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CHAPTER 6 HOW TO WRITE PUBLISHABLE QUALITATIVE RESEARCH KERSTIN STENIUS, KLAUS MÄKELÄ, MICHAL MIOVSKY, AND ROMAN GABRHELIK INTRODUCTION Conducting and publishing qualitative research requires the same principal skills as quantitative research. In addition, there may be special challenges for the qualitative researcher. She may have to overcome prejudice and communication barriers within the scientific community. This chapter provides advice to authors who wish to publish their research in a scientific journal. The chapter starts with some remarks on special characteristics of the processes of qualitative study that can have an impact on the reporting of the results. It continues by identifying the common criteria for good qualitative research. We then present some evaluation principles used by editors and referees. Finally, we give practical advice for writing a scientific article and discuss where to publish your results. In quantitative research the observations typically follow a systematic scheme where the classification of the observations is already determined to a large extent when the data collection starts. This makes it possible to gather large data sets for numerical analyses, but the understanding of the findings will be restricted by the concepts on which the collection of data was based. You can argue that in qualitative research, where the observations (e.g., texts, sounds, behaviour, images, etc.) are usually fewer, the researcher's preconception of a social phenomenon does not determine the research results to the same extent as in quantitative research (Sulkunen, 1987). Qualitative research is thus often used for the study of social processes, or for a study of the reasons behind human behaviour, or as Wikipedia puts it: the why and how of social matters, more than the what, where, and when that are often central to quantitative research. The topics dealt with in qualitative addiction research range from historical processes to treatment outcomes. Qualitative research is used increasingly to answer questions about alcohol and drug policy, including rapid assessment of policy developments (see for instance Stimson et al., 2004). It is used to study program implementation and in the evaluation of various policy measures. And ethnographers have employed qualitative methods to increase the understanding of patterns of substance use in various population groups (see for instance Lalander, 2003). There is also an important and growing interest in the combination of qualitative and quantitative research, so called mixed methods research, not least within evaluation and intervention research in the clinical and policy fields (Creswell & Plano Clark, 2007). The combination of qualitative and quantitative methods can deepen the understanding of processes, attitudes, and motives. 82 PUBLISHING ADDICTION SCIENCE: A GUIDE FOR THE PERPLEXED There is frequent discussion in theoretical mixed method studies of the relation between various kinds of knowledge, or the actual procedure of combining qualitative and quantitative methods (Creswell & Tashakkori, 2007). Box 6.1 presents criteria for good mixed-methods articles. Box 6.1 CRITERIA FOR GOOD MIXED-METHODS ARTICLES a) The study has two sizeable data sets (one quantitative, one qualitative) with rigorous data collection and appropriate analyses, and with inferences made from both parts of the study. b) The article integrates the two parts of the study in terms of comparing, contrasting, or embedding conclusions from both the qualitative and the quantitative strands. c) The article has mixed methods components that can enrich the newly emerging literature on mixed methods research. Source: Creswell & Tashakkori (2007) In spite of what we believe is an increasing interest in qualitative research, many journals do not publish qualitative studies. In addition, many editors of addiction journals have noted that qualitative manuscripts are more likely to present the editors with problems and are more often declined for publication than quantitative research reports. Some of the problems are related to how the articles are written. In the addiction field there is no journal dedicated exclusively to qualitative research, and in many journals the format of an article has to follow a strict standard. Qualitative articles tend to break with that format, putting special demands on the reader. Another problem for a comparatively small research field such as addiction research is that it is difficult to find referees who are competent to evaluate qualitative methods and analyses. The journal may have only a small pool of suitable referees. The author can thus run the risk of being judged by someone who is not only unqualified but also may be prejudiced against qualitative research. For all of these reasons, the qualitative researcher has to be particularly professional in her writing. ON QUALITATIVE AND QUANTITATIVE RESEARCH Qualitative methods can be used for pilot studies, to illustrate the results of a statistical analysis, in mixed methods studies, and in independent qualitative research projects (c.f. Denzin & Lincoln, 1998). This chapter will focus on the last category: original research reports building on qualitative methods. We will emphasise the similarities and considerable overlap in the evaluation, and effective presentation, of both qualitative and quantitative research. CHAPTER 6: HOW TO WRITE PUBLISHABLE QUALITATIVE RESEARCH 83 The first and foremost aim of all social research, quantitative as well as qualitative, is to present a conceptually adequate description of a historically specific topic, subject or target. In qualitative research the determination of the subject is as important as the choice of a population in a statistical study. The description of the subject is always, in both types of study, a theoretical task because it requires a conceptually well organized analysis. The processes of classification, deduction and interpretation are in their fundamental aspects similar in both qualitative and quantitative research. Quantitative analyzing operations, however, are more clear-cut than qualitative operations. Furthermore, the various steps of quantitative research can be more clearly distinguished than those of a qualitative study. The first issue is that, in qualitative work, the collection and processing of data are more closely intertwined than in a quantitative study. Especially when the researcher personally collects the data, she will not be able to avoid problems of interpretation during the collection phase. A specific issue in some qualitative research may be the fact that the methods used can change during the study, depending on interim results. It is a challenge to explain in a short article why this has happened, and why you have used a different method in the final phase of the data acquisition than in the previous parts; or why you changed a classification scheme and encoded the data in a different manner. The researcher must also carefully consider her relations with the study objects. Many qualitative reports often discuss at length the character and psychology of the process of data collection, but are less careful in describing what happened to the interview tapes afterwards. Were they transcribed in whole or in part, how was the resulting stack of papers handled and sorted out? In qualitative research these data processing explications may be necessary to render credibility to the analysis. A second issue is that qualitative analysis is not restricted to an unambiguously demarcated data set in the same way as a quantitative study. The good researcher may keep a detailed field diary and make notes of all discussions and thus produce a corpus to which she limits her analysis. Nevertheless, during the analysis phase she may recall an important detail which she has not recorded in her notes, but has to take into account in the analysis. The qualitative researcher has to describe this analytical process in an honest and convincing way. EVALUATION CRITERIA FOR QUALITATIVE ANALYSIS There are some differences between the evaluation of qualitative and quantitative research. The replicability of a qualitative study cannot be formulated as a problem of reliability, and the accuracy of a qualitative interpretation cannot be compared to the explanatory power of a statistical model. In the following paragraphs we propose three main criteria for evaluating qualitative studies. Since in qualitative research the analyses and reporting are very closely intertwined, the following criteria are as relevant to researchers and authors as they are to reviewers and editors: 1) significance of the data set and its social or cultural place; 2) sufficiency of the data, and coverage of the analysis; 3) transparency and repeatability of the analysis. 84 PUBLISHING ADDICTION SCIENCE: A GUIDE FOR THE PERPLEXED 1. SIGNIFICANCE OF THE DATA SET AND ITS SOCIAL OR CULTURAL PLACE The researcher should be prepared to argue that her data are worth analyzing. It is not easy to identify criteria for the significance of data. One precondition can, however, be presented: the researcher should carefully define the social and cultural place (contextualising) and the production conditions of her material. The production conditions can be discussed at various levels. When the data consist of cultural products, their production and marketing mechanisms should be considered. Texts produced by individuals should be related to their social position. Furthermore, the situational aspect of the data production and the researcher's potential influence on the data should be evaluated. The relationship of cultural products to people's everyday life depends on the production and distribution network. Weekly magazines and movies represent the ambient culture at a number of levels. When doing comparisons over time it is important to bear in mind that the social and cultural place of one and the same genre may vary from decade to decade. In international comparisons it is important to be able to exclude demographic variation as a factor causing differences. If we wish to identify the distinct characteristics of Finnish A.A. members' stories, we should make sure that we do not compare Finnish farmers to American college Professors. The criterion for selecting the target group is not demographic but cultural representativity. Additionally, people speak of the same things in different ways on different occasions, and it is the task of the researcher to decide which discourse she wants to study and argue for her decision in the article. Informal interviews are often advocated instead of questionnaires on the grounds that they will produce more genuine information. But, on the other hand, an in-depth interview is a more exceptional situation for a presentday person than completing a questionnaire. Possible effects of the power structures and gender relations present in every social situation should be considered in the discourse analysis, since it could affect the outcomes of the qualitative research. Study of the variations of discourse, i.e. the incorporation of the production conditions into the study design, can be rather laborious. Members of A.A. emphasise various sides of their story according to the composition of the audience, and depending on whether they talk at a closed or an open A.A. meeting. Furthermore, the life story will change in relation to how long the speaker has been in A.A. Even when variation cannot be incorporated into the actual study design, it is important to consider and discuss the conditions under which the material was produced and their place in the potential situational variation of the discourse. 2. SUFFICIENCY OF DATA AND COVERAGE OF ANALYSIS For statistical studies we are able to calculate in advance the extent of data needed to estimate the parameters accurately enough for the purpose of the analysis. We have no similar methods for estimating the extent of qualitative data required. We usually speak about data saturation: data collection can be terminated when new cases no longer disclose new features (Strauss & Corbin, 1998). CHAPTER 6: HOW TO WRITE PUBLISHABLE QUALITATIVE RESEARCH 85 The difficulty here, of course, is that the limit is not always known in advance, and the collection of data is rarely a continuing process which could be terminated or extended at will. Only in very special cases can you base your analyses on just a handful of observations. In most cases you will need to be certain that you cover the variation of the phenomenon you are studying. On the other hand, a loose but useful rule is that one should not collect too much data at a time. It is better to analyze a small data batch carefully first and only then determine what additional data will be needed. To divide the analyses into smaller parts also helps to end up with manageable results for a publishable report. It is often advisable to group the collection of data according to factors which may prove important as production conditions. The goal is not to explain the variation but to make sure that the data are sufficiently varied. For example, it would be helpful to stratify the collection of A.A. members' life stories according to the members' social position, sex, age and length of sobriety (Arminen, 1998). The only difficulty is that we will have no advance knowledge of which characteristics will decide the type of life stories; they may depend more on drinking experiences than on external circumstances, and within A.A. there may be various narrative traditions which have an influence on the life stories. A proper coverage of the analysis means that the researcher does not base her interpretations on a few arbitrary cases or instances but on a careful reading of the whole material. Qualitative reports are often loosely impressionistic because the excessive amount of material has made it unfeasible to analyze it carefully enough. 3. TRANSPARENCY AND REPEATABILITY OF THE ANALYSIS Transparency of the analysis means that the reader is able to follow the researcher's reasoning, that he is given the necessary information for accepting her interpretations -- or challenging them. The repeatability of an analysis means that the rules of classification and interpretation have been presented so clearly that another researcher applying them will reach the same conclusions. We may identify three ways of improving the transparency and repeatability of qualitative analysis and the report: 1) enumerating the data; 2) dividing the process of interpretation into steps; and 3) making explicit the rules of decision and interpretation. The best method to decrease arbitrariness and increase repeatability is to enumerate all units on which the interpretation is based. To do this an analytical unit must be specified and it should be as small as possible: in other words, not a movie or a group discussion but a scene, a statement or an adjacent pair. The identification of the unit of analysis is in itself part of the process of interpretation. The process of interpretation and analysis can never be fully formalized. It is above all a question of working step by step so that the process of interpretation can be made visible to both the researcher herself and the reader. 86 PUBLISHING ADDICTION SCIENCE: A GUIDE FOR THE PERPLEXED Qualitative analysis is of necessity more personal and less standardized than statistical analysis. Thus it is even more vital that the reader is given as exact a picture as possible of both the technical operations and the chain of reasoning that have led to the reported results. The reader must not be left at the mercy of the researcher's intuition alone. The demand for transparency in qualitative research is of crucial importance. EDITORS' AND REFEREES' ASSESSMENT OF QUALITATIVE RESEARCH REPORTS A discussion of the evaluation criteria for peer review of qualitative research can start with evaluation principles for quasi-experimental research or natural experiments. The American Journal of Public Health recently published an evaluation system for these types of study (Des Jarlais et al., 2004) entitled TREND (Transparent Reporting of Evaluations with Nonrandomized Designs). TREND was designed specifically for research results where the randomisation principle was somehow restricted. The criterion of transparency, which is central to this evaluation system, emphasises a detailed description of all steps and procedures, as well as a detailed justification of the choice and manner of application of the individual methods and theoretical background (see also Mayring, 1988, 1990). Mareš (2002) analysed quality criteria for research using pictorial documents and summarized the findings with the concepts of completeness -- how well the data captures the phenomenon examined, transparency -- the accuracy, clarity and completeness of the description of the individual phases of the study, reflexivity -- the ability of the researcher to reflect upon her different steps and measures during the study and how she may have influenced the research situation, and adequacy of interpretation and aggregation of contradictory interpretations -- the identification and weighting of alternative interpretations and other validity control techniques. Des Jarlais, et al. (2004, pp ) have drawn up a 22-item list to serve as a general assessment guide for authors and evaluators. Box 6.2 shows some of the requirements and recommendations.additional recommendations proposed by Gilpatrick (1999) and Robson (2002) are summarised in Box 6.3. It is true to say that the qualitative paper, both in its entirety and in its constituent parts, will be evaluated by and large according to the same criteria and expectations as those applied to a quantitative report. CHAPTER 6: HOW TO WRITE PUBLISHABLE QUALITATIVE RESEARCH 87 BOX 6.2 ASSESSMENT CRITERIA FOR QUALITATIVE STUDIES a) An article should be provided with a structured abstract (as a minimum: background, aims, sample, methods, results). b) The sampling should be described and justified, including an explanation of criteria used. c) The theoretical background of the entire study, or individual methods, should be described, to show that the sample and data collection were consistent with the study's theoretical background. d) The context (setting) in which the study was carried out should be described. The author must describe the characteristics of the field in which the study was carried out, and what made it different from other settings. e) A detailed description of the research intervention should be included, and of how study participants responded during that intervention. f) A detailed description of the analytical methods applied, how they were used, including the tools used for minimising bias, and a validation of the results should be presented. g) A description of the manner of data processing (e.g., technical aspects and procedures) is needed. h) Description of outcomes and their interpretation are obviously necessary. This includes a discussion of limitations (contextual validity of results), and an analysis of how the design of the study reflects these limitations. Source: Des Jarlais et al. (2004) 88 PUBLISHING ADDICTION SCIENCE: A GUIDE FOR THE PERPLEXED Box 6.3 EVALUATION CRITERIA FOR QUALITATIVE STUDIES a) The research issue and the research questions and goals derived from it, should be properly presented. b) The goals should be contextually embedded and put into a theoretical framework, with an analysis of the present state of knowledge. c) The author should argue for the importance of her study against this background (e.g. what questions or issues the results should contribute to, how they will move the field forward). d) Control tools (e.g., research logs, control points) should be reported and how ethical problems were handled (e.g., use o
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