Reflexivity: a journey with twists and turns

Becoming reflexive throughout the research journey in my PhD is a process which I have not always found easy. As my study has progressed and I have continued to chart my thoughts in an attempt at being reflexive either in my electronic diary notes or in hand written notes in my PhD “jotters”. (I have perhaps not been as systematic as I should have been.) However, recently I have been looking back at some on my earlier reflexive notes along with comments on early drafts of my work to see how my study has developed and I am glad to see that some progress has been made. But it is still work in progress.

I started out on my PhD thinking I wanted to explore a specific aspect of nursing however, my starting point was flawed and the process of realising this and changing focus was difficult. Sometimes it is challenging to be reflexive when you are heavily invested in an area and stepping back might be the wisest option. Fortunately my supervisors were wiser here and they challenged me to refocus my study which meant I wasn’t wholly entrenched in my own profession. Initially I wasn’t completely happy with the new focus, it didn’t feel like “my study” but I have come to enjoy the focus and feel much more open to the process of discovery.

I am now focussing on the experience of being diagnosed with MS, for the person and their closest support person. Reflexivity is still as important as before, my own experience as a nurse in the acute hospital setting and the hospice environment meant that my reference point for someone with MS was of individuals with significant physical symptoms. I had to explore how this might influence my preunderstanding of what a diagnosis of MS might mean for someone. My assumptions about being diagnosed with MS were that this would be a catastrophic event.

On reading the literature there is significant support for this view, particularly in the terms used by theorists such as Charmaz (1983) and Bury (1982).  Charmaz refers to the ‘loss of self’ as a result of chronic illness and Bury describes a theory of ‘biographical disruption’.  Both terms communicate the negative impact of the illness and led me to assume that this would lead to a negative psychological impact with an expressed need for support.

Additionally, on speaking to people about my research I met with further confirmation for my assumptions, an instance I recall which particularly confirmed this was when I met with a former colleague whose brother had had neurological symptoms for the previous year and was waiting and expecting a diagnosis of MS.  She described him as ‘beside himself with worry’ and like ‘a cat on a hot tin roof’ when outside the neurologists office.  This led me to become further entrenched in my own assumptions believing them to be true.

The challenge to look at how some people do get on with life as normal and learn to live with and adapt to having MS offered another possible alternative which my supervisors kept on encouraging me to consider.  Whilst I acknowledged this as a possibility and stated that I would be open to this possibility throughout the research I still held firm to my beliefs that a diagnosis of MS would be life changing.

A few years ago I attended the MS Society conference where I listened to a woman with MS give a talk about her experiences of living with the illness and how it had changed her life.  This I believe was the turning point for me in seeing a more positive projection of the impact of MS.   She then described how being diagnosed with the condition made her re-evaluate her life and ‘take stock’. The woman described how lucky she felt to have been given this opportunity which she put down to having MS changing her as a person.  One hearing this woman speak I was transfixed.   I thought to myself how fantastic it would be if some of my participants could describe so profoundly how MS has affected them. The main value of this experience for me was having my own previously entrenched assumptions exposed and challenged.

This experience and looking back on my reflexive notes helped me become more aware of my assumptions and how entrenched they were.  Instead of looking to my data for confirmation of my assumptions, being reflexive leaves me open to new possibilities and to be open to alternative (socially constructed) realities that exist.

As researchers it is important to expose and articulate our assumptions but it is not easy. My message in this blog is that keeping a reflexive diary is worthwhile, it is good to look back on and see the journey, re-remembering the significant points. I had forgotten about the chance meeting with my former colleague and how I felt this justified my stance until I revisited it in my diary. 

I would be interested to hear if any of the readers of this blog have had any other turning points in their studies and whether the process of being reflexive has helped refocus.  As I said in my first paragraph my reflexive journey is still work in progress, this is a mere punctuation in the process.

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Balancing power, choice and research integrity in qualitative research

Well I am in the middle of analysing data at the moment. I have 25 transcripts to work through. The data is comprised of one focus group with specialist nurses and a mixture of individual and coupled interviews. Why such a mix? Well, in this blog post I will tell you why…

I recruited participants to my study who had been recently diagnosed with MS and wanted to explore their perceptions of how this diagnosis impacted on their sense of “self” (the primary participants). As a way of triangluating their account of this experience, I also wanted to interview their nominated “support person” (secondary participants), most usually this was the person’s partner, but in two cases this was a parent (the participants were still adults).

As a researcher I wanted to be sure the participants felt at ease during the interviews, and was aware of the literature surrounding power imbalances etc, therefore the primary participants chose their support person and the time and place of the interviews were negotiated between the primary participants and myself. Nothing unusual about that you might think but, I also gave the participants the choice of being interviewed individually or together. As all participants chose to be interviewed in their own homes, I saw myself as a guest in their home, and felt that could not really come into their home and ask someone to leave if it was not of their choosing. What resulted was five couples choosing to be interviewed together and five choosing to be interviewed individually (although one chose no support person). Rather neat, but it was a chance occurrence.

As I interview each participant twice, on my second visit I gave them the opportunity to to decide again. All but one of the couples chose the same interview format which indicated to me that they were happy with their initial choice.

There were differences in the interviews with couples and those who were interviewed separately and I am glad I made the choice to be open to either as this has given me lots of opportunity to reflect on the data from the different interviews. This will be great for my PhD thesis. Put simply, those who were interviewed separately appeared more open about the impact on their relationships and a few even made comment about how much more open they were because their partner was not sitting beside them. Obviously as this was a qualitative study there are no statistics to hold this assertion up, but some verbal quotes, which will be hepful when writing this up will support this.

For those who were interviewed together, I got a sense from some that the interview almost “legitimised” them being open in their discussion of how MS was impacting their lives. For some participants the physical limitations were played down by the person with MS and the support person would bring up little instances like them being unable to turn taps on properly, or being too tired to shop by the time they had walked to the shops. Whilst these discussion may have gone on outwith the research interview it was almost like the interview gave them “permission” to talk and be honest about MS to each other.

The purpose of research interviews are to gather data, however the therapeutic nature of the interview must also be recognised and indeed has been widely, in the literature. The permission to talk to each other I believe, was also possibly a therapeutic benefit to the interview. Those who chose to be interviewed together clearly had this opportunity, but for those who chose to be interviewed individually, the interview gave them the space to offload and perhaps there might have been some follow up discussion between the participants, I don’t know.

So what are the implications for me as a PhD student? I think choosing to opt for a flexible approach to the interviews has addressed any potential power imbalances that may have arisen between myself and the participants. Additionally it has enriched my learning regarding the complexities of the interview dynamics and how this impacts on the data collected and offered me the opportunity to be more reflexive as a result.

I would be interested to hear any comments or shared experiences from anyone reading this blog.