Combining the analysies of three qualitative data

Journal of Advanced Nursing, 1997, 26, 664–671

Combining the analyses of three qualitative data
sets in studying young caregivers
Nancy R. Lackey RN PhD
Professor, University of Missouri–Kansas City, Missouri

and Marie F. Gates RN PhD
Associate Professor, University of Missouri-Kansas City, Missouri, USA

Accepted for publication 20 September 1996

LACKEY N.R. & GATES M.F. (1997) Journal of Advanced Nursing 26, 664–671
Combining the analysis of three qualitative data sets in studying young
caregivers
Adolescent care of the adult with cancer led the authors to choose three
qualitative methods to describe this unexplored phenomenon. In this study,
phenomenology, ethnography and unstructured survey were combined to
provide a more complete picture of the phenomenon. Data from interviews with
11 youngsters within seven family units, observations, and unstructured
questionnaire, demographic data form and field notes were analysed and
combined. The processes used in designing and conducting the study and
analysing the data, rather than the findings, are emphasized. The data obtained
by using these three methods have laid the foundation for further nursing
research on caregiving by youngsters and raise questions about combining
analyses of three qualitative data sets.

Keywords: triangulation, qualitative, youngsters, caregiving

theory (Wilson & Hutchinson 1991). A second paper
I NTRODUCTI ON
(Swanson-KauÂman 1986) delineates the process, pro-
The past 10 years have seen an increased interest in using cedure and results of the combined aspects of phenomen-
triangulation to explore nursing phenomena. Most defi- ology, ethnography and grounded theory to create a
nitions of triangulation refer to combining qualitative and unique nursing methodology to study women who had
quantitative methods (Knafl & Gallo 1995, Morse 1991, miscarried.
DuÂy 1987, Hinds & Young 1987, Tripp-Reimer 1985). In a study in 1993 (Gates & Lackey, unpublished data),
Although other authors do not specify the kinds of three qualitative methods — phenomenology, ethnogra-
methods that are combined, the assumption is that they phy, and unstructured survey — were selected to explore
are referring to triangulation of qualitative and quantitative a phenomenon that is essentially absent in the literature:
data (Kimchi et al. 1991, Mitchell 1986). care of the adult with cancer by children and adolescents.
The authors of this paper believe that the definition of The purpose of this paper is to describe issues involved
triangulation needs to include the combination of quali- in triangulating these three qualitative methods with
tative methods as well. An extensive review of the litera- specific focus on combining the analyses of the three data
ture revealed only one paper that discusses combining sets. In order to understand these issues, an overview of
two qualitative methods: hermeneutics and grounded the study will be included.

Correspondence: Professor N.R. Lackey, University of Missouri–Kansas
City, 2220 Holmes Street, Kansas City, Missouri 64108-2676, USA.

664 © 1997 Blackwell Science Ltd

Studying young caregivers

data sources refers to time, person or space. As Knafl &
REVIEW OF THE LI TERATURE
Gallo (1995) reported, this strategy involves combining
Denzin (1978) first categorized four basic types of triangu- data over time from more than one person in more than
lation: investigators, theories, methods and data sources. one context. Examples of triangulating unit of analysis
Knafl & Breitmayer (1991) added unit of analysis as a cate- include individual and family unit and interactions, and
gory. In addition, two more categories — analysis triangu- perceptions and behaviours of individuals (Knafl &
lation and multiple triangulation — were identified Breitmayer 1991). Both unit of analysis and data source
(Kimchi et al. 1991, Mitchell 1986). Discussion of the vari- triangulation are well documented and used in a variety
ous kinds of triangulation details all except analysis of of triangulation studies.
data sets, and almost exclusively relates to combining
qualitative and quantitative research.
Analysis combination
The use of more than one investigator is probably the
most common type of triangulation. Kimchi et al. (1991) Analysis combination is the least documented type of tri-
stated that triangulation of investigators occurs when two angulation. Kimchi et al. (1991) defined analysis triangu-
or more researchers with divergent backgrounds study the lation as using two or more methods of analysis for one
same phenomenon. Combining areas of expertise related set of data, which they stated will enhance validation but
to content, method or discipline in conducting research fail to delineate any process for accomplishing this. Waltz
allows for breadth and depth of what needs to be done. et al. (1991) gave the most detailed process for combining
Knafl & Breitmayer (1991) support the contribution such analyses, but their approach tends to be more quantitat-
diversity of backgrounds lends to a research study and to ively oriented.
the other types of triangulation. Waltz et al. (1991) list four questions that should be
Many authors list theory triangulation as important, but considered when combining data for analysis from diÂer-
few really describe how this is done. Janesick (1994) ent methods: (a) ‘Does each method employed demonstrate
defined theory triangulation as ‘the use of multiple per- reliability and validity in its own right?’; (b) ‘Should all
spectives to interpret a single set of data’. Patton (1990) methods employed in the analysis be given equal weight
stated that all phenomena can be viewed through many in terms of importance and usefulness? If not, on what
theoretical perspectives. He believes that viewing a basis should the data be weighted?’; (c) ‘What will consti-
phenomenon through several diÂerent theories provides tute evidence for consistency or congruence of methods?’;
expanded focus on the findings. Waltz et al. (1991) stated (d) ‘When diÂerent methods yield dissimilar or divergent
that hypotheses from competing theories should be tested results, how will the investigator reconcile and/or explain
with the same data set, as this process would allow for the diÂerences?’.
diÂerent perspectives to emerge. Breitmayer et al. (1993) described an analysis that
focuses on completeness and confirmation of a single con-
struct. While they emphasize qualitative research, their
Triangulation of methods
example triangulates results obtained from both qualitat-
Triangulation of methods is the category most discussed. ive and quantitative data. Tripp-Reimer (1985) reported
Confusion exists over triangulation of methods, because the results from combining two complementary data sets
some authors are referring to the way they collect data, but never combined them. In reviewing the literature, no
such as interviews, use of instruments or observations, papers that discussed combining qualitative data sets for
while others such as Patton (1990) talk about combining analysis were found.
diÂerent methodologies, such as a naturalistic design with
an experimental design.
Multiple triangulation
In the nursing literature, the discussion of triangulation
of methods focuses on the triangulation of qualitative and Multiple triangulation is still another type. Mitchell (1986)
quantitative research (Banik 1993, Breitmayer et al. 1993, described this triangulation as using more than one of the
Cowman 1993, Norman et al. 1992, Kimchi et al. 1991, following: several diÂerent data sources, more than one
Knafl & Breitmayer 1991, Morse 1991, Patton 1990, Hinds investigator, testing competing hypotheses, or using more
1989, Sohier 1988, DuÂy 1987, Hinds & Young 1987, than one methodology. Analysing more than one data set
Tripp-Reimer 1985). Knafl & Breitmayer (1991) make the should also be included.
case that combining quantitative and qualitative methods In this study, multiple triangulation was used (Table 1).
leads to confirmation and completeness in the domain of The combination of the three methods and two investi-
interest. Few papers (Wilson & Hutchinson 1991, gators gave a richer, fuller description of the phenomenon
Swanson-KauÂman 1986) discuss combining qualitative than could be accomplished by one method or investi-
methods. gator alone.
Denzin (1989) and Jick (1979) noted that triangulating Oberst (1993) stated that the ‘missing piece in most

© 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 26, 664–671 665

N.R. Lackey and M.F. Gates

Table 1 Types of triangulation used in young caregiver study

Type of triangulation How and why used

1. Investigator Two-investigator team: provided varying expertise in kinds of methods used, kinds of
nursing (e.g. medical/surgical nursing, public health nursing), and content areas (e.g.
hospice care, ambulatory care)

2. Methods Phenomenology: description of caregiving from youngsters’ perspectives
Ethnography: description of caregiving as influenced by context observation of caregiving
within cultural milieu; field journal
Unstructured survey: description of needs identified by youngster
Demographic form: description of sample from youngster and family data

3. Units of analysis and sources of Youngsters: phenomenological and ethnographic interviews, Object Content Test
data identifying needs, answers to questions on demographic form, observations
Family members: observations, responses to questions
Adults with cancer: observations, responses to questions
People outside family: observations, responses to questions
Interactions: observations, journal notations

4. Analysis Giorgi et al.’s (1975) five steps with outcome of phenomenological description of
caregiving
Leininger’s (1985) phases of analysis with identification of themes
Content analysis with categorization of needs of young caregivers
Descriptive statistics leading to demographic profile
Combined analysis with synthesized description providing completeness based on
uniqueness provided by each data set, confirmation based on similarities of data from
each data set, and divergence based on diÂerences of data from each data set

triangulated approaches,… is triangulation of investi- address the issue of adolescent caregiving. The only stud-
gators’. Each of the authors was experienced in a diÂerent ies found on this phenomenon were those conducted in
qualitative method and had a diÂerent nursing disciplin- Great Britain (Aldridge & Becker 1994, 1993).
ary focus, expertise in diÂerent content areas, and the same Because the phenomenon had not been studied in the
research philosophy and work ethic. The triangulation of United States, the authors decided to use three methods:
methods enabled the authors to describe diÂerent aspects (a) phenomenology, to describe the experience from the
of the phenomenon of caregiving by young caregivers adolescent’s point of view more fully; (b) ethnography, to
through diÂerent approaches. understand the experience in the context of the family
The first investigator could focus on the interior experi- and other environments of the adolescent; and
ence and feelings of the youngsters through phenomeno- (c) unstructured survey, to elicit the needs as described
logical interviews, thereby providing the youngster- by the adolescent.
centred description of caregiving and what it meant. The The purpose of this descriptive, exploratory study was
second could focus on the eÂects of caregiving on the to describe as completely as possible the experiences,
family and youngsters and vice versa through ethno- lifeways and needs of adolescent caregivers of adults with
graphic interviews and observations. Both investigators cancer. With the first family three young caregivers, two
could look at the needs as the youngsters described them of whom were younger than adolescent age, were found.
in written format. The use of the journals provided insight Permission was sought to include children in this study
and depth in the analysis. Analysis triangulation was the as well. Therefore, the terms ‘youngster’ or ‘young care-
final type of triangulation used. giver’ were used to include both the older child and the
This paper will focus on the values and problems of adolescent in this paper.
combining the analysis of the data sets. A brief description
of the study is provided in order to focus the discussion
Participants and setting
of multiple analysis.
Criteria for this purposive sample were: (a) 11–19 years of
age; (b) caregiving for an adult with cancer for at least 3
THE STUDY
months; and (c) ability to understand and speak English.
Greater numbers of adolescents are providing care for Eleven participants, aged 11 to 19 years, from seven famil-
adults with cancer, but the caregiving literature does not ies were included in this study: three boys and eight girls,

666 © 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 26, 664–671


seven blacks and four whites. Their grades in school revealed patterns of caregiving experiences as guided by
ranged from fifth grade to college. Leininger’s sunrise model (1985). The patterns were syn-
The adults had cancer of the lung, breast, pancreas, or thesized into the following selected themes.
multiple myeloma. The ages of the adults ranged from 39
to 70 years. The relationship of adults to the young caregiv- 1 Kinds of caregiving involved personal tasks, household
ers included grandfather, grandmother, mother and father. tasks, but not intimate caregiving; tasks were performed
by single and multiple combinations of young
caregivers.
Procedures
2 Responsibility of caregiving was an expectation of
After obtaining parent consent and child or adolescent family life and of the child or adolescent role in that
assent, the investigators collected data using audio-taped family life.
interviews; participant observation; the Object Content 3 Support in the home environment depended on who
Test (OCT) (Hartley 1970), an unstructured, self- had cancer, the presence of at least one other adult in
administered, paper and pencil test; and a demographic the home, and the relationship of the family with the
data form. The phenomenological interview asked the external environment.
question: ‘What is it like to be a caregiver of [name of the 4 The school had the potential for the most social support
adult with cancer]?’. After the phenomenology interview, in terms of external influences in the situation. The
the participant was asked to fill out the OCT, which asked potential for church, friends and health care providers
the question: ‘What are my needs as a caregiver of an adult as social supports was also present.
with cancer?’. The demographic data form was also com-
pleted at this time.
COMBINING THE ANALYSIS OF THE THREE
Ethnographic interviews and participant observation
DATA SETS
were used to explore the youngster’s lifeways and caregiv-
ing within the family and outside environmental milieu, The problem arose when the combination of the three
and the relationship of the youngster with the adult with analyses was attempted. Kimchi et al. (1991) defined
cancer and others. In addition to observing the care of the analysis triangulation ‘as using two or more approaches to
adult with cancer, such activities as school events, family the analysis of the same data set’. The task was diÂerent
times and community suppers were included in the par- for this study. Analyses from three data sets had to be
ticipant/observation experiences. combined. Should the data sets or the results of the data
sets be combined? Which analysis method would work
best? What would the final outcome look like — a descrip-
BRIEF ANALYSIS AND GENERAL RESULTS
tion, a listing of themes? If themes were selected, how
OF EACH DATA SET
would they diÂer from the ethnographic themes?
The phenomenological, ethnographic and needs survey At one point, the authors discussed analysing all the raw
data were transcribed verbatim. The demographic data data as one large data set but realized that in doing so the
were analysed with descriptive statistics. Each data set assumptions of each of the qualitative methods would be
was analysed separately. Content analysis of the needs violated. Phenomenology, for example, speaks to the
listed on the OCT by the youngsters led to the following experience from the person’s point of view. Therefore,
categories: (a) focusing on self and personal needs; including observations of the investigator or other mem-
(b) focusing on adult with cancer; (c) focusing on relation- bers of the family would be contradictory to the
ship with family and others. assumptions.
Analysis of the phenomenological data followed Giorgi’s Therefore, the authors decided to triangulate the results
steps (Giorgi et al. 1975). In the phenomenological descrip- of the analysis of each data set: the phenomenological
tion, youngsters described caregiving as a dichotomy: description, the ethnographic themes and the categories of
hard, yet gratifying. It is hard because it not only adds needs. By combining the analysis from each data set, any
responsibilities and interferes with normal activities, but assumptions of the qualitative methods would not be
because stress and fear are involved. Stress occurs, for violated.
instance, when the adult with cancer shouts at them or This approach is consistent with the process outlined
when the adult does not cooperate when the youngsters by Waltz et al. (1991) and reinforced by Breitmayer et al.
carry out a specific responsibility, such as feeding. (1993) for triangulating qualitative and quantitative analy-
Youngsters expressed fears regarding the possibility of sis sets. Waltz et al. (1991) talk about looking for conver-
something happening to the adult, doing something wrong, gence and divergence across methodologies. Breitmayer
or being left alone. Often the youngsters described feel- et al. (1993) spoke to confirmation and completeness
ing fatigued. in doing so. The authors see convergence and confirmation
The ethnographic analysis of the youngster lifeways as referring to the same aspect of analysis. Three



considerations were finally identified as important: con- noted in the ethnographic analysis, versus school as haven
firmation or convergence, divergence and completeness. from caregiving, as depicted in the phenomenological
description; and (c) the self-centred versus other-centred
focus as determined from the needs survey analysis. As
Matrix
the authors were grappling with these dichotomies,
A matrix (Miles & Huberman 1994) that identified the diÂerences in parent/youngster perception of caregiving
major findings from each data set — phenomenological became apparent and suggested the need for including
description, ethnographic themes, demographic data and more defined perspectives from youngsters and other
survey categories — was developed to assist with the family members in future work.
analysis. First, the authors found that combining the data
sets gave a broader depth and scope of the phenomenon
Further exploration
which deals with completeness. For example, the young-
sters provided the authors with a phenomenological Finally, the combined analyses helped in identifying
description of their caregiving tasks and accompanying specific areas of youngster caregiving that required further
emotional overlay. The ethnographic data analysis exploration. For example, in multiple caregiving situ-
allowed the authors to see the categorization of these tasks ations, phenomenology focused on the bickering amongst
within the role and milieu of the family and other environ- the youngsters, while ethnography provided the oppor-
ments. The demographic data gave a description of the tunity to see the negotiation of tasks inherent when a group
youngster, the adult with cancer, and the family. The of youngsters was present. Decision-making rules, auth-
survey analysis reflected on the needs of the youngster for ority and the process by which youngsters become engaged
more information about tasks of caregiving. in caregiving tasks in multiple caregiving situations
Table 2 shows the matrix devised as an aid in determin- emerged as research areas for further study.
ing completeness, confirmation and divergence, as well as The qualitative methods of phenomenology, ethnogra-
unique findings from the separate and combined analyses. phy and survey can be combined to give a richer, fuller
Along with providing depth and scope, aspects of care- description of the phenomenon of youngster caregiving
giving such as daily routine, types of caregiving, the eÂect than could be accomplished by one method alone. Aspects
of caregiving on the life of the youngster, and vice versa of the phenomenon such as daily routine, and types of
provided confirmation or convergence. For example, the caregiving, the life of the youngster, as well as the eÂect
Object Content Test identified needs of the youngsters of the life of the youngster on the caregiving could be con-
most completely. However, confirmation or convergence firmed. Other aspects such as varying perspectives of
was identified through both phenomenological and ethno- youngsters and family regarding extent of caregiving could
graphic interviews and observation of the youngsters in be challenged. Table 2 provides a composite picture of the
school and at home. emerging concepts and relationships between concepts
From the combination column in Table 2, the authors identified from the separate analyses and triangulation of
began to note divergences. For example, divergence the results.
occurred when inconsistency was found in the analysis
results. For example, a 13-year-old youngster stated in the
DISCUSSION
phenomenological interview that she bathed and helped
dress her grandmother, but this activity was not observed The attempt to combine analyses of three diÂerent data
in the ethnographic data analysis. Furthermore, the grand- sets from three diÂerent research approaches was a fruitful,
mother stated that she did not need help with this activity. as well as a harrowing task. A matrix assisted in deter-
Could this have been an example of youngster embellish- mining completeness, confirmation or convergence, and
ment or the grandmother’s forgetting that this activity divergence of the phenomenon. A higher level of concep-
occurred earlier in her illness? In the families with mul- tualization was reached in combining the analyses by
tiple caregivers, each of the youngsters stated that he or obtaining a broader description rather than portraying each
she did the most caring for the adult in the phenomenologi- analysis alone. For example, the three dichotomies would
cal interviews, but the ethnographic interviews and obser- not have been apparent in any of the separate analyses.
vations demonstrated that, in essence, the older child had Furthermore, additional questions for further study were
the greater responsibility. derived, which would not have occurred on the basis of
As the matrix was filled in, three dichotomies emerged one research method alone. For example, in order to ident-
from the combination of the analyses: (a) the ‘hard yet ify more completely caregiving tasks in a future study, the
gratifying’ work of caregiving as depicted in the phenom- authors would suggest including questions for the young-
enological description, paralleled with the ‘challenging ster, the patient with cancer, and the family members, as
and burdensome’ pattern of caregiving in the ethnographic this would permit more purposeful comparison of
interviews; (b) the school as support for caregiving, as responses.



Table 2 Matrix of completeness, confirmation and divergence of initial concepts and relationships found in separate and combined
analyses

Concept/relationship Phenomenology Ethnography Survey/demographic Combination
data

1. Caregiving: Unique: not found Synthesized in overall
feelings in other data description; suggested
questions for further
study regarding
youngsters’ feelings

2. Caregiving: kinds Identified by Confirmed by Synthesized in overall
youngsters in youngsters, family, description; suggested
interviews patients, investigator questions for further
through study regarding multiple
observations and careivers and negotiation
interviews; regarding who does
contributed to caregiving; suggested
completeness in kinds and tasks of
adding kinds; caregiving not yet
contributed to complete
divergence by
suggesting
discrepancies in
youngsters and
family members

3. Needs of Confirmed selected Confirmed selected Most complete in Synthesized in overall
youngsters needs identified in needs identified in identification on Object description
survey survey Content Test

4. Influences of Unique in Unique in identifying Synthesized in overall
environment of identifying family family rituals, rules description; suggested
family on coping and and interactions as need to describe family
caregiving feelings towards they influenced environment more fully
youngsters as they caregiving
influenced
caregiving

5. Influences of Unique in Unique in identifying Synthesized in overall
outside identifying family members’ description; dichotomy
environment on youngsters’ concerns about of youngster/family
caregiving feelings related to support from school, views identified
involvement of church, friends for divergence and suggested
school, church and youngsters further study needs to
friends as separate include perspectives of
from caregiving both young caregiver and
family

6. Influences of Most complete in Confirmed via Synthesized in overall
caregiving on interviews observations and description; suggested
youngsters as comments of others areas for further study
persons

7. Influences of Confirmed through Most complete as Synthesized in overall
caregiving on interviews noted in description; suggested
child and observations of areas for further study
adolescent roles, school, home and
development interviews with
youngsters and
others



Table 2 (continued)

Concept/relationship Phenomenology Ethnography Survey/demographic Combination
data

8. Multiple Identified by Identified by Synthesized in overall
caregivers youngsters youngsters, family, description; suggested
adults with cancer, need to stratify by age and
investigator number of caregivers for
further study

9. Description of Unique as answered by Incorporated in overall
youngsters, demographic data form description
family, adults
with cancer

Using diÂerent qualitative methods and combining the Breitmayer B.J., Ayres L. & Knafl K.A. (1993) Triangulation in
analyses enabled the authors to stay true to each method. qualitative research: evaluation of completeness and confir-
Too often, investigators say they are doing phenomenology mation purposes. Image: Journal of Nursing Scholarship 25,
237–243.
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Cowman S. (1993) Triangulation: a means of reconciliation in
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