**2. Understanding qualitative approaches in COPD research**

Phenomenology is an example of a widely applied method in the qualitative COPD literature. Edmund Husserl, the founder of *descriptive* phenomenology sought a rigorous scientific method, grounded in the experience of people living within their world. Husserl's transcendental phenomenology attempted to strip away what we know and take for granted about a phenomenon to reveal and describe its fundamental essence (Husserl, 1936:1970). He called this the phenomenological reduction and suggested this process required us to suspend or *bracket* our prior knowledge of the subject being studied (Husserl, 1931:1960).

Husserl's student, existential philosopher Martin Heidegger, further developed Husserl's ideas around discovering the essence of an experience to create an *interpretative* phenomenology. He did not agree that we could separate ourselves objectively from phenomena in our world. He saw people, not as passive recipients of information about, and perceptions of, objects in the world, but rather believed that we exist *in-the-world* and are drawn towards and grasp things of significance for us that need to be taken care of (Heidegger, 1927:1996).

In Heideggerian phenomenology, the essence of the experience, for example 'breathlessness in a shrinking-life world' (Gullick & Stainton 2008), acts as a lens through which to view the participants' story. The story is interpreted through language (i.e. transcripts of in-depth interviews) against the background of their personal concerns (perhaps expression of masculinity, earning a wage, social connection), that are aspects of the person's history, culture and family and comprise their *being-in-the-world*. The result is a rich narrative that interprets experiences to describe the meaning behind them for the participants.

Another common approach to qualitative inquiry is Grounded Theory. First described by Glaser & Strauss (1967) and further developed by Strauss & Corbin (1998), this method may use both in-depth interviews and field observations. The resulting data is coded progressively from the first interview by a method of *constant comparison* according to a highly structured framework. During coding, the researcher memos their ideas and these may grow into theories about the phenomena. As these theories emerge they are tested by theoretical sampling; this is a type of purposive sampling that increases the diversity of the sample, seeking participants and pursuing questioning that tests the developing theory until that particular idea is 'saturated' with enough data to evidence it. Traditionally, literature is collected only as it becomes relevant to the data, rather than as a precursor to the study. Past literature is given the same status as data and is treated as data to support the new theory. Many studies use a modified approach to this method.

Good qualitative research is underpinned by a philosophical framework to strengthen the scholarly rigour of the interpretation. Examples include s*ymbolic interactionism* (Blumer,

perceived impacts of health problems and treatments. What they do not always achieve is firstly, the sensitivity necessary to reveal subtle but important changes in patient experience, and secondly, an explanation of the meanings behind results. Qualitative research methods have a different purpose to positivist, quantitative studies. Rather than seeking objective 'truth', they seek to gain an understanding of the meanings of illness and treatments for people. As such, there is an acceptance of the subjectivity of experience, and an acknowledgement of the context of an experience, rather than trying to control for context.

Phenomenology is an example of a widely applied method in the qualitative COPD literature. Edmund Husserl, the founder of *descriptive* phenomenology sought a rigorous scientific method, grounded in the experience of people living within their world. Husserl's transcendental phenomenology attempted to strip away what we know and take for granted about a phenomenon to reveal and describe its fundamental essence (Husserl, 1936:1970). He called this the phenomenological reduction and suggested this process required us to suspend or *bracket* our prior knowledge of the subject being studied (Husserl, 1931:1960).

Husserl's student, existential philosopher Martin Heidegger, further developed Husserl's ideas around discovering the essence of an experience to create an *interpretative* phenomenology. He did not agree that we could separate ourselves objectively from phenomena in our world. He saw people, not as passive recipients of information about, and perceptions of, objects in the world, but rather believed that we exist *in-the-world* and are drawn towards and grasp things of significance for us that need to be taken care of

In Heideggerian phenomenology, the essence of the experience, for example 'breathlessness in a shrinking-life world' (Gullick & Stainton 2008), acts as a lens through which to view the participants' story. The story is interpreted through language (i.e. transcripts of in-depth interviews) against the background of their personal concerns (perhaps expression of masculinity, earning a wage, social connection), that are aspects of the person's history, culture and family and comprise their *being-in-the-world*. The result is a rich narrative that

Another common approach to qualitative inquiry is Grounded Theory. First described by Glaser & Strauss (1967) and further developed by Strauss & Corbin (1998), this method may use both in-depth interviews and field observations. The resulting data is coded progressively from the first interview by a method of *constant comparison* according to a highly structured framework. During coding, the researcher memos their ideas and these may grow into theories about the phenomena. As these theories emerge they are tested by theoretical sampling; this is a type of purposive sampling that increases the diversity of the sample, seeking participants and pursuing questioning that tests the developing theory until that particular idea is 'saturated' with enough data to evidence it. Traditionally, literature is collected only as it becomes relevant to the data, rather than as a precursor to the study. Past literature is given the same status as data and is treated as data to support the new theory.

Good qualitative research is underpinned by a philosophical framework to strengthen the scholarly rigour of the interpretation. Examples include s*ymbolic interactionism* (Blumer,

interprets experiences to describe the meaning behind them for the participants.

Many studies use a modified approach to this method.

**2. Understanding qualitative approaches in COPD research** 

(Heidegger, 1927:1996).

1969), which is frequently used alongside Grounded Theory to find social explanations for behaviours. Symbolic interactionism sees people as 'pragmatic actors' who constantly adjust their own behaviour in response to others, and we can do this because we have the cultural and social understandings to interpret the meaning of those actions (McClelland, 2000). Maurice Merleau-Ponty's philosophy of the body (Merleau-Ponty, 1945:1962) is an example often applied to phenomenological studies that explore the embodied experience of illness. Merleau-Ponty describes people as perceiving the world through their body which acts spontaneously, in a *taken-for-granted* manner until something goes wrong.

Other modes of qualitative inquiry informing this review include, but are not limited to, content analysis (Krippendorff, 2004) and narrative analysis (Reissman, 1994). As with all research, findings from qualitative studies should be carefully considered according to the pre-determined criteria for rigour within the chosen methodology (Ezzy, 2002).
