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      Application of four-dimension criteria to assess rigour of qualitative research in emergency medicine

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          Abstract

          Background

          The main objective of this methodological manuscript was to illustrate the role of using qualitative research in emergency settings. We outline rigorous criteria applied to a qualitative study assessing perceptions and experiences of staff working in Australian emergency departments.

          Methods

          We used an integrated mixed-methodology framework to identify different perspectives and experiences of emergency department staff during the implementation of a time target government policy. The qualitative study comprised interviews from 119 participants across 16 hospitals. The interviews were conducted in 2015–2016 and the data were managed using NVivo version 11. We conducted the analysis in three stages, namely: conceptual framework, comparison and contrast and hypothesis development. We concluded with the implementation of the four-dimension criteria (credibility, dependability, confirmability and transferability) to assess the robustness of the study,

          Results

          We adapted four-dimension criteria to assess the rigour of a large-scale qualitative research in the emergency department context. The criteria comprised strategies such as building the research team; preparing data collection guidelines; defining and obtaining adequate participation; reaching data saturation and ensuring high levels of consistency and inter-coder agreement.

          Conclusion

          Based on the findings, the proposed framework satisfied the four-dimension criteria and generated potential qualitative research applications to emergency medicine research. We have added a methodological contribution to the ongoing debate about rigour in qualitative research which we hope will guide future studies in this topic in emergency care research. It also provided recommendations for conducting future mixed-methods studies. Future papers on this series will use the results from qualitative data and the empirical findings from longitudinal data linkage to further identify factors associated with ED performance; they will be reported separately.

          Electronic supplementary material

          The online version of this article (10.1186/s12913-018-2915-2) contains supplementary material, which is available to authorized users.

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          Most cited references45

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          Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research.

          Purposeful sampling is widely used in qualitative research for the identification and selection of information-rich cases related to the phenomenon of interest. Although there are several different purposeful sampling strategies, criterion sampling appears to be used most commonly in implementation research. However, combining sampling strategies may be more appropriate to the aims of implementation research and more consistent with recent developments in quantitative methods. This paper reviews the principles and practice of purposeful sampling in implementation research, summarizes types and categories of purposeful sampling strategies and provides a set of recommendations for use of single strategy or multistage strategy designs, particularly for state implementation research.
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            Rigor in qualitative research: the assessment of trustworthiness.

            L Krefting (1991)
            Despite a growing interest in qualitative research in occupational therapy, little attention has been placed on establishing its rigor. This article presents one model that can be used for the assessment of trustworthiness or merit of qualitative inquiry. Guba's (1981) model describes four general criteria for evaluation of research and then defines each from both a quantitative and a qualitative perspective. Several strategies for the achievement of rigor in qualitative research useful for both researchers and consumers of research are described.
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              Critical Analysis of Strategies for Determining Rigor in Qualitative Inquiry.

              Criteria for determining the trustworthiness of qualitative research were introduced by Guba and Lincoln in the 1980s when they replaced terminology for achieving rigor, reliability, validity, and generalizability with dependability, credibility, and transferability. Strategies for achieving trustworthiness were also introduced. This landmark contribution to qualitative research remains in use today, with only minor modifications in format. Despite the significance of this contribution over the past four decades, the strategies recommended to achieve trustworthiness have not been critically examined. Recommendations for where, why, and how to use these strategies have not been developed, and how well they achieve their intended goal has not been examined. We do not know, for example, what impact these strategies have on the completed research. In this article, I critique these strategies. I recommend that qualitative researchers return to the terminology of social sciences, using rigor, reliability, validity, and generalizability. I then make recommendations for the appropriate use of the strategies recommended to achieve rigor: prolonged engagement, persistent observation, and thick, rich description; inter-rater reliability, negative case analysis; peer review or debriefing; clarifying researcher bias; member checking; external audits; and triangulation.
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                Author and article information

                Contributors
                r.forero@unsw.edu.au
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                17 February 2018
                17 February 2018
                2018
                : 18
                : 120
                Affiliations
                [1 ]ISNI 0000 0004 0527 9653, GRID grid.415994.4, The Simpson Centre for Health Services Research, South Western Sydney Clinical School and the Ingham Institute for Applied Research, Liverpool Hospital, UNSW, ; Liverpool, NSW 1871 Australia
                [2 ]Psychiatry Research and Teaching Unit, Liverpool Hospital, NSW Health, Sydney, Australia
                [3 ]ISNI 0000 0004 4902 0432, GRID grid.1005.4, School of Psychiatry, Faculty of Medicine, University of New South Wales, ; Sydney, Australia
                [4 ]ISNI 0000000089150953, GRID grid.1024.7, School - Public Health and Social Work, , Queensland University of Technology (QUT), ; Brisbane, Qld Australia
                [5 ]ISNI 0000 0001 2222 605X, GRID grid.464519.b, Australasian College for Emergency Medicine (ACEM), ; Melbourne, VIC Australia
                [6 ]ISNI 0000 0004 0389 4302, GRID grid.1038.a, School of Nursing and Midwifery, Edith Cowan University (ECU), ; Perth, WA Australia
                [7 ]Emergency Care Institute (ECI), NSW Agency for Clinical Innovation (ACI), Sydney, Australia
                [8 ]Clinical Support Directorate, System Policy & Planning Division, Department of Health WA, Perth, WA Australia
                Author information
                http://orcid.org/0000-0001-6031-6590
                Article
                2915
                10.1186/s12913-018-2915-2
                5816375
                29454350
                fed7b2c8-3216-4899-9103-cf95647704dc
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 5 May 2017
                : 6 February 2018
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000925, National Health and Medical Research Council;
                Award ID: App 1029492
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/100008489, Australasian College for Emergency Medicine;
                Award ID: cash contribution
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100006065, Department of Health, Government of Western Australia;
                Award ID: cash contribution
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100008810, NSW Ministry of Health;
                Award ID: cash contribution
                Award Recipient :
                Funded by: Agency of Clinnical Innovation NSW
                Award ID: cash contribution
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100001078, Queensland Emergency Medicine Research Foundation;
                Award ID: cash conttribution
                Award Recipient :
                Categories
                Technical Advance
                Custom metadata
                © The Author(s) 2018

                Health & Social care
                emergency department,four-hour rule,australia,policy assessment,qualitative methods,interviews,research design

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