ENSAYO / ESSAY /ENSAIO

Access to information in qualitative research. A matter of care

Acceder a la información en la Investigación Cualitativa. Un asunto de Cuidado

Aceder à informação na Investigação Qualitativa. Um assunto de Cuidado

Carmen de la Cuesta Benjumea¹

¹RN, Ph.D. Professor, Universidad de Alicante, Spain. email: ccuesta@ua.es.

Receipt date: June 24, 2014. Approval date: August 25, 2014.

Article linked to research: none.

Subventions: none.

Conflicts of interest: none.

How to cite this article: De la Cuesta C. Access to information in qualitative research. A matter of care. Invest Educ Enferm. 2014; 32(3): 480-487.

ABSTRACT

In this article attention is focused on access to data; a process that tends to be taken for granted and which in practice takes time and energy from the person who investigates.  Access implies a process of contacting key people in institutions; negotiating with them, being invited to obtain data, achieving formal permission, and -; finally -; constructing relationships with the participants. Access to data is negotiated, trust is constructed in relationships with study participants, and data is obtained. All this constitutes an interactive process in which the person who investigates is revealed as an instrument in obtaining the data. Thus, the appearance, manners, and the way of being of the person who investigates will facilitate access to broad and detailed information.

Key words: qualitative research; data collection; ethics, research.

RESUMEN

En este artículo se centra la atención en el acceso a los datos, un proceso que se suele dar por hecho y que en la práctica lleva tiempo y energía de quien investiga. El acceso implica un proceso que implica varios pasos: contactar con las personas clave en las instituciones, negociar con ellas, ser invitado para obtener los datos, lograr el permiso formal y, finalmente, construir relaciones con los participantes. El acceso a los datos se negocia, la confianza se construye en las relaciones con los participantes del estudio y los datos se obtienen. Todo ello constituye un proceso interactivo en el cual quien investiga se revela como instrumento en la obtención de los datos. Así, la apariencia, los modales y la manera de ser de quien investiga facilitaran el acceso a una información amplia y detallada.

Palabras clave: investigación cualitativa, recolección de datos, ética en investigación

RESUMO

Neste artigo se centra o atendimento no acesso aos dados, um processo que se costuma dar por fato e que na prática leva tempo e energia de quem pesquisa. O acesso implica um processo de contatar com as pessoas importantes nas instituições; negociar com elas, ser convidado para obter os dados, conseguir a permissão formal e finalmente, construir relações com os participantes. O acesso aos dados se negocia, a confiança se constrói nas relações com os participantes do estudo e os dados se obtêm. Tudo isso constitui um processo interativo no qual quem pesquisa se revela como instrumento na obtenção dos dados. Assim, a aparência, os modais e a maneira de ser de quem pesquisa facilitassem o acesso a uma informação ampla e detalhada.

Palavras chave: pesquisa qualitativa; coleta de dados; ética em pesquisa.

INTRODUCTION

Achieving access to informants and to information are crucial issues in qualitative research. It is necessary to obtain permission to contact the potential participants, find them, and build the type of relationship, which permits obtaining data.^1,2 At the beginning, it is a slow process that requires persistence and then care to maintain it over time. The permission granted is revocable, people may stop participating whenever they wish; this applies to the place of study to which going and returning is something the person who investigates must gain day to day. Access has to be accomplished, maintained, and deepened, given that with superficial data quality qualitative studies cannot be conducted. Paying special attention to the theme of obtaining access to information must be done, at least, for two motives. First, qualitative data are not collected but obtained, as traditionally indicated, or they are constructed -; as recently stated.^3,4 This means that data are not accessible first hand, but that they are a product of the interaction between the person who investigates and the participants. Second, the information requested has to do with intimacy, with that which is not in plain sight and that revealing it can cause disgrace, modesty, or fear of suffering damage to the image. Thus, qualitative data, which are seemingly innocuous, for those from whom these are requested are not, implies discovering and making strangers visible (and sometimes oneself as in the case of phenomenology), their daily private lives, and their intimate feelings. It requires from the study participants an act of faith in the person requesting the information, in their integrity and capacity. This tends to occur at a moment when nobody knows the other enough to know if they are deserving of such.

Some attention has been paid to the issue of Access, above all, referring to field work -; understood as the process of directly interacting with people to learn something about their way of living and about their experiences-,⁵ highlighting the importance of maintaining good relationships with the participants to collect good information. Nevertheless, what attracts the attention of students, novel researchers, and much of the methodological bibliography is the techniques to obtain or construct data. In this article I focus attention on a process that tends to be taken for granted and which in practice takes time and energy: access to data.

Places, people, and difficult themes

One of the first things noted in the bibliography and in the experience of the researchers is to bear in mind is that there are places that are difficult to access, and to know how to promptly detect if delays in obtaining permission, silence to requirements, and breaches of appointments are, in reality, signals that participation in the study is not desired. Given that nobody is obligated to accept opening the doors of an institution, a home, or concede data, it is necessary to be prepared for these covert negatives to not mortgage the study or produce long delays. Private institutions, like homes for the elderly and religious centers, can be examples of places of difficult access. In this regard, during a study on pregnancies during adolescence, a religious institution refused to give a Masters student they were supervising permission for her to interview the pregnant girls who, prior to giving birth, lived in the institution. The elite, like physicians and delegated consultants from companies, also tend to show resistance to being asked about their companies and lives.⁶ The difficulties faced by Cassel⁶ are well-known when she sought to interview a group of surgeons. After receiving many negative responses, she managed to access them when a surgeon introduced her as an acquaintance.

Similarly, if the study topic entails a stigma, as in gender violence and that of mental disorders, difficulties in access can also be expected. During a study on family care of individuals with mental problems, upon obtaining the necessary permissions, a PhD student whose thesis I was advising confronted difficulties at several levels. On the one hand, the entity that had to grant her permission to access the potential participants requested a series of requisites like the right to supervise the study progress and the property of the data. For this reason she had to withdraw her request to this entity and deliver it to another. In this new place, the psychiatry professionals, who had to endorse the study for it to be presented to the ethics committee, were reticent with the methodology described and with the presence of the researcher in mutual assistance groups. This reticence was solved by the doctorate student after several meetings in which she explained the methodology and answered all the questions made. This whole process took several months in which she not only had to deliver the research project, but also call up the personal contacts to finally achieve entering the field. Not permitting access to the field or to the informants is an eventuality present in the whole study, for this reason contacts are in reserve to substitute a place and an informant for another. Nonetheless, we must first discern if the resistance emerges from the way the permission was solicited and not from the individual desire to participate. Hence, obtaining access to information is basically a social process and not a technical one, as shown ahead.

Access

In methodological bibliography it is distinguished between managing the initial entry and remaining in the field;⁷ two distinct processes for the same objective: having broad access to information. Nigel Barley⁸ in the book The innocent anthropologist, describes with humor and detail the formal process of obtaining permission to go to an African country and enter to do field work in a town. His ''adventures'' teach that accessing data is a slow process, which with persistence, some luck and contacts may be accomplished even in the most foreign and remote places. In general terms, it could be said that there are three access levels in qualitative research: 1) access to the people in the institution who have ''the key'' for the group of participants and for the place of interest for the study; 2) access to potential participants; and 3) access the information itself, that is, to the data. But before, from the ethical point of view, the person who investigates must wonder if the study should be carried out and if he or she is the most adequate person to conduct it;⁹ this conviction should be presented to those who grant permission to enter places and in the lives of others. Access implies a process of contacting key people in institutions; negotiating with them, being invited to obtain the data, achieving formal permission, and -; finally, constructing relationships with the informants.⁷ But these are not stages to which we do not return. Care with formal relationships is present throughout the study. For example, although the director of a health area and the manager of a center have approved the study, it is necessary to continue reporting and requesting collaboration at all hierarchical levels, out of courtesy, responsibility, and to achieve the maximum collaboration. For example, in a study on relatives of elderly individuals with reduced mobility, the group of researchers of which I am a part,¹⁰ obtained access to a health institution from the ethics committee and from the institution's area director.

When we began to collect data to contact the possible participants, a service chief called our attention because we had not communicated this to him; he was right, in that aspect we had been neglectful. It has been indicated that success in gaining entry to the field is achieved if we have contacts and connections, if we can explain the motive of the study, if we show knowledge of the theme, and if we are courteous.^7,9 In a study on the context of pregnancy during adolescence conducted in Medellín (Colombia),¹¹ I spent more than three months waiting for a maternity hospital to grant me access to the girls who were under prenatal control. I addressed them a formal letter, with my then University's letterhead, letting them know that the study was being funded by said University and that it was approved by the corresponding ethics committee. I delivered the letter twice, made several unsuccessful phone calls. Upon realizing that said hospital was a ''difficult place'', I spoke to a fellow professor who said she knew the sub-director of nursing at another hospital. She contacted me with her and in a matter of weeks I already had the permission to solicit from the girls their participation in the study. I never got word from the first hospital. Gaining entry to the field is, in truth, a process in which personal relationships play a fundamental role and the appearance should not be neglected, as I will expose ahead.

The importance of the personal appearance and manners

When two strangers meet, the personal appearance and their manners is the information each has of the other and due to this it may act as a barrier or facilitate the first encounters. During the process of obtaining data, the way of dressing and the manners must be such that they facilitate the process.¹ Avoid remarking differences in status or sending confusing messages, as can occur if you are requesting participation in a study and you are wearing an institutional uniform that inhibits the potential participants. The physical presentation also influences on the class of data that is obtained. Sudnow¹² reports that during field work in two hospitals, wearing a white lab coat in one and going in street clothes to the other generated different information and all types of questions, given that in the first he was seen as a physician. Appearance is, along with manners, what is denominated ''personal façade'' and reports on the person's social status.¹³ Accessing the field and the data implies, ultimately, a social encounter between ''friendly'' strangers. Social encounters are theatrical representations in which impressions must be managed, given that ''being a certain type of person does not simply mean having the required attributes, but also maintaining the norms of conduct and appearance attributed by the social group to which one belongs''.¹³ Due to this, what is put to the test in access to data are the social skills of the person requesting permission, those that, during treatment, invite to openness.

Thus, while the personal characteristics of the person who investigates, like gender and age cannot be altered, they can be managed in such a way that they facilitate and not hinder access. In the case study on the adolescent pregnancy already mentioned, I used the difference in age and nationality to highlight my ignorance and justify my curiosity for knowing the girls' point of view and understanding how things were ''there''. Being from a specific race, social class, gender, age, as well as how one dresses will influence on the relationship established with the informants and on the information obtained. The most the person who investigates can do is to neutralize them, use them to his/her advantage, and -; lastly -; consign them in the reflexive diary. Data are obtained precisely by how we relate to the participants. Thereby, it is increasingly evident that researchers are a flexible instrument in obtaining the data.¹⁴

Access to places and participants: firsts encounters

To obtain access to data, we must negotiate. What is at stake is your visibility, which is why you must achieve the best possible. Here, the challenge is to negotiate a relationship that is as ethical, sensitive, and as natural as possible, given the temporary and artificial nature of the field work.⁷ During the negotiation process issues of reciprocity are present, that is, of mutual benefit and ethical issues, like not causing damage to people or to the institution's good name for having granted access to the information. Goffman,¹⁵ in a study on interns, comments that in exchange for being allowed to do the field work in a psychiatric hospital, agreement was reached with hospital directors that they would see the final report before it was made public and that they could modify some aspect, if they were not satisfied. In fact they did and, according to the author, this improved the report.

Ethical issues are present throughout the process. All participants must be informed and will provide written or oral consent to participate. The way to inform and present the study will influence, in turn, on the information obtained. The information facilitated on the study should be presented in a way that it states enough for permission to be granted in informed manner, but without conditioning the information obtained. Also, care must be taken to avoid revealing details that may identify potential participants and endanger their anonymity. Ethical behavior is a requirement that, additionally, promotes trust to obtain data.

The negotiation to enter the field rarely happens swiftly and without setbacks;⁷ ideally, broad permission is obtained to avoid requesting additional authorizations in case these are needed during the study. The theoretical sampling, which guides data analysis in qualitative studies, can indicate the need to contact other informants and go to other places that were not foreseen at the beginning of the study. The cost of obtaining this broad permission tends to be that of portraying an expert image, given that precise decisions cannot be made regarding the number of participants in the study, their specific characteristics, or the exact places that will be visited. If these questions are posed, the answers will be vague. Committing at the beginning may close doors to valuable information.

Upon obtaining formal permission, make sure everyone implied knows the same about the study and that there are no misunderstandings; one way to avoid them is to make a written presentation, no more than half a page, informing on the characteristics of the study and of the research team. This becomes the presentation letter or visit card. It should contain, among others, the title of the study, what is sought with the study, what is required from the participants, who is funding, how will data be disseminated, who are the researchers, and how to contact them in case of needing additional information.¹⁶ During a study on primary-care nursing I conducted in England, I let others request the permission to go to a healthcare center and carry out the exploratory study. Even now, after 25 years, I remember that first day of field work. From the moment I arrived at the healthcare center, I was assigned a nurse who provided, non-stop, the information. I ended the shift exhausted and overwhelmed by the amount of information received. Then, I learned that my presence in that healthcare center had been announced as that of a visitor who wanted to the operation of primary care in that country, but actually, I was a new PhD student in my first days of field work. A written presentation of the project would have avoided the misunderstanding.

Nonetheless, an important difference exist between obtaining formal entry to the field and acceptance of the participants who will permit conducting the study.⁵ For the latter it is crucial that they do not associate the person who investigates with those who have granted permission to conduct the study; otherwise, it is quite likely that the information obtained will not be as detailed and honest as desired. A good strategy to gain acceptance from potential participants is to spend time with them, not gathering data but familiarizing with their environment and establishing relationships of collaboration and -; lastly -; of trust. Thus, we distinguish among the physical access, obtaining permission, social aspects, and being accepted in the field; a matter that will be discussed in the following section.

Accessing information: develop a relation of trust

If to gain access to places and participants negotiation is key, to obtain access to information trust is crucial. Relationships of trust permit accessing the intimacy and privacy of people and institutions.^1,2,9 This is clearly shown in ethnographic studies that imply long periods of observation. Sudnow¹⁰ states that during the field work in a hospital, three friends were made and that these friendships permitted gathering rich data and reaching places that furnished unexpected information. In turn, Punch¹⁷ in his ethnography on the Amsterdam police, recounts that he decided to do the same shifts as a group of them and that in each opportunity he showed a disposition to help when required, so that he established such relationships that he was considered almost as a colleague and ''paid dividends in terms of acceptance''.

Social relationships are also cared for during face-to-face interviews. If throughout an interview the person who investigates maintains an attitude that promotes openness, the qualitative interview actually becomes a guided conversation.¹⁸ The information obtained is detailed, specific, first hand, and the participants feel listened to without considering themselves judged; they can state their account naturally and freely. This relationship constructs a climate in which the participants feel comfortable in revealing their thought and the person who investigates making personal questions. Along with trust, reciprocity will be another issue to care for in relationships with study participants. They should not feel exploited or used; relationships must be balanced. While there are cultures in which it is expected for the person who investigates to repay economically for the time invested as in the USA; in others, what is expected is, for example, for the person who investigates to share some of the his/her knowledge or personal life. Thus, in a study on health in women, more than once, upon finishing the interview the participants asked me about matters from my personal life related to my family and I responded, given that I understood that it was as if at that moment it was their turn and this way the encounter was balanced. Accepting to listen to other stories, meeting other family members, responding to courtesy invitations, or visiting the rooms in the house are examples of actions that demonstrate to study participants the disposition to respond and correspond by the person who investigates. All these are gestures that promote participant trust and openness.

The importance of ''being so''

Entries to the field and to the lives of informants are fluid and changing; these are negotiated and renegotiated.⁷ Throughout the study, it should be transmitted that the person who investigates is a person who can be trusted, who does not reveal study data to others, who is genuinely interested in knowing the world of the participants or what ordinarily occurs, for example, in their places of work. Schatzman and Strauss¹⁶ state: ''we cannot say precisely what a researcher should or should not do, but we can say something about the general impression that should be caused. The researcher is an apprentice; he is patient, tolerant, and empathic; first, questions and lastly judges, he/she seems to be so, he/she is so. Moreover, researchers generally accept what they hear and see; they do not underestimate any motive. They do not visibly take sides in discussions in spite of how much they are asked to do so. They are open to the discovery of everything that is not as obvious to others. Researchers are the most considerate, educated, but not shy; in fact, they are rather firm given that they cannot be marginalized for too long, or embarrassed or curtailed'' (Emphasis added). In effect, it has been indicated that researchers must develop a ''field personality''; that is, present a version of themselves that permits doing good field work.⁵ The person who investigates adopts a low profile, of apprentice of the world of others;¹⁵ theirs is a position of marginality, the center is occupied by the informants and their stories. This requires what sociologists denominate ''deep acting'' referring to incorporating the emotions, perspectives, and behaviors that allows acting in a place with the lowest emotional stress,⁵ what Schatzman and Strauss¹⁶ indicated when they wrote that the researcher does not appear to be a certain way but rather ''is so''.

Although acting deeply, relationships in the field cause emotional stress that will affect access to information.⁹ Stress can come from the feeling that participants are being deceived, it can emerge when feeling dissatisfied with what is heard or observed or, on the contrary, great sympathy may be felt for the participants and impulse to help. All these feelings must be contained by the person who investigates; field work obligates a position of neutrality that can turn out uncomfortable.⁹

In spite of these sensations, researchers must be able to continue with themselves and relate with the informants in such way as to obtain data. Likewise, informants should relate with the researchers during the time the field work lasts. The role to assume is that of acceptable incompetent, someone who does not represent a threat.⁹ A role that should be learnt and in which not everyone feels comfortable.

Conclusion

Access to data is negotiated, trust is built in the relationships with the study participants, and data are obtained. All this constitutes an interactive process in which the person who investigates is revealed as an instrument in obtaining the data. The process is continuous, researchers should not only be able to enter the institutions and the private lives of the people, but should be able to remain in them. Ethical issues and of reciprocity are present in the whole process to obtain qualitative data, managing them requires attention to social keys along the whole study. Accessing rich and subjective information entails an emotional effort that must be cared for and sustained over time.

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