Triangulating qualitative approaches within mixed methods designs: A theory-driven proposal based on a French research in social health psychology

International audienceCurrently qualitative research in psychology is underrepresented in the French academic setting; however, it has gained more importance over the past two decades. Within the context of the French academic setting, the aim of this article is to present the development of a theory-driven mixed method design in the critical health psychology approach and to demonstrate its contribution to the advancement of theoretical conceptualization. It proposes that triangulation, when viewed as a qualitative research strategy, should be considered as a meaningful research paradigm for designing mixed methods strategies in psychology. A methodological case, adopting a social representations approach to study medical decision making under uncertainty in oncology, will be used as an illustration, and the multiple triangulation strategy this case is based on will be fully described. The research will discuss how qualitative analyses contribute to empirically objectifying complex and dynamic psychosocial phenomena through the example of enhancement of the hypothesis of “cognitive polyphasia,” developed in the social representations theory, and how it is enabled by the design applied

When “the Dream Dies” But the Ideal Persists: Representations of the Couple Relationship and Its Connection To Intimate Partner Violence Experiences

International audienceIntimate partner violence (IPV) is now recognized internationally as a significant problem against which public action is being taken. However, victims commonly disclose little of this violence. The understanding of sociocultural factors that prevent women from talking about their male partner’s violence towards them thus appears to be an important issue. Using a qualitative approach, this study examines the representations that women survivors of IPV draw on to give meaning to the couple relationship and the links that these representations maintain with IPV and the help-seeking process. Nineteen women, who had previously experienced abuse from an intimate partner, participated in semi-structured interviews. Despite the experience of violence, an idealized vision of the couple relationship persists among the majority of respondents and conflicts with their experience of violence. This gap between an ideal and lived experience appears to be a major source of suffering for the participants who thus develop different strategies to preserve their ideal. These strategies appear to have the effect of minimizing and concealing violence

Researcher Triangulation in Interview Analyses: Inter-Subjectivity as an Asset for the Production of Original Interpretative Ideas

International audienceResearcher triangulation is often used in studies based on qualitative research in order to look for consensus and to limit the influence of researcher subjectivity. A more innovative way of comprehending this strategy is to consider subjectivity as an aid to the understanding of the phenomena under study. This perspective refers to long-standing concerns in the literature, particularly in feminist research in which subjectivity appears as a resource for scientific production. The objectives of this contribution are to describe step by step a researcher triangulation procedure “in action”, to highlight its utility for grasping the complexity of the object under analysis and to discuss the epistemological implications raised by the implementation of such a practice. It is based on a French study aimed at exploring women’s experiences and representations of intimate partner violence. Results highlighted that the triangulation sessions, spaces of intersubjectivity and reflexivity for researchers, appeared as a way of identifying zones of tension involved in the interpretational work of experiential discourses. Here triangulation was used as a relevant space for questioning what these tensional zones were able to reveal about the phenomena under study rather than an arena for discussing researchers’ agreements/disagreements

What makes decision-making difficult for oncologists faced with critical situations? The socio-affective side of the physician–patient relationship

International audienceThe aim of this qualitative study based on a Social Representations approach was to explore experienced oncologists' representations of difficult decision-making situations. In total, 22 semi-structured interviews with oncologists were conducted and analysed by performing a thematic content analysis. The thematic content analysis brought to light the main medical problem involved such as uncertainty, the lethal nature of cancer and physicians' specialties, as well as the psychosocial ones, such as patients' non-medical characteristics and the patient-physician relationships. This analysis also showed the painful tensions experienced by specialists in the context of decision-making situations when the medical arguments conflict with the psychosocial ones. These findings suggest that in order to understand more clearly the complex processes involved in difficult medical decision-making situations, studies on physicians' expertise should include the socio-affective climate involved in each patient-physician relationship

“Fortunately I felt pain, or I would have thought I was on my way out”: experiencing pain and negotiating analgesic treatment in the context of cancer

International audienceObjectives: To explore cancer patients' experience of pain and coping strategies as well as beliefs and representations associated with pain, pain management and treatments.Method and participants: A qualitative study based on semi-structured interviews was conducted among 16 patients with cancer. The inductive research strategy adopted derived from the Grounded Theory approach and the data transcribed verbatim were gradually analyzed involving researcher triangulation.Findings: The experience of pain and the coping strategies developed by patients to deal with it are shaped by the experience and representations of cancer associated with death and suffering. Pain acts both as an indication to the patients that they are still alive and as an indicator of the progression of the disease. Cancer also models patients' relationships to analgesic treatments and health care providers, since pain is an area in which patients can take back control of what is happening to them. Patients' expression of reluctance to accept analgesic treatments is also influenced by the significance of opioid treatments in this context, which are perceived as an indication that the end of life is close.Conclusions: The contextualization of pain through the particularities of cancer is critical in order to understand cancer patients' experience of pain.Implications for psychosocial providers: Not only patients' knowledge but also the meaning-making of pain should be incorporated in interventions targeting pain management

Patients' Non-Medical Characteristics Contribute to Collective Medical Decision-Making at Multidisciplinary Oncological Team Meetings.

BACKGROUND:The contribution of patients' non-medical characteristics to individual physicians' decision-making has attracted considerable attention, but little information is available on this topic in the context of collective decision-making. Medical decision-making at cancer centres is currently carried out using a collective approach, at MultiDisciplinary Team (MDT) meetings. The aim of this study was to determine how patients' non-medical characteristics are presented at MDT meetings and how this information may affect the team's final medical decisions. DESIGN:Observations were conducted at a French Cancer Centre during MDT meetings at which non-standard cases involving some uncertainty were discussed from March to May 2014. Physicians' verbal statements and predefined contextual parameters were collected with a non-participant observational approach. Non numerical data collected in the form of open notes were then coded for quantitative analysis. Univariate and multivariate statistical analyses were performed. RESULTS:In the final sample of patients' records included and discussed (N = 290), non-medical characteristics were mentioned in 32.8% (n = 95) of the cases. These characteristics corresponded to demographics in 22.8% (n = 66) of the cases, psychological data in 11.7% (n = 34), and relational data in 6.2% (n = 18). The patient's age and his/her "likeability" were the most frequently mentioned characteristics. In 17.9% of the cases discussed, the final decision was deferred: this outcome was positively associated with the patients' non-medical characteristics and with uncertainty about the outcome of the therapeutic options available. LIMITATIONS:The design of the study made it difficult to draw definite cause-and-effect conclusions. CONCLUSION:The Social Representations approach suggests that patients' non-medical characteristics constitute a kind of tacit professional knowledge that may be frequently mobilised in physicians' everyday professional practice. The links observed between patients' attributes and the medical decisions made at these meetings show that these attributes should be taken into account in order to understand how medical decisions are reached in difficult situations of this kind

Distribution of patients’ non-medical characteristics mentioned at MDT meetings (N = 95 cases).

<p>Distribution of patients’ non-medical characteristics mentioned at MDT meetings (N = 95 cases).</p

Strategy of case-records selection for the analysis.

<p>Strategy of case-records selection for the analysis.</p

MDT meeting characteristics.

<p>MDT meeting characteristics.</p

A case-vignette illustrating the coding process used in this study on patients’ non-medical characteristics.

<p>A case-vignette illustrating the coding process used in this study on patients’ non-medical characteristics.</p