & Ormston, C. (2013). Qualitative research practice; a guide for social science students and researchers. London: Sage Publications Ltd.

Silverman, D. & Marvasti, A. (2008). Doing qualitative research: a comprehensive guide. London: Sage.

Smith, J. A. (2015). Qualitative psychology: A practical guide to research methods. (3rd ed). London: Sage.

Willig, C. (2008). Introducing qualitative research in psychology. (2nd ed). Maidenhead: Open University Press.

Single case studies

Single case studies can be a robust approach to measuring the effectiveness of an intervention. They present clinicians with an option to carry out research alongside everyday practice on a small scale and add to the evidence-base. However care needs to be taken in designing your case study, to ensure that you are using a ‘single-case experimental design’.

What is a single-case experimental design?

The same (single) participant is used as their own control to evaluate the effectiveness of one or multiple interventions. The introduction and the withdrawal of the intervention are experimentally controlled. There are different designs that can be used such as:

  • Cross-over designs (A-B-A-B) or more complex variations of this (A-B-A-C-A-B).
  • Multiple baseline designs.
  • Alternating treatment designs.

Single case experimental designs are also known as single subject designs (SSD), single participant designs or n-of-1-trials.

What our experts say

Dr Maggie Vance (Department of Human Communication Sciences, University of Sheffield) offers the following guidance on baselines and ethics:

“It is certainly possible to use a waiting list period for taking base-lines. For Masters student projects we have identified case studies as being “service evaluation” and therefore not requiring full NHS ethical approval – see this defining research leaflet.”

You can also read Maggi Vance’s editorial and presentation on single case studies.

Professor Victoria Joffe (School of Health Sciences, City University London) adds:

“I understand that baselines may not be possible ethically if children are ready for therapy, but after initial assessment, we do have children on the waiting list. So I think we can be more strategic with our planning and setting-up of care plans, having some children start the intervention a little later and act as the baseline.

Of course, another way of getting around this is what Barbara Dodd often does, which is to use an alternating treatment design, which looks at two different treatments. This can be the same group having two treatments at different times, which gives us comparisons but takes away the ethical dilemma of someone not getting treatment. I also think we can look at control items or skills.

I know this is harder with language and communication, as we do hope that our learning generalises across the board. However, we could look at targeted and untargeted areas. So we focus on training vocabulary, look at targeted and non-targeted vocabulary items, and in this way generalisation of treatment through non-targeted vocabulary, but within the area of vocabulary. In addition, you may choose to look at grammar or an area where you would not predict the same improvement. This allows you to compare maturational change with change from treatment of specific areas.”

Professor Juliet Goldbart (Research Institute for Health and Social Change, Manchester Metropolitan University) provides some advice on ethical approval for single case designs:

“In terms of ethics, it could be argued that single-case designs are really just formalised normal practice and therefore don’t need ethical approval. I would not be very comfortable with that, as they are intended to generate new knowledge and clients/their immediate carers are entitled to know when their individual data is being used in research papers. Also, more pragmatically, most journals will ask that ethical approval be identified in published papers, so no approval would limit publication. Therefore, I would suggest talking your Research and Development team (if working for the NHS) about the level of approval required. If the work is being carried out as part of a qualification, the university would have an approval system. Where clients are being treated outside the statutory sector, I think RCSLT would need to advise.

In terms of baseline measures, there are two issues. Firstly, the same measures as you are using to assess progress during intervention would need to be used, so that you can demonstrate change. A good example is in Nind’s paper on intensive interaction (Nind 1996). But it is often also useful to take more general measures (outcome measures rather than task-related performance) at the beginning of the study. This would have been, for example, the Preverbal Communication Schedule.”

Dr Lotte Meteyard (School of Psychology and Clinical Language Sciences, University of Reading) recommends:

‘Data analysis tools by John Crawford that allow you to calculate very simply whether scores for an individual case are significantly different to a set of control scores. You need to know the number of controls, mean scores and standard deviation. These tools might help to get around having only a few time points to measure against. For example, you could take pre- and post- scores, then test if they are significantly different to normal at those time points. The prediction would be that a successful therapy would result in scores that are not significantly below normal, in contrast to before therapy.’

Further information on single case designs

Use of single-case study research in child speech, language and communication interventions - Maggie Vance, Judy Clegg: Provides further information on different designs that can be used for speech, language and communication interventions.

Using Single-Case Methodology to Evaluate Speech, Language and Communication Interventions in Educational Contexts - Maggie Vance presentation RCSLT Conference 2012.

Critical appraisal of single case studies

The SCED scale - developed by Tate et al, available on PsycBITE. Used for the critical appraisal of single-case experimental designs.

Data analysis

Data analysis tools by John Crawford. Allows you to calculate very simply whether scores for an individual case are significantly different to a set of control scores.

AAC case studies

Communication Matters collates a database of AAC case studies, and is seeking submissions from professionals working with AAC. An AAC Case Study template, developed by the University of Manchester is available on the Communication Matters Research website here.

References and further information on single case designs - (PDF) 

Resources and references