ARTÍCULO ORIGINAL / ORIGINAL ARTICLE/ ARTIGO ORIGINAL

Potentialities and deficiencies of qualitative research with families

Potencialidades y debilidades de la investigación cualitativa con familias

Potencialidades e debilidades da investigação qualitativa com famílias

Geisa dos Santos Luz¹; Silvana Sidney Costa Santos²; Mara Regina Santos da Silva³; Priscila Arruda da Silva⁴

¹ RN, Ph.D. candidate, Universidade Federal do Rio Grande (FURG), Brazil email: geisaluz@yahoo.com.br.

² RN, Ph.D., Professor, FURG, Brazil email: silvanasidney@terra.com.br.

³ RN, Ph.D., Professor, FURG, Brazil. email: marare@brturbo.com.br.

⁴ RN, Ph.D. candidate, FURG, Brazil. email: patitaarruda@yahoo.com.br.

Receipt date: December 18^th 2011. Approval date: September 19^th 2012.

Subventions: none.

Conflicts of interest: none.

How to cite this article: Luz GS, Santos SSC, Silva MRS, PAS Silva. Potentialities and deficiencies of qualitative research concerning families. Invest Educ Enferm. 2012;30(3): 346-352

ABSTRACT

Objective. To analyze the literature relating to qualitative research about the theme family that was published in Brazilian nursing journals in the period from 2006 to 2010. Methodology. Research involving investigation of bibliographic databases of articles presenting descriptors like the following terms: family, qualitative research and nursing. Results. 47 articles were analyzed. The most frequent topic areas are: child health (40.4%), adult health (23.4%), mental health (19.1%), collective health (6.4%), elderly health (6.4%) and woman's health (4.3%). 70.6% of the articles were published in journals classified by QUALIS/ CAPES as B1. 93.6% of the articles were written by nurses with a doctorate degree. Data collection was predominantly carried out using semistructured (57.4%) and open interviews (39.8%). The interviews were followed by observation methods in 8.5% of the analyzed studies. Conclusion. The literature about qualitative studies that address the theme family which was published in Brazilian nursing journals during the study period is rare, which shows the need to further address the topic.

Key words: qualitative research; nursing; family.

RESUMEN

Objetivo. Analizar la producción bibliográfica de los estudios cualitativos sobre el tema de la familia publicados en las revistas de enfermería brasileñas en el período 2006-2010. Metodología. Se consultó en las bases de datos bibliográficas los artículos que tuvieran como descriptores los términos: familia, investigación cualitativa y enfermería. Resultados. Se analizaron 47 artículos. Por áreas de atención, los más frecuentes son: salud del niño (40.4%), salud del adulto (23.4%), salud mental (19.1%), Salud colectiva (6.4%), salud del anciano (6.4%) y salud de la mujer (4.3%). El 70.6% de los artículos se publicaron en revistas clasificadas por QUALIS/CAPES como B1. El 93.6% de los artículos tenían por autores enfermeros con doctorado. Como instrumento de recolección de los datos predominaron la entrevista semi-estruturada (57.4%) y la abierta (30.8%). La conducción de las entrevistas fueron acompañadas de métodos observacionales en 8.5% de los estudios analizados. Conclusión. La producción bibliográfica de los estudios cualitativos sobre el tema de la familia publicados en las revistas de enfermería brasileñas en el período de estudio es escasa, mostrando que hay necesidad de un mayor desarrollo en la misma.

Palabras clave: investigación cualitativa; enfermería; familia.

RESUMO

Objetivo. Analisar a produção bibliográfica dos estudos qualitativos sobre o tema da família publicados nas revistas de enfermaria brasileiras no período 2006-2010. Metodologia. Investigação na que se conferiu nas bases de dados bibliográficas os artigos que tivessem como descritores os termos: família, investigação qualitativa e de enfermaria. Resultados. Analisaram-se 47 artigos. Por áreas de atendimento, os mais frequentes são: saúde da criança (40.4%), saúde do adulto (23.4%), saúde mental (19.1%), Saúde coletiva (6.4%), saúde do ancião (6.4%) e saúde da mulher (4.3%). O 70.6% dos artigos se publicaram em revistas classificadas por QUALIS/CAPES como B1. O 93.6% dos artigos tinham por autores enfermeiros com doutorado. Como instrumento de recolha dos dados predominaram a entrevista semiestruturada (57.4%) e a aberta (30.8%). A condução das entrevistas foram acompanhadas de métodos observacionais em 8.5% dos estudos analisados. Conclusão A produção bibliográfica dos estudos qualitativos sobre o tema da família publicados nas revistas de enfermaria brasileiras no período de estudo é escassa, mostrando que há necessidade de um maior desenvolvimento na mesma.

Palavras chaves: pesquisa qualitativa; enfermagem; família.

INTRODUCTION

The production of scientific articles using the theme family has presented a gradual increase in the last few years within the academic nursing field. Knowing the family context and the impact of the disease in the development and organization of its members can help nurses to plan health care actions. It is in the inner family environment that individuals' most intimate demonstrations are expressed, be it through affection, shelter or care, conflict, oppression, violence, abandonment, social contact between different generations. Over time, however, several social, political, economic and cultural changes allowed for alternative ways of being a family, resulting in about 200 types of family structures.¹

In Professional Nursing, the actions directed towards families are in a constant transition process, particularly with the consolidation of the Unified Health System (SUS) and the Family Health Strategy (FHS).² As for the research undertaken within the area, an increasing emphasis on the development of studies that have the family as a main focus can be noted. In this perspective, and as a complex system, research about the family needs flexible, sensitive and practical methods. In addition to quantitative methods, qualitative methods are appropriate for the study of a broad range of family experiences due to their ability to provide different perspectives.³ The qualitative approach involves the use and collection of a variety of evidence based materials, through case study, personal experience, introspection, life history, interview, artifacts, texts and cultural productions, amongst others. Aiming to understand the family context, researchers apply interpretative technics to better describe the topic.⁴ A study undertaken in the Southern region of Brazil (Rio Grande do Sul, Santa Catarina and Paraná states) in 2006 showed that 70% of research about the theme family is qualitative nature, which demonstrates the need for further studies with appropriate methods in family research.⁵

Qualitative research is almost always not well defined and concrete, as all choices will depend on a set of decisions about the research design. Therefore, the flexibility obtained from working with qualitative methods can permit a choice of methods and criteria that often are not directed at the research problem. In order to avoid a conflict of methods, it is believed that all methodological decisions originate in the research question.^6,7 When a group/family is involved in the choice of the number of participants, the means of representation can be more complex than in studies with individuals.³ The satisfaction concerning the number of participants in qualitative research with families is questioned as, in general, the interviewed family member speaks on behalf of the whole family, and vice versa. Thus, investigations about qualitative research with a family focusing may show directions to strengthen Professional Nursing research.

METODOLOGY

A bibliographical study was undertaken, using the Bireme (Virtual Health Library) and SciELO databases. The criteria used to select the articles were the search for combined words: family, qualitative research, Professional Nursing. Another stage for the inclusion of articles in the study was carried out in the present review: entire studies focusing on the family as the object of study; having the term family in the article title; having been published between 2006 and 2010; having been published in Portuguese; having been published in journals with QUALIS/CAPES B1 and A2.

The data collection stage took place between December 2010 and January 2011. In order to select the publications, the following guiding questions were used: 'What are the qualitative methodological trends in Professional Nursing scientific production involving families?' Each title and summary was exhaustively read to confirm if they answered the guiding question and if they fulfilled the established criteria for inclusion.

Concerning the registration of the information, a record with the following information was created and used: the authors' professional category, number of authors per article, year of publication, journal, thematic, place of research, number and representation of families, qualitative technic and data analysis. An Excel spreadsheet was used to insert the data, which was organized in tables and figures. Descriptive and quantitative analysis was applied.

RESULTS

The bibliographical search involved 227 publications, 47 of which had the family as the object of study, which corresponds to 20.7%. The analyzed studies included various areas of health care, such as: child health - 19 (40.4%), adult health - 11 (23.4%), mental health - 9 (19.1%), collective health - 3 (6.4%), elderly health - 3 (6.4%) and woman's health - 2 (4.3%).

In relation to the publication period of the analyzed articles, the year 2009 stood out with 16 (34.0%) publications, followed by 2010 with 12 (25.5%) articles, 2008 with 10 (14.1%), 2007 with 8 (17.0%) and 2006 with 1 (2.1%). Table 1 shows the distribution of Brazilian publications related to Professional Nursing according to the QUALIS stratification of the journals in the period between 2006 and 2010.

It is evidenced that journals classified by the system QUALIS/CAPES as B1 published more articles containing qualitative studies with families, corresponding to 70.6% (33).

The publications were distributed according to the author's professional category, as follows: Undergraduate Nursing student (U), Graduate Nursing Student (G), Nurse (N), Master (M), Ph.D. (D) and other professionals (Ot). Under the classification 'other professionals', Psychologists stand out (Table 2).

It can be noted that publications by Ph.D. graduates and graduate students are more frequent, totaling 57.4% (27) of co-authors, followed by Ph.D. and M.Sc. graduates and graduate students with 12.8% (6). Although limited in this study, approximation between Professional Nursing and other health professions was seen in 3 (6.4%) analyzed studies.

This study showed an average of 3.1 authors per publication (minimum of 2 authors and maximum of 8 authors).

The themes addressed in the studies involving families were broad, for example: breast cancer, alcoholism, patients hospitalized in adult and pediatric Intensive Care Unit (ICU), mental illness, health care service evaluation, rare diseases, pregnancy in adolescents, transmissible diseases, health education, newborn and the elderly.

In this study, the articles were identified because the title contained the term family. The family was in most cases represented by a member of the family but, in other studies, there were members who were not part of the family circle. In 31 (65.9%) of the analyzed studies, the family caregiver and/or family members with different degrees of kinship (grandparents, cousins, uncles/aunties, nephews/nieces, sister, married couples and boyfriend) served as the sources; 9 (19.1%) studies had parents as sources (mother and/or father), and 7 (14.9%) studies parents and grandparents.

The number of participants in the analyzed studies varied between 1 and 38 family members, with an average of 11.4 participants per article. As for the data collection method, this study used semistructured (57.4%) and open interviews (30.8%). The interviews were followed by observation methods in 4 (8.5%) of the analyzed studies.

The ecomap and genogram were strategies applied in the analyzed studies in order to complement the data collection procedures, mainly in those studies that used a case within the family.

DISCUSSION

The analyzed studies mainly addressed the mental healthcare and child healthcare field. This can be related to the ethical rules (National Health Council Resolution 196/96; Regulation number 2048/2009) under which participants that are vulnerable, mentally ill and children are protected. These people cannot be held responsible for their participation in research involving human beings.⁸

The classification of the analyzed journals under QUALIS B1 (33 studies) was predominant and this can be related to the fact that more Brazilian Professional Nursing journals are classified under QUALIS B1 than QUALIS A2. In regards to the author's academic title, the information obtained seems to be similar to another study that aimed to analyze research focusing on elderly healthcare, amongst which authorships of faculty members with a Ph.D. degree and graduate students can be highlighted.⁹

Psychologists stood out as supporting professionals in this study, together with nursing authors. Psychology is an area of social science that can assist in scrutinizing the emotional and social aspects of family relationships.¹⁰ The knowledge explored in multidisciplinary studies can provide more theoretical support, mainly when nursing professionals apply theoretical frameworks originating from other areas, such as Psychology, Philosophy, Sociology, Anthropology, amongst others.

The issue about the number of authors per publication has never been that discussed and explored as it has currently been within Professional Nursing. There are some journals that even request a description of each author's participation in the study in order to avoid an excess of co-authorship. Some of them establish the maximum number of five authors per article.

The possibility to research the family perception allows a large number of professionals to explore it as a special subject of knowledge about the study topic, even in studies without a family focus. In studies in which participants were parents and/or grandparents, the child health area was predominant, and this can be explained by the fact that they are the children's main family caregivers.

In relation to the number of participants, qualitative studies are generally based on information saturation to limit that number and, therefore, to define the number of subjects in the study. This strategy is a tool used in a range of health care areas to establish or decide on the final size of a study sample.¹¹

There is a mistaken belief that, in qualitative research samples, the numbers are not important to ensure an appropriate sampling strategy. Defining the appropriate number of participants in a qualitative research is basically a matter of judgment and experience when evaluating the quality of the collected information.¹² With this in mind, the criteria and evaluation researchers use in order to decide when the number of participants is sufficient in family research can explain the variation in the number of participants (1 to 38) in the analyzed studies.

Qualitative interviews are the most commonly used in the health care field. Semistructured interviews are based on a flexible structure, which consists of open questions defining the area to be explored; in-depth interviews are less structured and can include one or two aspects, but are much more detailed. These types of interviews depend on the researcher's sensitivity and ability.¹³

There is a variety of qualitative interview questions: behavior/experience, opinion or belief, feelings, knowledge, sensory, formation or demographics. As for the registration of interviews, it can be done using the following: note taking on the spot, note taking after the interview and audio recording.¹³

Interviews are essential elements for the proper development of data collection in studies with families. They may be followed by observation methods, which was the case in 4 (8.5%) analyzed studies. In this approach, the researcher systematically watches people and events in order to observe their behaviors and everyday relationships. These are often used to analyze the daily work of health care professionals.⁶

The technics for data collection need to be carefully discussed, as there exist published studies using collective interviews (with the participation of many members of the same family) and individual interviews (only one participant representing all members of the family), taking into consideration that the experiences/perceptions reported depend on the family participant(s).

In addition to data collection in the analyzed studies, the ecomap and genogram were used. The ecomap refers to the diagram of the relationship between the family and the community and it contributes to the evaluation of the available social support and networks and their use by the family. The genogram also provides clear knowledge about which members are part of the family, whether or not they are related by blood and, consequently, it provides basis for discussion and family interaction analysis.¹⁴ These tools enable an understanding about family interactions, even with only one participant.

Final considerations. The concept of family has been changing as a result of the introduction of new behaviors, attitudes, affections and social relationships, enabling the rising of new concepts of family. To approach and discuss a study focused on the family involves particular and responsible criteria. The sources used in this study show the need to discuss the qualitative methodology when the subject of the study is the family. Discussing the methodological problems of qualitative studies about family can be challenging for nursing professionals, for example the definition of family, the access, data collection methods and data management. It is noted that studies involving families have similar attributes to those involving individuals, however, they also have different features.

The participants representing the family in the analyzed studies were mainly the caregivers. No matter the kinship degree, the target of the study was the family member responsible for the care of others. When the focus of the analysis was on children's health care, the participants were the parents or the grandparents. The care, as the center point in Professional Nursing, should be visualized through more precise methods, so that this knowledge is as close as possible to the planned and implemented health care actions.

Concerning Professional Nursing in Brazil, there is the need for improvement in the technics used in qualitative family research methods. Despite the awareness that families could be viewed through individual members' perceptions, like in the analyzed studies, this study suggests that other studies could discuss the issue about the number of participants per family, so that the quality of family experiences demonstrates the real needs of the Brazilian population.

REFERENCES

1. Dessen MA, Lewis C. Como estudar a família e o pai? Paidéia, 1998;1:106-21.         [ Links ]

2. Roecker S, Denardi ML, Marcon SS. Trabalho educativo do enfermeiro na Estratégia Saúde da Família: dificuldades e perspectivas de mudanças. Rev Esc Enferm USP 2012; 46(3):641-9.         [ Links ]

3. Kurki PA, Paavilainen E, Lehti K. Methodological issues in interviewing families in family nursing research. J Adv Nurs. 2001;35(2):288-93.         [ Links ]

4. Denzin N K, Lincoln YS. A disciplina e a prática da pesquisa qualitativa. Em: Denzin N K, Lincoln YS. O planejamento da pesquisa qualitativa - teorias e abordagens. 2nd Ed. Porto Alegre: Artmed; 2006. p.15-42.         [ Links ]

5. Marcon SS, Waidman MAP, Decesaro MN e Areas MMM. Produzindo conhecimento sobre família: a contribuição da enfermagem do Sul do Brasil. Acta Paul. Enferm. 2006; 19(1);21-7.         [ Links ]

6. Pope C, Mays N. Métodos observacionais. Em: Pope C, Mays N. Pesquisa qualitativa na atenção à saúde. 3. ed. Porto Alegre: Artmed; 2009. p.45-55.         [ Links ]

7. Unesco. Primary and Second Education: Age-specific enrolment ratios by gender 1960/61-1995/96. Paris: Unesco; 1997        [ Links ]

8. Ministério da Saúde. Brasil. Regulamento do Sistema único de Saúde -SUS.Portaria 2048. (3-09-2009)        [ Links ]

9. Veiga KCG, Menezes TMO. Produção do conhecimento em Enfermagem: a (in) visibilidade da atenção à saúde do idoso. Rev Esc Enferm USP. 2008;42(4):761-8.         [ Links ]

10. Ronchi, JP, Avellar LZ. Família e ciclo vital: a fase de aquisição. Psicol Rev. 2011;17(2):211-25.         [ Links ]

11. Fontanella BJB, Ricas J, Turato ER. Amostragem por saturação em pesquisas qualitativas em saúde: contribuições teóricas. Cad Saúde Pública. 2008;24(1);17-27.         [ Links ]

12. Sandelowski M. Sample size qualitative research. Iss Res Nur Health; 1995.18(2):179-83.         [ Links ]

13. Britten N. Entrevistas qualitativas na pesquisa em atenção à saúde. In: Pope C, Mays N. Pesquisa qualitativa na atenção à saúde. 3th Ed. Porto Alegre: Artmed; 2009. p.23-31.         [ Links ]

14. Nascimento LC, Rocha SMM, Hayes VE. Contribuições do genograma e do ecomapa para o estudo de famílias em enfermagem pediátrica. Texto Contexto Enferm. 2005; 14(2):280-6.         [ Links ]