Why Qualitative Research is Needed in Gerontology and How We Can Do It Better

In her guest editorial of Journal of Gerontology: Social Sciences, Warren-Findlow (2013) described the potential strengths of high-quality qualitative research and why more of it was needed. Qualitative research, she explained, can allow scholars to learn about the voices of marginalized persons, understand the thoughts and processes that people engage with in their everyday lives, and potentially develop theory. Within social gerontology, research using qualitative methods has provided important insights into a range of topics including retirement (Moffatt & Heaven, 2017), sexual relationships (Hinchliff, Tetley, Lee, & Nazroo, 2018), suffering (Black & Rubinstein, 2004), dementia (Van Gennip, Pasman, Oosterveld-Vlug, Willems, & Onwuteaka-Philipsen, 2016), active ageing (Phoenix & Bell, 2018; Tulle & Phoenix, 2015), and independence (Hillcoat-Nallétamby, 2014) to name but a few. The papers in this special section extend this valuable body of knowledge via different forms of qualitative research. These studies vary in terms of their research design (e.g., entirely qualitative, mixed method, cross-sectional, longitudinal), data collection techniques (e.g., in-depth interviews (in person and by telephone), participant observation, participant produced photographs, photo-elicitation interviews), and data analyses (e.g., grounded theory (Charmaz, 2007), framework analysis (Ritchie & Lewis, 2003), and group interaction analysis (Borkan, 1999). Yet these papers bear a similarity in that they offer insights which broadly cohere around the notion of environments of aging. Suitor and colleagues (2018) focus on care environments; specifically, the role of family conflict embedded within the experiences of black and white adult children caring for their mothers. The authors highlight the importance of considering relationships with different categories of family members when studying well-being within the context of caregiving and race. Weir and colleagues (2017) also allude to care environments as they examine shared decision-making around polypharmacy from the perspective of older adults and their companions. Notably, their work provides a typology which represents different attitudes towards medicines in later life. Their work also advocates the importance of shared decision-making, signaling the relational dimension to medicine use and the subsequent implications for communication and trust between older adults, companions, and prescribers. The concept of trust—or, more specifically, loss of trust—is at the forefront of Fritz, Cutchin, and Cummins (2018) concern with environments of aging from a place-based perspective. The authors reflect on older African Americans’ perspectives on their neighborhood environments and the role they play in both supporting daily activities, but also serving as a source of stress. Collectively, these papers demonstrate the value of qualitative methods in shedding light on “the muddle and messiness of aging” (Warren-Findlow, 2013 p. 407). They provide rich understanding of older people’s perspectives of their care, medicine use, and neighborhoods, foregrounding voices which are often absent from what gets reproduced within the evidence base. These spaces open up the possibility for a critical framework to assume a more prominent position in our work. The need for and timeliness of which is emphasized by Denzin and Lincoln (2018) who argue that “We need to become better accomplished in linking these interventions to those institutional sites where troubles are turned into public issues and issues are transformed into social science” (p. x). In short, they assert, we need to show how the practices of qualitative research can help change the world in positive ways. For this to be achieved with respect to the social worlds of older adults, we must ensure that the highest quality qualitative research is being produced. I briefly outline four areas that gerontologists engaging with qualitative research may benefit from being mindful of. The first area relates to the generation, or coproduction, of qualitative data. Alongside innovation taking place within more traditional and well used (for good reason!) methods such as interviews, participant observation, or focus groups (see e.g., Barbour & Morgan, 2017), increasingly novel and contemporary methods have also been developed and refined in recent years. As examples, “netnography” (Kozinets, 2015) is an online research method, which is applied to understanding social interaction in contemporary digital communications contexts such as online chat forums, comments and their responses on social media such as Facebook, Twitter, and Instagram. This method is useful because it offers a means of examining social and machine interaction at a time when older adults’ engagement with the internet and smart phones is becoming increasingly prevalent, and to a certain extent, advocated. Sensitive to the ageist perception of older people as asexual, Berdychevsky and Nimrod (2017) applied a netnography approach and studied language-based seniors’ online communities to examine the links between sex and wellbeing in later life. In doing so, they drew attention to the importance, leisurely qualities, and benefits of sexual activity in older adulthood, alongside the negotiation and management of various constraints to sexual function and expression. A second example of contemporary qualitative methods might include those that are increasingly used to pay closer attention to what it is like, and what it means to be on the move. Responding to current trends in environmental gerontology and geographical gerontology noted by Fritz and colleagues (this issue), these techniques are referred to as mobile methods because they enable the researcher to collect date as they “go along with” the kinds of moving systems and experiences that characterize much of the contemporary world (Büscher, Urry, & Witchger, 2011). As but one example, Bell, Phoenix, Lovell, and Wheeler (2015) used a mobile method called geo-narratives to help them understand how people routinely used outdoor nature spaces; where they went (routes, shortcuts, detours), how they moved through certain places (e.g., meandering, striding out, or perhaps stopping midway to take in a view), and the stories they told about these experiences (connected to life events, mood, weather, and so forth). Aligned with these methods, Franke, Winters, McKay, Chaudhury, and Sims-Gould (2017) utilized what they termed a “grounded visualization approach” to explore the complexity of older adults’ mobility experiences over time. Their study drew attention to the ways in which time was a necessary component of older adult’s engagement with space. A final example is story-completion methods. These are a time and resource efficient, flexible means of investigating people’s perceptions, understandings and social constructions (Clarke, Hayfield, Moller, Tischner, & The Story Completion Research Group, 2017). Story completion contrasts typical qualitative methods, where research participants are requested to report directly about their attitudes, beliefs, experiences, and behaviors. It invites a contrasting approach by inviting participants to complete the opening lines of a story (or “stimulus”), which provide the entry point into a story plot. As an example, asking older adults, companions, and their health care providers to complete a story plot based on opening lines depicting a scenario about sexuality, end of life care, or grandparenting, can make novel and valuable contributions to our understanding of such potentially sensitive topics. A second area that gerontologists engaging in qualitative research may benefit from being mindful of relates to the analyses of the qualitative data. Just as the use of individual interviews have dominated the field of social gerontology, so too has the thematic analysis. While identifying key themes (the “whats”) from qualitative data is often a vital component for ascertaining salient content about a given phenomenon, there is also a need to explore how people talk, how people do things and so forth (Phoenix, Smith, & Sparkes, 2010; Phoenix & Smith, 2011). Narrative analyses, discourse analyses, and conversation analysis can help with this, as evidenced by Gendron, Inker, and Welleford (2018), who, used discourse analysis to examine how age was being discussed and referred to at the 2015 White House conference. Their work demonstrated the widespread use of ageist language and sentiments by those on the front line of advocacy, service and policy provision for older adults. Phoenix and Orr (2017) also demonstrated an analytical interest in the “how” of qualitative data when they examined “exceptional stories” of physical activity in later life. Here, exceptional stories were defined as those that while telling us something about a central theme, deviated significantly from its defining plotline and characteristics. Thus, in addition to focusing on the “whats” and “hows,” further analytical opportunities are presented for those engaging with analytical pluralism—the application of more than one qualitative analytical method to a single data set—as a means of grappling with greater complexity and revealing more practical opportunities (Clarke et al., 2014; Frost & Nolas, 2011). Having highlighted the importance of maintaining an awareness of and willingness to engage with the full range of qualitative techniques available (data collection and analysis), that is not to suggest that “just because one can, one should.” Choices made about methods must respond to the requirements of the research question being asked. Furthermore, using multiple methods or more contemporary rather than traditional does not automatically produce better or more important findings. In other words, the issue is not always that we need more, or more novel data, but rather that the productive possibilities of our data could be more fully realized via a comprehensive theoretical framing. Thus, a third area highlighted here relates to the role of theory within qualitative research; a point well-articulated by Nettleton and Green (2014) in their discussion of how a social practice approach can help think about changing mobility practices. These authors assert how “[T]his framing issue has methodological implications: if we want to further our understanding of social practices that have relevance for health, we cannot rely on naive readings of interview data that merely document articulated theories of practice and, crucially we must not take at face value insiders’ explicit rationales for their action” (p. 248). The emphasis here is on using theory to fully interpret and give meaning to the data, rather than using data to “prove” an existing theory stands true. A fourth area which has advanced significantly in recent years relates to the notion of rigor. This includes the ways in which we report qualitative research that can often be poor quality—sometimes despite the research itself having been conducted to a high standard (Garside, 2013). Poor reporting is important because it has implications for the inclusion of qualitative studies into some systematic reviews, and the confidence that reviewers can have in their findings. In this regard, Warren-Findlow (2013) offers helpful guidelines for qualitative authors in terms of how a qualitative manuscript might be structured and the level of detail that is expected to be included (at least for JGSS). It is worth noting, however, that since this piece was published, debates regarding how two of the topics commented on by Warren-Findlow (rigor and generalizability) are conceptualized, have evolved (e.g., see Birt, Scott, Cavers, Campbell, & Walter, 2016; Levitt, Motulsky, Wertz, Morrow, & Ponterotto, 2017; Morse, 2016). While techniques such as member checking, inter-rater reliability, and the application of universal criteria (see Tracy, 2010) have, for a long time, been advocated as a means of ensuring rigor within qualitative research, developments in our thinking, explain Smith and McGannon (2017), can mean that “certain historically popular qualitative methods and methodologies might now need rejecting, corrective action, or exigent deliberation” (p. 2). While it is beyond the scope of this essay to discuss these developments in depth, like many of the authors listed above, Braun and Clarke (2013) usefully summarize what they see as the problem associated with member checking, which stems from the philosophical (ontological and epistemological) assumptions underpinning much qualitative work. For these authors, understanding and representing peoples’ experiences requires “interpretive activity; this is always informed by our own assumptions, values and commitments” (p. 285). Member checking, therefore, cannot deliver objective knowledge. Nor can it provide an independent foundation to adjudicate valid research from less valid research. Often overlooked here, is how the frequently cited early advocates of member checking, Lincoln and Guba (1985, see also Guba & Lincoln, 1989) later reconsidered their original position on rigor and the value of member checking, acknowledging it was philosophically flawed (Guba & Lincoln, 2005; Lincoln, 2010). This is not to imply of course, that “anything goes” in qualitative research. Scholars still have a duty to demonstrate how their research has been conducted in a rigorous way. It does mean though, that alternative ways of doing this, such as the use of member reflections and critical friends (see Smith & McGannon, 2017) might be more appropriate. Like rigor, generalization should also be a legitimate concern for qualitative researchers. Yet this concern does not equate with a need to sacrifice the rich and detailed accounts that may have been gathered about human experience and social worlds. Quite rightly, Warren-Findlow (2013) explains that attempting to generalize qualitative work in quantitative terms is inappropriate and should be avoided. That noted, the different ways in which qualitative researchers might consider generalization has been increasingly discussed in recent years (see Green & Thorogood, 2009; Kay, 2016; Smith, 2018). For example, aiming to dispel misunderstandings that qualitative research lacks generalizability, Smith (2018) has recently argued that generalizations can be made from qualitative research, though not in the same way as quantitative results are. Instead, drawing on the work of scholars such as Stake (1995), Tracy (2010), and Lewis, Ritchie, Ormston, and Morrell (2014), he notes that qualitative researchers should consider their findings in relation to their capacity to enable naturalistic generalization, transferability, analytical generalizability, and intersectional generalizability. These methodological developments are yet to appear within the field of gerontology. Qualitative research has much to offer a social scientific understanding of aging processes. The examples featured in this special section are testimony to this. Yet the landscape of qualitative methods (which features contributions from many different disciplines) is continually shifting and evolving. If, as gerontologists, we are to conduct the best qualitative research, harness the potential of a critical framework and help change the world in positive ways, it is incumbent on us to stay abreast of contemporary methodological debates and developments. And, to continue with Warren-Findlow’s (2013) wonderful barbecue metaphor, “bring them to the table.”