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 Table of Contents 
RESEARCH AND AUDIT
Year : 2015  |  Volume : 4  |  Issue : 3  |  Page : 324-327  

Validity, reliability, and generalizability in qualitative research

Lawrence Leung
Department of Family Medicine and Centre of Studies in Primary Care, Queen's University, Kingston, Ontario, Canada

Date of Web Publication23-Jul-2015

Correspondence Address:
Lawrence Leung
Centre of Studies in Primary Care, Queen's University, 220 Bagot Street, Kingston, ON K7L 5E9
Canada
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2249-4863.161306

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  Abstract 

In general practice, qualitative research contributes as significantly as quantitative research, in particular regarding psycho-social aspects of patient-care, health services provision, policy setting, and health administrations. In contrast to quantitative research, qualitative research as a whole has been constantly critiqued, if not disparaged, by the lack of consensus for assessing its quality and robustness. This article illustrates with five published studies how qualitative research can impact and reshape the discipline of primary care, spiraling out from clinic-based health screening to community-based disease monitoring, evaluation of out-of-hours triage services to provincial psychiatric care pathways model and finally, national legislation of core measures for children's healthcare insurance. Fundamental concepts of validity, reliability, and generalizability as applicable to qualitative research are then addressed with an update on the current views and controversies.

Keywords: Controversies, generalizability, primary care research, qualitative research, reliability, validity


How to cite this article:
Leung L. Validity, reliability, and generalizability in qualitative research. J Family Med Prim Care 2015;4:324-7

How to cite this URL:
Leung L. Validity, reliability, and generalizability in qualitative research. J Family Med Prim Care [serial online] 2015 [cited 2020 Oct 20];4:324-7. Available from: https://www.jfmpc.com/text.asp?2015/4/3/324/161306


  Nature of Qualitative Research versus Quantitative Research Top


The essence of qualitative research is to make sense of and recognize patterns among words in order to build up a meaningful picture without compromising its richness and dimensionality. Like quantitative research, the qualitative research aims to seek answers for questions of "how, where, when who and why" with a perspective to build a theory or refute an existing theory. Unlike quantitative research which deals primarily with numerical data and their statistical interpretations under a reductionist, logical and strictly objective paradigm, qualitative research handles nonnumerical information and their phenomenological interpretation, which inextricably tie in with human senses and subjectivity. While human emotions and perspectives from both subjects and researchers are considered undesirable biases confounding results in quantitative research, the same elements are considered essential and inevitable, if not treasurable, in qualitative research as they invariable add extra dimensions and colors to enrich the corpus of findings. However, the issue of subjectivity and contextual ramifications has fueled incessant controversies regarding yardsticks for quality and trustworthiness of qualitative research results for healthcare.


  Impact of Qualitative Research upon Primary Care Top


In many ways, qualitative research contributes significantly, if not more so than quantitative research, to the field of primary care at various levels. Five qualitative studies are chosen to illustrate how various methodologies of qualitative research helped in advancing primary healthcare, from novel monitoring of chronic obstructive pulmonary disease (COPD) via mobile-health technology, [1] informed decision for colorectal cancer screening, [2] triaging out-of-hours GP services, [3] evaluating care pathways for community psychiatry [4] and finally prioritization of healthcare initiatives for legislation purposes at national levels. [5] With the recent advances of information technology and mobile connecting device, self-monitoring and management of chronic diseases via tele-health technology may seem beneficial to both the patient and healthcare provider. Recruiting COPD patients who were given tele-health devices that monitored lung functions, Williams et al. [1] conducted phone interviews and analyzed their transcripts via a grounded theory approach, identified themes which enabled them to conclude that such mobile-health setup and application helped to engage patients with better adherence to treatment and overall improvement in mood. Such positive findings were in contrast to previous studies, which opined that elderly patients were often challenged by operating computer tablets, [6] or, conversing with the tele-health software. [7] To explore the content of recommendations for colorectal cancer screening given out by family physicians, Wackerbarth, et al. [2] conducted semi-structure interviews with subsequent content analysis and found that most physicians delivered information to enrich patient knowledge with little regard to patients' true understanding, ideas, and preferences in the matter. These findings suggested room for improvement for family physicians to better engage their patients in recommending preventative care. Faced with various models of out-of-hours triage services for GP consultations, Egbunike et al. [3] conducted thematic analysis on semi-structured telephone interviews with patients and doctors in various urban, rural and mixed settings. They found that the efficiency of triage services remained a prime concern from both users and providers, among issues of access to doctors and unfulfilled/mismatched expectations from users, which could arouse dissatisfaction and legal implications. In UK, a care pathways model for community psychiatry had been introduced but its benefits were unclear. Khandaker et al. [4] hence conducted a qualitative study using semi-structure interviews with medical staff and other stakeholders; adopting a grounded-theory approach, major themes emerged which included improved equality of access, more focused logistics, increased work throughput and better accountability for community psychiatry provided under the care pathway model. Finally, at the US national level, Mangione-Smith et al. [5] employed a modified Delphi method to gather consensus from a panel of nominators which were recognized experts and stakeholders in their disciplines, and identified a core set of quality measures for children's healthcare under the Medicaid and Children's Health Insurance Program. These core measures were made transparent for public opinion and later passed on for full legislation, hence illustrating the impact of qualitative research upon social welfare and policy improvement.


  Overall Criteria for Quality in Qualitative Research Top


Given the diverse genera and forms of qualitative research, there is no consensus for assessing any piece of qualitative research work. Various approaches have been suggested, the two leading schools of thoughts being the school of Dixon-Woods et al. [8] which emphasizes on methodology, and that of Lincoln et al. [9] which stresses the rigor of interpretation of results. By identifying commonalities of qualitative research, Dixon-Woods produced a checklist of questions for assessing clarity and appropriateness of the research question; the description and appropriateness for sampling, data collection and data analysis; levels of support and evidence for claims; coherence between data, interpretation and conclusions, and finally level of contribution of the paper. These criteria foster the 10 questions for the Critical Appraisal Skills Program checklist for qualitative studies. [10] However, these methodology-weighted criteria may not do justice to qualitative studies that differ in epistemological and philosophical paradigms, [11],[12] one classic example will be positivistic versus interpretivistic. [13] Equally, without a robust methodological layout, rigorous interpretation of results advocated by Lincoln et al. [9] will not be good either. Meyrick [14] argued from a different angle and proposed fulfillment of the dual core criteria of "transparency" and "systematicity" for good quality qualitative research. In brief, every step of the research logistics (from theory formation, design of study, sampling, data acquisition and analysis to results and conclusions) has to be validated if it is transparent or systematic enough. In this manner, both the research process and results can be assured of high rigor and robustness. [14] Finally, Kitto et al. [15] epitomized six criteria for assessing overall quality of qualitative research: (i) Clarification and justification, (ii) procedural rigor, (iii) sample representativeness, (iv) interpretative rigor, (v) reflexive and evaluative rigor and (vi) transferability/generalizability, which also double as evaluative landmarks for manuscript review to the Medical Journal of Australia. Same for quantitative research, quality for qualitative research can be assessed in terms of validity, reliability, and generalizability.


  Validity Top


Validity in qualitative research means "appropriateness" of the tools, processes, and data. Whether the research question is valid for the desired outcome, the choice of methodology is appropriate for answering the research question, the design is valid for the methodology, the sampling and data analysis is appropriate, and finally the results and conclusions are valid for the sample and context. In assessing validity of qualitative research, the challenge can start from the ontology and epistemology of the issue being studied, e.g. the concept of "individual" is seen differently between humanistic and positive psychologists due to differing philosophical perspectives: [16] Where humanistic psychologists believe "individual" is a product of existential awareness and social interaction, positive psychologists think the "individual" exists side-by-side with formation of any human being. Set off in different pathways, qualitative research regarding the individual's wellbeing will be concluded with varying validity. Choice of methodology must enable detection of findings/phenomena in the appropriate context for it to be valid, with due regard to culturally and contextually variable. For sampling, procedures and methods must be appropriate for the research paradigm and be distinctive between systematic, [17] purposeful [18] or theoretical (adaptive) sampling [19],[20] where the systematic sampling has no a priori theory, purposeful sampling often has a certain aim or framework and theoretical sampling is molded by the ongoing process of data collection and theory in evolution. For data extraction and analysis, several methods were adopted to enhance validity, including 1 st tier triangulation (of researchers) and 2 nd tier triangulation (of resources and theories), [17],[21] well-documented audit trail of materials and processes, [22],[23],[24] multidimensional analysis as concept- or case-orientated [25],[26] and respondent verification. [21],[27]


  Reliability Top


In quantitative research, reliability refers to exact replicability of the processes and the results. In qualitative research with diverse paradigms, such definition of reliability is challenging and epistemologically counter-intuitive. Hence, the essence of reliability for qualitative research lies with consistency. [24],[28] A margin of variability for results is tolerated in qualitative research provided the methodology and epistemological logistics consistently yield data that are ontologically similar but may differ in richness and ambience within similar dimensions. Silverman [29] proposed five approaches in enhancing the reliability of process and results: Refutational analysis, constant data comparison, comprehensive data use, inclusive of the deviant case and use of tables. As data were extracted from the original sources, researchers must verify their accuracy in terms of form and context with constant comparison, [27] either alone or with peers (a form of triangulation). [30] The scope and analysis of data included should be as comprehensive and inclusive with reference to quantitative aspects if possible. [30] Adopting the Popperian dictum of falsifiability as essence of truth and science, attempted to refute the qualitative data and analytes should be performed to assess reliability. [31]


  Generalizability Top


Most qualitative research studies, if not all, are meant to study a specific issue or phenomenon in a certain population or ethnic group, of a focused locality in a particular context, hence generalizability of qualitative research findings is usually not an expected attribute. However, with rising trend of knowledge synthesis from qualitative research via meta-synthesis, meta-narrative or meta-ethnography, evaluation of generalizability becomes pertinent. A pragmatic approach to assessing generalizability for qualitative studies is to adopt same criteria for validity: That is, use of systematic sampling, triangulation and constant comparison, proper audit and documentation, and multi-dimensional theory. [17] However, some researchers espouse the approach of analytical generalization [32] where one judges the extent to which the findings in one study can be generalized to another under similar theoretical, and the proximal similarity model, where generalizability of one study to another is judged by similarities between the time, place, people and other social contexts. [33] Thus said, Zimmer [34] questioned the suitability of meta-synthesis in view of the basic tenets of grounded theory, [35] phenomenology [36] and ethnography. [37] He concluded that any valid meta-synthesis must retain the other two goals of theory development and higher-level abstraction while in search of generalizability, and must be executed as a third level interpretation using Gadamer's concepts of the hermeneutic circle, [38],[39] dialogic process [38] and fusion of horizons. [39] Finally, Toye et al. [40] reported the practicality of using "conceptual clarity" and "interpretative rigor" as intuitive criteria for assessing quality in meta-ethnography, which somehow echoed Rolfe's controversial aesthetic theory of research reports. [41]


  Food for Thought Top


Despite various measures to enhance or ensure quality of qualitative studies, some researchers opined from a purist ontological and epistemological angle that qualitative research is not a unified, but ipso facto diverse field, [8] hence any attempt to synthesize or appraise different studies under one system is impossible and conceptually wrong. Barbour argued from a philosophical angle that these special measures or "technical fixes" (like purposive sampling, multiple-coding, triangulation, and respondent validation) can never confer the rigor as conceived. [11] In extremis, Rolfe et al. opined from the field of nursing research, that any set of formal criteria used to judge the quality of qualitative research are futile and without validity, and suggested that any qualitative report should be judged by the form it is written (aesthetic) and not by the contents (epistemic). [41] Rolfe's novel view is rebutted by Porter, [42] who argued via logical premises that two of Rolfe's fundamental statements were flawed: (i) "The content of research report is determined by their forms" may not be a fact, and (ii) that research appraisal being "subject to individual judgment based on insight and experience" will mean those without sufficient experience of performing research will be unable to judge adequately - hence an elitist's principle. From a realism standpoint, Porter then proposes multiple and open approaches for validity in qualitative research that incorporate parallel perspectives [43],[44] and diversification of meanings. [44] Any work of qualitative research, when read by the readers, is always a two-way interactive process, such that validity and quality has to be judged by the receiving end too and not by the researcher end alone.

In summary, the three gold criteria of validity, reliability and generalizability apply in principle to assess quality for both quantitative and qualitative research, what differs will be the nature and type of processes that ontologically and epistemologically distinguish between the two.

 
  References Top

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The Cleft Palate-Craniofacial Journal. 2020; 57(9): 1105
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32 Reactions to COVID-19, Information and Technology Use, and Social Connectedness among Older Adults with Pre-Frailty and Frailty
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33 Study protocol for the COvid-19 Toolbox for All IslaNd (CONTAIN) project: A cross-border analysis in Ireland to disentangle psychological, behavioural, media and governmental responses to COVID-19
Catherine D. Darker,Nicola OćConnell,Martin Dempster,Christopher D. Graham,Cliodhna OćConnor,Lina Zgaga,Ann Nolan,Katy Tobin,Niamh Brennan,Gail Nicolson,Emma Burke,Luke Mather,Philip Crowley,Gabriel Scally,Joseph Barry
HRB Open Research. 2020; 3: 48
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34 Barriers to Prostate Cancer Screening Among Indo-Guyanese
Harrynauth Persaud,Jeanetta Yuan,Aimee Afable,Denise M. Bruno
Journal of Community Health. 2020;
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35 A Review of the Quality Indicators of Rigor in Qualitative Research
Jessica L. Johnson,Donna Adkins,Sheila Chauvin
American Journal of Pharmaceutical Education. 2020; 84(1): 7120
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36 General practitioners’ perceptions of compassionate communities: a qualitative study
E. Abbey,C. Craig,C. R. Mayland
BMC Palliative Care. 2020; 19(1)
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37 Strategies for implementing innovation in small and medium-sized enterprises
Monther I. Haddad,Irene A. Williams,Mohamad Saleh Hammoud,Rocky J. Dwyer
World Journal of Entrepreneurship, Management and Sustainable Development. 2019; 16(1): 12
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38 The policy transfer of community-based rehabilitation in Gulu, Uganda
Colton Brydges,Lauchlan T. Munro
Disability & Society. 2019; : 1
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39 Comprehension of Safety Pictograms Affixed to Agricultural Machinery among Pakistani Migrant Farmworkers in Italy
Lucia Vigoroso,Federica Caffaro,Margherita Micheletti Cremasco,Giorgia Bagagiolo,Eugenio Cavallo
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40 Quality of life and health status after Girdlestone resection arthroplasty in patients with an infected total hip prosthesis
Cornelis M. Vincenten,Brenda L. Den,Pieter K. Bos,Stefan B.T. Bolder,Taco Gosens
Journal of Bone and Joint Infection. 2019; 4(1): 10
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41 Inclusion Programmes for Students Who are Deaf and Hard of Hearing in Saudi Arabia: Issues and Recommendations
Khalid Alasim
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42 Childhood Vaccine Attitudes and Information Sources Among Oregon Parents and Guardians
Jessica Deas,Sandra J. Bean,Iva Sokolovska,Charlie Fautin
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43 The unheard voice of the clinician: Perspectives on the key features of an adolescent inpatient model of care
Claire Hayes,Magenta Simmons,Victoria J. Palmer,Bridget Hamilton,Christine Simons,Malcolm Hopwood
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44 Parenting and Incarceration: Perspectives on Father-Child Involvement during Reentry from Prison
Pajarita Charles,Luke Muentner,Jean Kjellstrand
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45 A model explaining refugee experiences of the Australian healthcare system: a systematic review of refugee perceptions
Michael Au,Athire Debbie Anandakumar,Robyn Preston,Robin A. Ray,Meg Davis
BMC International Health and Human Rights. 2019; 19(1)
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46 Triangulating perspectives to inform the development of a smartphone application for foster, kinship, and adoptive parents
Greg L. Forehand,Allison D. Schisler-Blizzard,Abigail Hemenway Deaver,Jessica Strolin-Goltzman,Nicole Breslend,Alexandra D. W. Sullivan,Geovana S. Mendoza,Amy Bielawski-Branch,Jennifer Jorgenson,Rex Forehand
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47 Exploring Spirituality With Older People: (2) A rigorous process
Laurence Lepherd,Cath Rogers,Richard Egan,Helen Towler,Coralie Graham,Andrea Nagle,Ilsa Hampton
Journal of Religion, Spirituality & Aging. 2019; : 1
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48 Intörn hekimlerin hemsirelik meslegi ile ilgili algilari: nitel bir arastirma
Aynur Çetinkaya,Süheyla Rahman,Hüseyin Elbi,Selim Altan
Cukurova Medical Journal. 2019; 44: 148
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49 The views and experiences of general dental practitioners (GDP’s) in West Yorkshire who used the International Caries Detection and Assessment System (ICDAS) in research
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50 Factors that influence patient empowerment in inpatient chronic care: early thoughts on a diabetes care intervention in South Africa
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BMC Endocrine Disorders. 2019; 19(1)
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51 A 15-year follow-up of former self-harming inpatients in child & adolescent psychiatry – a qualitative study
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52 ‘Eating to survive’: A qualitative analysis of factors influencing food choice and eating behaviour in a food-insecure population
Jo-Anne Puddephatt,Gregory S. Keenan,Amy Fielden,Danielle L. Reeves,Jason C.G. Halford,Charlotte A. Hardman
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53 Discharge planning, self-management, and community support: Strategies to avoid psychiatric rehospitalisation from a service user perspective
M. Ĺdnanes,J. Cresswell-Smith,L. Melby,H. Westerlund,L. Šprah,R. Sfetcu,C. Straßmayr,V. Donisi
Patient Education and Counseling. 2019;
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54 Learning and coping through reflection: exploring patient death experiences of medical students
Travuth Trivate,Ashley A Dennis,Sarah Sholl,Tracey Wilkinson
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55 Toward a Deep Insight into Employee Participation in Employer-Supported Volunteering in Iranian Organizations: A Grounded Theory
Ahmad Afkhami,Ali Nasr Isfahani,Mahdi Abzari,Hadi Teimouri
VOLUNTAS: International Journal of Voluntary and Nonprofit Organizations. 2019;
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56 Adolescent’s use of the Nutrition Information Panel for Food Choice: A Content Validation of Focus Group Discussions
NORSAKIRA JEFRYDIN,NORAZMIR MD NOR,RUZITA ABD TALIB
Current Research in Nutrition and Food Science Journal. 2019; 7(1): 75
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57 Why Triple Helix governance is useful to dual apprenticeship systems
Michele Coletti
Industry and Higher Education. 2019; 33(6): 381
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58 Patient Perspectives to Inform a Health Literacy Educational Program: A Systematic Review and Thematic Synthesis of Qualitative Studies
Margot Jager,Janine de Zeeuw,Janne Tullius,Roberta Papa,Cinzia Giammarchi,Amanda Whittal,Andrea F. de Winter
International Journal of Environmental Research and Public Health. 2019; 16(21): 4300
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59 An exploration of fathers’ subjective experiences of parenting a child that presents with dyspraxia
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60 Health-Related Quality of Life: A Qualitative Exploration of Employment Concerns of Veterans With Post-Traumatic Stress Disorder
Christina Dillahunt-Aspillaga,Jolie Haun,Jason D. Lind,Nitin Patel,Nicole Antinori,Stephen L. Luther
Rehabilitation Research, Policy, and Education. 2019; 33(1): 24
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61 “I remember how I felt, but I donćt remember the gene”: Families’ experiences of cancer-related genetic testing in childhood
Brittany C. McGill,Claire E. Wakefield,Janine Vetsch,Qishan Lim,Meera Warby,Alison Metcalfe,Jennifer A. Byrne,Richard J. Cohn,Katherine M. Tucker
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62 Fieldwork protocol as a safety inventory tool in public places
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63 Compliance with water advisories after water outages in Norway
Susanne Hyllestad,Lamprini Veneti,Annechen Bahr Bugge,Thea Grav Rosenberg,Karin Nygĺrd,Preben Aavitsland
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64 A Qualitative Study to Inform a More Acceptable Pulmonary Rehabilitation Program after Acute Exacerbation of Chronic Obstructive Pulmonary Disease
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65 Helping hospitalized smokers in Hong Kong quit smoking by understanding their risk perception, behaviour, and attitudes related to smoking
William Ho Cheung Li,K. Y. Ho,Viveka W. Xia,M. P. Wang,Katherine K. W. Lam,Sophia S. C. Chan,T. H. Lam
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66 Qualitative research in Colorectal Disease, Sutton et al .
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67 How acceptable is this? How user experience factors can broaden our understanding of the acceptance of privacy trade-offs
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68 How vlogging promotes a destination image: A narrative analysis of popular travel vlogs about the Philippines
Rachel Luna Peralta
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69 Rinse and Repeat: Understanding the Value of Replication across Different Ways of Knowing
Jean Penders,Jean Holbrook,Jean de Rijcke
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70 Does ecotourism contribute to sustainable destination development, or is it just a marketing hoax? Analyzing twenty-five years contested journey of ecotourism through a meta-analysis of tourism journal publications
Amare Wondirad
Asia Pacific Journal of Tourism Research. 2019; 24(11): 1047
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71 Factors that contribute to psychological resilience to suicidal thoughts and behaviours in people with schizophrenia diagnoses: qualitative study
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72 German translation, cultural adaption and validation of the unidimensional self-efficacy scale for multiple sclerosis: a study protocol
Barbara Seebacher,Roger J Mills,Markus Reindl,Laura Zamarian,Raija Kuisma,Simone Kircher,Christian Brenneis,Rainer Ehling,Florian Deisenhammer
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73 Surgeon Communication and Family Understanding of Patient Prognosis in Critically Ill Surgical Patients: A Qualitative Investigation Informs Resident Training
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74 Factors influencing adherence to antiretroviral treatment among adults accessing care from private health facilities in Malawi
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75 Autism and the right to education in the EU: policy mapping and scoping review of Nordic countries Denmark, Finland, and Sweden
Robin van Kessel,Sebastian Walsh,Amber N. V. Ruigrok,Rosemary Holt,Anneli Yliherva,Eija Kärnä,Irma Moilanen,Eva Hjörne,Shruti Taneja Johansson,Diana Schendel,Lennart Pedersen,Meta Jřrgensen,Carol Brayne,Simon Baron-Cohen,Andres Roman-Urrestarazu
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76 Overcoming Performance Slumps: Psychological Resilience in Expert Cricket Batsmen
Christopher J. Brown,Joanne Butt,Mustafa Sarkar
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77 Comparison of rapid vs in-depth qualitative analytic methods from a process evaluation of academic detailing in the Veterans Health Administration
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78 A narrative analysis of barriers encountered by a sample of immigrant entrepreneurs in the Eastern Cape province of South Africa
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79 What factors influence physical activity participation in people with rheumatoid arthritis?
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80 Treatment Attitudes and Adherence Among Patients with Bipolar Disorder
Subho Chakrabarti
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81 Ineffectiveness of information and access to health services: vulnerability to human papillomavirus
M.C.M.P. Carvalho,A.B.A. Queiroz,M.A. Ferreira,M.A.V. Moura,C.B. Pinto,B.D.G. Vieira
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82 A fragile normality – illness experiences of working-age individuals with osteoarthritis in knees or hips
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83 How do parents influence their adolescents’ use of over-the-counter analgesics: A review of the current literature
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84 The views of people with joint hypermobility syndrome on its impact, management and the use of patient-reported outcome measures. A thematic analysis of open-ended questionnaire responses
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85 The Nutritional and Social Contexts of Celiac Disease in Women
Julián RODRGUEZ-ALMAGRO,David RODRGUEZ-ALMAGRO,MCarmen SOLANO-RUIZ,José SILES-GONZLEZ,Antonio HERNNDEZ-MARTINEZ
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86 Perceptions of bioenergy with carbon capture and storage in different policy scenarios
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87 “It is not just any pill”-Women’s experiences of endocrine therapy after breast cancer surgery
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88 Using an Experiential Learning Assignment to Teach BSW Students about Culture and End-of-Life Care Planning
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89 Information Needs for Treatment Decision-making of Hematopoietic Cell Transplant Patients 65 Years or Older and Caregivers
Jackie Foster,Heather Moore,Jaime M. Preussler,Linda J. Burns,Jenna Hullerman Umar,Brett Glotzbecker,Shirley Johnson,Hannah MacDougall,Lih-Wen Mau,Elizabeth A. Murphy,Celalettin Ustun,Stacy Stickney Ferguson,Ellen Denzen
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90 Describing and organizing green practices in the context of Green Supply Chain Management: Case studies
Miguel Afonso Sellitto,Felipe F. Hermann,Attila E. Blezs,Ana P. Barbosa-Póvoa
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91 Process evaluation of the midwifery initiated oral health-dental service program: perceptions of pregnant women
A George,AR Villarosa,T Patterson Norrie,J Hoolsema,HG Dahlen,S Ajwani,S Bhole,A Blinkhorn,R Srinivas,A Yaacoub,A Milat,J Skinner,M Johnson
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92 A Qualitative Study to Understand the Potential Efficacy of an Information-Based Sugar Reduction Intervention among Low Socioeconomic Individuals in the UK
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93 Defining modifiable barriers to uptake of dietary recommendations in Chinese immigrants with type 2 diabetes: a qualitative study
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94 Inequalities in older LGBT peoplećs health and care needs in the United Kingdom: a systematic scoping review
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95 Representations of maladaptive daydreaming and the self: A qualitative analysis of drawings
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96 A Qualitative Evaluation of the Implementation of an Intimate Partner Violence Education Program in Fracture Clinics
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97 Advancing Student-Centric Education in Korea: Issues and Challenges
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98 Delaying factors for maternal health service utilization in eastern Ethiopia: A qualitative exploratory study
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99 Experience of care through patients, family members and health professionals in an intensive care unit: a qualitative descriptive study
Julian Rodriguez-Almagro,María Azucena Quero Palomino,Elena Aznar Sepulveda,María Del Mar Fernandez-Espartero Rodriguez-Barbe,Francisca Ortiz Fernandez,Virginia Soto Barrera,Antonio Hernandez-Martinez
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100 Comparing life satisfaction and functioning 15 years after September 11, 2001 among survivors with and without injuries: a mixed-method study
Lisa M. Gargano,Ho Ki Mok,Melanie H. Jacobson,Patricia Frazier,Sascha K. Garrey,Lysa J. Petrsoric,Robert M. Brackbill
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101 Why is reporting quality improvement so hard? A qualitative study in perioperative care
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102 Nursing assistantsć perceptions of their role in the resident experience
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103 Simulation-Based Learning Strategies to Teach Undergraduate Students Basic Surgical Skills: A Systematic Review
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104 Service guarantees as a base for positioning in B2B
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105 Trends in Contemporary Holistic Nursing Research: 2010-2015
Colleen Delaney,Ruth G. McCaffrey,Cynthia Barrere,Amy Kenefick Moore,Dorothy J. Dunn,Robin J. Miller,Sheila L. Molony,Debra Thomas,Teresa C. Twomey,Xiaoyuan (Susan) Zhu
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106 Validating factors influencing monitoring and evaluation in the Ghanaian construction industry: a Delphi study approach
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107 Hazards from physical attributes of the home environment among patients on outpatient parenteral antimicrobial therapy
Sara C. Keller,Sara E. Cosgrove,Michael Kohut,Amanda Krosche,Huai-En Chang,Deborah Williams,Ayse P. Gurses
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108 How Indonesia media deal with Sustainable Development Goals
Irwansyah Irwansyah,H. Herdiansyah
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109 Changing practice using recovery-focused care in acute mental health settings to reduce aggression: A qualitative study
Eric Lim,Dianne Wynaden,Karen Heslop
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110 Towards a public health approach for palliative care: an action-research study focused on engaging a local community and educating teenagers
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111 Mental health service users’ experiences of psychiatric re-hospitalisation - an explorative focus group study in six European countries
M. Ĺdnanes,L. Melby,J. Cresswell-Smith,H. Westerlund,L. Rabbi,M. Z. Dernovšek,L. Šprah,R. Sfetcu,C. Straßmayr,V. Donisi
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112 Older Patient Preferences for Internal Fixation after a Distal Radius Fracture
Jacob S. Nasser,Helen E. Huetteman,Melissa J. Shauver,Kevin C. Chung
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113 Implementing A Competency-Based Midwifery Programme In Lesotho: A Gap Analysis
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114 Defining the minimally clinically important difference of the SF-36 physical function subscale for paediatric CFS/ME: triangulation using three different methods
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115 Attitudes toward tobacco among low-income Hispanic adolescents: Implications for prevention
Denise Vasquez,Mika Cohen Jones,Louis D. Brown
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116 Surgeons and preventative health: protocol for a mixed methods study of current practice, beliefs and attitudes influencing health promotion activities amongst public hospital surgeons
Stephen Barrett,Stephen Begg,Michael Kingsley
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117 “I Treat Him as a Normal Patient”: Unveiling the Normalization Coping Strategy Among Formal Caregivers of Persons With Dementia and Its Implications for Person-Centered Care
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118 Reflexividad y reciprocidad: una mirada a la ética en la investigación a través de las relaciones inter-clase social en la Universidad de los Andes
José Leonardo Guevara Fino
Voces y Silencios. Revista Latinoamericana de Educación. 2018; 9(2): 178
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119 Process evaluation of the midwifery initiated oral health-dental service program: Perceptions of dental professionals
Shilpi Ajwani,Mariana S. Sousa,Ariana C. Villarosa,Sameer Bhole,Maree Johnson,Hannah G. Dahlen,Julia Hoolsema,Anthony Blinkhorn,Ravi Srinivas,Albert Yaacoub,Andrew Milat,John Skinner,Ajesh George
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120 Community-based mealtime management for adolescents with anorexia nervosa: A qualitative study of clinicians’ perspectives and experiences
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121 A qualitative study of primary healthcare professionals’ views of falls prevention
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122 A Guide to Multisite Qualitative Analysis
Emily K. Jenkins,Allie Slemon,Rebecca J. Haines-Saah,John Oliffe
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123 Dysphonia, Perceived Control, and Psychosocial Distress: A Qualitative Study
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124 Master degree under crisis: the salient motives of Business students to enroll in a postgraduate programme
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125 An Application of Hofstede’s Cultural Dimension among Female Educational Leaders
Charmaine Bissessar
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126 Study design and the estimation of the size of key populations at risk of HIV: lessons from Viet Nam
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127 Relevance of the intervention module “Coping with stress and unhelpful emotions” for parents living in multi-ethnic deprived neighborhoods
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128 Collaborative risk management: a systematic literature review
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129 Nursing student perspectives on a quality learning environment in general practice
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130 Scaling a waterfall: a meta-ethnography of adolescent progression through the stages of HIV care in sub-Saharan Africa
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131 When and why does the name of the brand still matter? Developing the temporal dimension of brand name equity theory
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132 Narrative inquiry as a research methodology exploring person centred care in nursing
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133 Dutch youth of parents with a mental illness reflect upon their feelings of guilt and shame
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