Transparency

A Rigorous Qualitative Study to Explore Type 1 Diabetes in Older Adults: Using the Total Quality Framework

Diabetic MedicineIn “Supporting the ‘lived expertise’ of older adults with type 1 diabetes: An applied focus group analysis to characterize barriers, facilitators, and strategies for self-management in a growing and understudied population” (Cristello Sarteau et al., 2024), the authors discuss their study among older adults (OAs, defined as adults 65 years of age or older) with type 1 diabetes concerning care management. This research consisted of nine in-person focus group discussions with a total of 33 OAs and caregivers.

Central to the design and implementation of this research was the Total Quality Framework (TQF) (Roller & Lavrakas, 2015). The authors selected the TQF due to their focus on rigor and a quality approach to investigate the lived experiences of OAs with type 1 diabetes.

To support rigorous research and reporting, we selected the Total Quality Framework (TQF), a comprehensive set of evidence-based criteria for limiting bias and promoting validity in all phases of the applied qualitative research process. (p. 2)

In this article, the authors provide a unique and useful table describing the rationale behind their methodological decisions pertaining to each component of the TQF, i.e., Credibility, Analyzability, Transparency, and Usefulness. For example, with respect to Credibility, the table offers a lengthy discussion of sample design, including the impact of limited resources on the recruitment process and why the size of each group discussion was kept to 4-5 participants. Other areas of discussion in the table include the coding format and identification of themes (Analyzability), complete disclosure of elements related to design, data collection, and analysis (Transparency), and “how the study should be interpreted, acted upon, or applied in other research context in the real world” (Usefulness). Importantly, readers are directed to areas within the article where they can read about the explanations of methodological decisions that go beyond the limited space of the table, e.g., definition of the target population.

This research “revealed, above all, the complex and dynamic nature of managing type 1 diabetes over the lifespan” and provided “valuable foundational information for future research efforts” (p. 13). In addition to the perceived strengths of the research, the authors’ quality approach also allowed for an informed discussion of the limitations (e.g., diversity in the sample). By way of the TQF Transparency component, the authors provide readers with the details they need to build on this research and move forward in defining care-management solutions for the OA population with type 1 diabetes. As the authors state, the TQF enabled them to “promote confidence in using results from our study to inform future decision-making” (p. 17).

Cristello Sarteau, A., Muthukkumar, R., Smith, C., Busby‐Whitehead, J., Lich, K.H., Pratley, R.E., Thambuluru, S., Weinstein, J., Weinstock, R.S., Young, L.A. and Kahkoska, A.R., 2024. Supporting the ‘lived expertise’of older adults with type 1 diabetes: An applied focus group analysis to characterize barriers, facilitators, and strategies for self‐management in a growing and understudied population. Diabetic Medicine, 41(1), e15156.

Roller, M. R., & Lavrakas, P. J. (2015). Applied qualitative research design: A total quality framework approach. Guilford Publications.

Ethnography: An Example of Transparent Reporting

A portion of the following is an excerpt from Applied Qualitative Research Design: A Total Quality Framework Approach (Roller & Lavrakas, 2015, p. 221).

Ethnography: An Example of TransparencyThe important component in research design concerning transparency has been discussed many times in Research Design Review. And indeed, Transparency is the third component of the Total Quality Framework. The integrity and ultimate Usefulness of qualitative research hinges on exposing design and data collection details in the final reporting documents.

An excellent example of transparency can be found in “Impacts of intensified police activity on injection drug users: Evidence from an ethnographic investigation” (Small et al., 2006). Here, the authors report on a participant–observation study that was conducted to complement a broader study concerning the impact of enforcement on illicit drug-use-related behavior. Their description of what went on in the field is a good example of giving the reader a clear understanding of the field activity:

Trained observers spent time “hanging out” in and around locales where drug sales and injecting took place, talking to and interacting with drug users. Discussions, occurrences, and observations were documented in fieldnotes. Observational data recorded in extensive fieldnotes included: location and character of public injection venues; syringe acquisition, availability, and disposal; public drug consumption patterns for injection and non-injection drugs; and description of public drug users. . . . Each observational field visit incorporated two hours of participant–observation conducted in streets and alleys as well as time spent writing fieldnotes to document observations and discussions. A target area and schedule of observations was devised, drawing on previous ethnographic research examining needle exchange practices. . . . The observations targeted both street-side and in the alleyways along 10 blocks of Hastings Street, where numerous clusters of drug market and consumption activity were identified by ethnographic mapping techniques. . . . Observations were distributed between morning, afternoon, and evening hours, with an increased number of observations occurring around monthly welfare payments when public drug scene and police activity increases. As some drug market and using locales shifted and new ones emerged, ethnographic data collection activities were altered accordingly to survey the largest portion of the open drug using scene, including areas far outside the central Hastings corridor. (pp. 86–87)

 

Small, W., Kerr, T., Charette, J., Schechter, M. T., & Spittal, P. M. (2006). Impacts of intensified police activity on injection drug users: Evidence from an ethnographic investigation. International Journal of Drug Policy, 17(2), 85–95. https://doi.org/10.1016/j.drugpo.2005.12.005

Elevating Qualitative Design to Maximize Research Integrity

The following is a modified excerpt from Applied Qualitative Research Design: A Total Quality Framework Approach (Roller & Lavrakas, 2015, pp. 9-10).

All research that is aimed at understanding how people think and behave requires a principled approach to research design that is likely to maximize data quality and to instill users’ confidence in the research outcomes. This is no less so in qualitative than it is in quantitative research; and, in fact, the distinctive attributes and underlying complexities in qualitative research necessitate a quality approach to qualitative research design. This approach requires qualitative researchers to build certain principles into their research studies by way of incorporating and practicing fundamental research standards.

Total Quality FrameworkTo that end, the Total Quality Framework (TQF) was devised to provide a basis by which researchers can develop critical thinking skills necessary to the execution of qualitative designs that maximize the integrity of the research outcomes. This framework is not intended to prescribe a formula or specific procedure by which qualitative researchers should conduct qualitative inquiry. Rather, the TQF provides researchers with a flexible way to focus on quality issues, examine the sources of variability and possible bias in their qualitative methods, and incorporate features into their designs that mitigate these effects and maximize quality outcomes. Integral to the TQF is the idea that all qualitative research must be Credible, Analyzable, Transparent, and Useful. These four components are fundamental to the TQF and its ability to help researchers identify the strengths and limitations of their qualitative methods while also guiding them in the qualitative research design process.

By holding the quality of qualitative research design to a deep level of scrutiny when applied across the diverse, multidisciplinary fields utilizing qualitative methods — e.g., education; psychology; anthropology; sociology; nursing, public health, and medicine; communication; information management; business; geography and environmental science; and program evaluation — the discussion of qualitative research is significantly elevated and enables students, faculty, and practitioners to design and interpret qualitative research studies based on the quality standards that are the hallmark of the TQF.

Roller, M. R., & Lavrakas, P. J. (2015). Applied qualitative research design: A total quality framework approach. New York: Guilford Press.