CHAPTERIIIMETHODOLOGY            This chapter discusses the general definition of thetopics as well as their application to the study. The topics included areresearch design, general and applied methods of inquiry, description of studyparticipants inclusion/ exclusion criteria, research setting, confidentiality,informed consent and ethical considerations, data collection plan, dataanalysis plan, and methods to establish rigor and trustworthiness and integrityof data. ResearchDesign A phenomenological researchattempts to understand the perception, perspective, and understanding of peopletoward a particular situation (Van Manen M.,1990).

Generalizations are then formulated based on multiple perspectives of the samesituation. In other words, phenomenological research study directly examinesand describes a phenomenon as consciously experienced without consideringcausal explanations (Van Manen M.,1990).Qualitative research dealswith the development of concepts which could help in the understanding of socialphenomena in natural (rather than experimental) settings. It provides due emphasisto the meanings, experiences, and views of all participants rooted in first-handaccounts, truthful reporting, and quotations of actual conversations (Pope & Mays 1995) (Van Manen M.,1990).Furthermore, it explores issues, understands phenomena, and answers questionsby analyzing and making sense of unstructured data (QSRInternational, 2014). It does not manipulate variables, introducetreatments, or impose operational definitions of variable on the participants.

Rather, it lets the meaning come out from the respondents and relate it totheir behavior.  Generaland Applied Methods of InquiryPhenomenological inquiry concentrateson the experiences of people in relation to a phenomenon and how they areinterpreted (VanManen M. 1990). An interview is usuallyperformed with a group of individuals who have personal knowledge of the situationor experience. It tries to find answers to two general questions (Moustakas, 1994) (Creswell, 2013): What have youexperienced? What influenced your experiences? Documents, art, and otherobservations may also be used to gather data. These data are read and reread tocollect themes that are subsequently grouped to form clusters of meaning(Creswell, 2013). This process would allow the construction of the universalmeaning of the event, situation or experience to have a deep understanding ofthe phenomenon.

(A [email protected] Site, 2013)Descriptionof Study Participants            Thisstudy involves ESRD patients undergoing dialysis in Aklan who are selectedpurposively. Purposive sampling technique is used in qualitative research inorder to gain meaningful awareness of the effects of the phenomena beingstudied. The participants describe their experiences, providing varyingaccounts of the phenomenon, to attain a profound understanding of the livedexperiences.

            The criteria for the selection of the participants aredisplayed below:            Inclusion Criteria: Aresident of Aklan for at least five years.Participantsaging 18 years and above.Diagnosedwith ESRD and undergoing dialysis for more than 3 months.Exclusion Criteria:Participantswho are not willing to participate.Participantsunder the age of 18.

Participantswho are not residing in Aklan for at least five years.Participantswho are mentally-challenged.Participantsthat have been diagnosed with ESRD who undergo dialysis for less than three months.ResearchSetting            The study is conducted at Dr.

Rafael S. Tumbokon MemorialHospital Dialysis Department, Kalibo, Aklan. It is chosen as the researchsetting because of its accessibility to the researcher and participants. Theinterview, about 45 – 60 minutes long for each participant, takes place in acomfortable and confidential environment. Confidentiality/Informed Consent/ Ethical Considerations            The Chief of Hospital, Head and Advising Physician of thedialysis department of Dr.

Rafael S. Tumbokon Memorial Hospital in Kalibo,Aklan are approached and informed about the purpose of the study through aletter of request for participation. The researcher asks for their consent toconduct the study and to interview participants who are willing to partake inthe study. The participants are properly informed of the purpose, risks, andadvantages of their participation in the study. A confidentiality clausestating their right to a) exclude their names in the written reports, b) keepthe recorded materials confidential and be heard solely by a third partytranscriber, and c) withdraw from the study any time, is included. Allparticipants should agree to the terms and conditions of the study beforesigning the informed consent.  DataCollection            Data are gathered from the narrative descriptions of theparticipants. This is through an in-depth interview and observation utilizingfield notes and audiotape recording (as permitted).

Interviews are conductedthrough a face-to-face conversational unstructured interview. Interview startswith small talks in order to establish rapport with the respondents. Once therespondent feels comfortable enough, the signed consent is again explained. Theinterview focuses on the description of lived experiences of the patients, writtenor oral self-report, observation of their behavior, and even their aestheticand artistic expressions (including art, music, narratives, drama, poetry,dance, or film) (Dr. Janet Waters, 2017).

Open-ended questions areasked. Participants are encouraged to give a full description of theirexperience, including their thoughts, feelings, images, sensations, memories -their stream of consciousness – along with a description of the situation inwhich the experience occurred. Clarification of details in the self-report orinterview may need to be asked. If so, follow up questions are again asked for thefurther description of details without suggesting what is looked for (Dr. Janet Waters, 2017). At the end of the interview,the phone number of the respondents is asked to inform them of a possiblefollow-up meeting or ask for feedback on the research findings. DataAnalysis            This study uses the phenomenological data analysisprocedural steps by Colaizzi (1978) to describethe analytical procedure of data set and description of data collection. Describethe phenomenon of interest.

            The participants are asked to sharetheir experiences from the diagnosis, treatment, and management of the wholeprocess. Collectthe descriptions of the phenomenon.   The descriptions of the phenomenon of theparticipants are extracted from the interview with the aid of audiotape andfield notes. Readthe descriptions of the phenomenon.

In this step, significantstatements of each participant are reviewed through transcription of therecordings verbatim. Bracketing is made to ensure validity and rigor of thestudy. Returnthe original transcripts and extract significant statements.During this process, significantstatements and phrases are highlighted and then sorted out in an analysissheet. Tryto spell out the meaning of each significant statement.Meanings are formulatedfrom the significant statements. Each underlying meaning is coded in onecategory as it reflects an exhaustive description. The formulated meanings arethen compared with the original meanings to maintain the consistency ofdescriptions.

Organizethe aggregate formalized meanings into clusters of themes.The formulated meanings aregrouped into categories that reflect a unique structure of clusters of themes.Each cluster of theme is coded to include all formulated meanings related to thatgroup of meanings. After that, groups of clusters of themes that reflect aparticular vision are integrated together to form a distinctive construct oftheme (Mason, 2002). After merging all studythemes, the whole structure of the phenomenon, “lived experiences of ESRD patientsundergoing dialysis” is obtained.Writean exhaustive description.All evolving themes aredefined through in-depth descriptions.

The findings are thoroughly examined to eliminateoverestimated, misused, or redundant descriptions from the overall structure.Some amendments are applied to establish a clear connection between clusters oftheme and the extracted themes. Ambiguous structures are also eradicated to strengthenthe whole description.Returnto the participants for validation of the description.

The findings are validatedusing “member checking” technique. This is through returning theresearch findings to the participants and discussing the results with them. Theviews of the participants on the results are acquired directly through eitherphone calls or face-to-face conversation.Ifnew data are revealed during the validation, incorporate them into anexhaustive description.In the case when theparticipant adds new data upon validation, these data are processed throughexhaustive description.

Methodsto Establish RigorQualitative researchmethodology has been criticized for lacking justification, transparency, andrigor that is attributed to the weak data collection and analytical tools beingused. This consequently impairs the integrity of the findings, and the study,in general.  Therefore, it is universallyaccepted to adopt different techniques from quantitative researches to furtherimprove rigor and uphold high standards of the discipline, such as thefollowing: Reflexivity: It is theprocess of reflecting critically on the self as a researcher (Lincoln et al2011).

That is, being open about own strengths and shortcomings, and able to weighup the consequences in connection to the study (Tracy2010) (Baillie L (2015). For instance, as researchers couldsignificantly influence, consciously or unconsciously, how the data arecollected and analyzed, their non-verbal communication (which is linked totheir emotions) could shape what the participant discloses duringsemi-structured interviews.Peer debriefing: Itinvolves the collaboration with other researchers to compare findings. Thisreinforces the credibility as peers may spot errors of fact, biases, convergencebetween data and phenomena, competing interpretations, and the emergence ofthemes (Billups,2014).

Prolonged engagement in theresearch setting: In order to equalize the bias of the researcher andprofoundly understand the perspectives of the participants, it is apt to spendadequate time in the field and focus on the aspects of setting and phenomenon. (Wallendorf& Belk, 1989) (Billups,2014)Triangulation: It is notrelevant for all studies. Phenomenological studies are often based only oninterviews to elicit understanding about lived experiences, conducted with aspecific group of participants by a single researcher. Other qualitativestudies may use multiple sources and methods to collect data, increasingconfidence in findings since the research question has been explored fromdifferent perspectives.

While similar findings from different sources mayprovide reassurance, the absence of a particular finding from one type of datadoes not mean that it should be refuted, as each data set provides a ‘snapshotof the entire picture’ (Ryan-Nicholls and Will 2009). Differentmethods, data or researchers often do, and perhaps should, yield differentresults (Tracy 2010). Despite these caveats,many researchers consider that triangulation supports the quality of theirresearch, where congruent with their methodology (BaillieL (2015).Member checking: It isperformed to reexamine the data collected and how they are interpreted by theresearcher.

This is an opportunity for the respondent to authenticate theirstatements so as to fix any mistakes as early as possible. (Gigi DeVault, 2017)Examining negative orexceptional cases: It is recommended that researchers analyze negative cases,where data contradict the emerging pattern (Meyrick 2006, Pilnick and Swift2011). Researchers should continue to return to the data throughout analysisand pay attention to the exceptions in the data (BaillieL (2015).Audit trail: It is theblueprint of the study that outlines detailed procedural records (including therationale of the process), which is kept by the researcher. This is accessibleto other researchers so as to build up the reproducibility and confirmabilityof the study. (Billups,2014)Rich description: Providingrich description could help readers decide whether the research is transferableto their setting. To evaluate the transferability of the findings reported, theresearchers should review the setting and participants in the study, in orderto ascertain whether the research findings can improve the study. Richdescription also strengthens the audit trail by providing a transparent anddetailed account of the sampling method and decisions made, so that the readerscould assess whether the actions and decisions of the researchers are reasonable(Baillie L (2015).

TrustworthinessTrustworthiness isconsidered the conventional framework for evaluating qualitative research Lincoln and Guba (1985).  Although many institutional researchers,particularly those who are primarily inclined to quantitative methods, do notfocus on this, the application of trustworthiness strategies incorporates theelements of engagement, outreach, and collaboration with participants,colleagues, and fellow researchers. This adds depth to a study and demonstratesa reliable practice (Billups,2014).

Thetrustworthiness framework includes five evaluative elements such as dependability(consistency), confirmability (neutrality), credibility (truth), transferability(applicability), and authenticity (genuiness) (Polit&Beck, 2011).Credibility: It deals withthe congruence of the findings with reality. That is, the results should be factual,capturing a holistic representation of the phenomenon under investigation, toestablish credibility. (Shenton , 2004).Dependability: It looksinto the consistency and stability of findings over time and across condition (samedata collection methods yield the same or similar results) to ensure that sameresearch procedure produces the same essential findings. This is often dependenton external audits, a significant approach for feedback, that evaluates thetruthfulness of preliminary findings (Miles&Huberman, 2014).

(Billups,2014).Transferability: It is employedto generate findings that could be interpreted by others for similar settings (sameplace, circumstance of people, and phenomenon under similar situation, withsimilar participants), even to the point of utilizing the research approach fortheir own purposes (Trochim, 2006). This isattained when a phenomenon is provided with enough details through thickdescription. Thick description includes the field notes which consists extensivedetails and explicit descriptions when recording conversations, observations,and interpretations during data collection.

Billups,2014)Confirmability: Thisverifies the accuracy of data and the results. This is vital in a systematicstudy as it reflects the truthfulness of the perspectives of the participants (Billups,2014).Authenticity: Itconcentrates on the intended value of the research.

This is by looking into thebenefits of the research to the participants and giving meaning to the findingsthrough all the realities presented (Billups,2014). 

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