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

Roberto Forero, Shizar Nahidi, Josephine De Costa, Mohammed Mohsin, Gerry Fitzgerald, Nick Gibson, Sally McCarthy, Patrick Aboagye-Sarfo, Roberto Forero, Shizar Nahidi, Josephine De Costa, Mohammed Mohsin, Gerry Fitzgerald, Nick Gibson, Sally McCarthy, Patrick Aboagye-Sarfo

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.

Keywords: Australia; Emergency department; Four-hour rule; Interviews; Policy assessment; Qualitative methods; Research design.

Conflict of interest statement

Ethics approval and consent to participate

As indicated in the background, our study received ethics approval from the respective Human Research Ethics Committees of Western Australian Department of Health (DBL.201403.07), Cancer Institute NSW (HREC/14/CIPHS/30), ACT Department of Health (ETH.3.14.054) and Queensland Health (HREC/14/QGC/30) as well as governance approval from the 16 participating hospitals. All participants received information about the project; received an invitation to participate and signed a consent form and agreed to allow an audio recording to be conducted.

Consent for publication

All the data used from the interviews were de-identified for the analysis. No individual details, images or recordings, were used apart from the de-identified transcription.

Competing interests

RF is an Associate Editor of the Journal. No other authors have declared any competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Conceptual framework with the three stages of analysis used for the analysis of the qualitative data
Fig. 2
Fig. 2
Data saturation gain per interview added based on the chronological order of data collection in the hospitals. Y axis = number of new codes, X axis = number of interviews over time

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