The industry case studies from previous editions have been added to the ancillaries' website and can be used as a basis for “research in practice” discussions.
Chapter 9: Surveys—Putting Numbers on Opinions
Using Qualitative and Post-Studies to Transform Student Advising
Mountain View Community College (not its real name) received a generous grant to enhance its student advising system. In order to assist Mountain View with its goal, Market Street Research (MSR) conducted pre- and post-studies of stakeholders at the college.
The first step in this process was to understand what the existing experience of the student advising system was like at Mountain View. In order to truly understand the strengths and weaknesses of the system, it was important to hear from everyone involved in student advising and understand the different ways these stakeholders might experience advising.
To achieve this aim, MSR conducted a series of nine focus group with a total of 51 stakeholders, including frontline staff (e.g., staff who assist students through the Admissions Department, Student Registrars Office, Financial Aid Office, etc.), administrative staff, part-time faculty, full-time faculty, full-time new and continuing students, and part-time new and continuing students. Mountain View staff recruited the focus groups, which were held on the college campus.
The focus groups yielded tremendous insights. Perhaps the single most significant findings to emerge from the research is that under Mountain View’s system at the time, student advising was perceived as having little value, and was not meaningfully differentiated from registration. For most students, their only experience with advising was to obtain a signature during class registration. Visits with advisors felt rushed, stressful, and pro forma, with many students seeing whatever advisor was on hand to give them the needed signature. Many did not know who had even been assigned to be their personal advisor.
For their part, many faculty had received little or no training in advising before taking on the role. Faculty did not know what constituted high-quality student advising and were therefore often unable to provide it. The dedicated faculty member who is passionate about and highly skilled at mentoring students, the student who understands the impact such mentoring relationships can have on his or her academic and professional career—they certainly existed at Mountain View, but they tended to be more the exception than the rule.
The research also found a powerful internal conflict between the opposing forces of time and quality. Systems, such as open registration days, had been implemented by the college with the good intention of offsetting the burdens associated with advisors having too many students on their roster and not enough time on the days of scheduled appointments. These systems, however, were described by some stakeholders as offering a “quick fix” analogous to fast food. The student may have been getting help quickly, but was sacrificing the level of quality that could only be provided by an advisor who knows that student, has a sense of the bigger picture, and is considering the impact individual decisions may have on the student’s goals and outcomes at the college.
MSR’s focus groups revealed numerous additional problems impacting the success of the student advising system, from training needs to information system enhancements, to the impact of the physical facility itself. Mountain View used these findings to direct its initiative of enhancing the student advising system.
Two years later, MSR conducted a post-study to assess the impact of the grant on advising at the college. This assessment was comprised of an analysis of quantitative secondary data (including detailed reports from internal annual surveys, pre- and post-assessments, and audits conducted by the college) and qualitative research in the form of in-person interviews and small group meetings with a total of 56 stakeholders at Mountain View, including faculty, staff, deans, and students.
The results of the post-study were remarkable. In two short years, Mountain View had achieved a complete transformation in the campus philosophy toward advising. Mountain View used its grant funding to implement a massive technological upgrade, including numerous web-enabled computer kiosks and an advising system infrastructure. The college conducted extensive staff trainings on high-level advising and the use of the new computer systems. In addition, the college launched a campus-wide promotional campaign, including posters, brochures, and events, to increase awareness and shape the image of student advising.
Following these efforts, the image of “advising” was much more than simply registering students; rather, it was now seen as a holistic approach to student support that encompassed advice and support related to students’ academic and career goals and personal issues.
This reflected a clear sea change in the perception of what constitutes advising: many advisors said that interactions they might have viewed as merely casual conversation in the past, they now viewed as “advising moments.” Furthermore, stakeholders believed that the status of advising had been elevated during this process, which had effectively given faculty and staff permission to spend more time advising students than they had in the past.
The training and professional development opportunities afforded by the grant proved a tremendous help both in terms of the practical dimension of helping faculty become better advisors, as well the emotional dimension of helping them feel more confident about the advising work they are doing. Internal studies conducted annually by the college showed a 36% increase in Liberal Arts students’ satisfaction with advising, compared with the baseline.
In terms of the technological upgrades, having instant access to information on pre-requisites, the ability to perform immediate degree audits, and produce and forecast class schedules for students proved tremendously beneficial at catching potential problems before they could adversely impact a student’s success at the school. Internal studies conducted annually by the college indicated that a majority of advisors trained in the new intake services were proficient with most of the new services.
MSR’s research showed that the changes Mountain View had undertaken had positively impacted every facet of the advising experience, and had a broader positive influence on stakeholders’ experience of the college. Faculty and staff believed they had formed deeper, more personal relationships with students. With much of the labor involved in advising processes shifted to quick, streamlined electronic systems, more time had been freed up to talk with students about “big picture” issues: academic goals, career goals and options, and personal issues that may be affecting their work at Mountain View. Internal studies conducted by the college showed a fall-to-fall attrition rate of 40%, below the national average.
Stakeholders believed that changes in advising had a direct impact on the quality of teaching as well. Faculty reported an increase in the number of students who are appropriately placed in their classroom. Prior to these enhancements, faculty were more likely to encounter problems with students who lacked the skills and abilities to function in their course. Following the grant, faculty felt appropriate placements had increased dramatically.
Students reported having a fundamentally better experience at Mountain View as a result of these shifts, and were experiencing much more successful outcomes. They were more likely to be placed in courses that were appropriate for their skill level and learning style, which helped them do well in the course. They had better access to tools like degree audits, which helped them complete their program requirements within the anticipated timeline. Advisors now had the time and technology to sit down with students and look at the requirements for schools students hope to transfer into, so that they are better equipped to select classes that will transfer.
Stakeholders believed that the philosophical shift in orientation toward advising at Mountain View had led students to believe that they are really being listened to and cared for by the school.
Contributed by Ingrid Steblea
Vice-President, Market Street Research, Inc.
Market Street Research, Inc., based in Northampton, Massachusetts, provides quantitative and qualitative marketing research and analysis services for heath care, finance, technology, manufacturing and education clients.
Chapter 10: Experiments—Researching Cause and Effect
Using Qualitative Research to Understand Hispanic Banking Needs
Mutual Bank (the bank’s name has been changed for this case study) is one of Connecticut’s largest community banks. According to U.S. Census projections, the Hispanic population in Connecticut is projected to double between 1995 and 2025. Mutual Bank is strongly committed to meeting the needs of the people in its marketplace, and so the bank wanted to gain an in-depth understanding of the unique banking needs and decision drivers among area Hispanics.
Market Street Research (MSR) decided to conduct focus groups with Hispanic residents, as this is an ideal research methodology to understand the deeper attitudes and desires that drive decisions about products and services. The focus groups were held in English and in Spanish and were recruited using a community-based outreach strategy. This recruitment strategy, which relied on personal outreach conducted at churches, community centers, and other neighborhood organizations, enabled us to reach less acculturated Hispanics, who may be new to the country, may not have telephone services, and are likely to have a unique set of needs and challenges when it comes to opening a bank account.
What we discovered in the focus groups was that, while Hispanics wanted many of the same things from their bank as the general population—low fees, convenient locations—they were distinctly different in several key ways.
Hispanics face a particular set of challenges—both practical and emotional—related to opening new bank accounts. Hispanics who are new to the country may lack the necessary identification required to open accounts. Others may simply lack information about what documentation they need. Many who have all the required documentation are nonetheless sensitive around documentation issues and alert to any treatment that could indicate a prejudicial attitude against Hispanics. A bank that wanted to attract new Hispanic customers would need to ensure that it wasn’t creating barriers to entry by asking for too many official forms of ID, and would need to provide clear information about the forms they accept.
MSR’s research confirmed the idea that culturally, Hispanics place particular importance on relationships. More so than the general population, Hispanics prize friendly service and a high level of personal attention. In order to gain their trust and accounts, a bank needed to show that it was “Hispanic-friendly.” This means something more than simply a smiling bank teller. Hispanics prefer to use banks staffed by Hispanic tellers—what this communicates to them is that bank managers truly values Hispanics, not just as a source of revenue, but as colleagues. Furthermore, Hispanic employees are likely to be known within the community; some Hispanics open bank accounts as a direct result of knowing someone who works there. On a practical level, the presence of Spanish-speaking Hispanic staff makes it easier to accommodate the needs of Spanish-speaking bank customers.
Another interesting finding to emerge from this research is that Hispanics in this marketplace had unique unmet needs for bank products and services. There are a few products and services that were not in high demand by the general population in this area, but which were in high demand among area Hispanics. For example, Hispanics wanted banks to offer a low-cost money transfer service, as many were regularly sending funds to family living outside the U.S. and paying sizable fees per transactions through services such as Western Union.
Hispanics in this area also had an unmet need for Christmas Club accounts. While demand for this type of account may not be as strong among the general population, Hispanics considered these accounts both easy to use and highly valuable. Furthermore, the focus groups revealed that Hispanics had strongly positive emotional connections with this type of account, which summoned memories of childhood, Christmas, family, and gift-giving. Opening a Christmas Club account gives them a more powerful, deeper sense of connection to that bank than would an ordinary deposit account.
Among the general population, individuals who use financial management and investment services tend to receive these services through an investment specialist and have concerns about using a bank for these services. Hispanics, however, expressed interest in receiving these services through a bank. They wanted to have access to a higher level of guidance about the different types of products and services available to them, such as deposit accounts that could yield earn more interest. Again, this sense that their bank could provide them with this level of highly personal, individualized service was highly appealing to Hispanics.
The focus groups proved to be an excellent method for determining that Mutual Bank already had a positive relationship with its Hispanic community and that little needed to be done to strengthen relationships. The bank employed Hispanics who were well-known and trusted within the community, and was in a good position to begin promoting the types of products and services this sector desired in the media channels, such as Spanish-language radio and television, most likely to reach them.
Contributed by Ingrid Steblea
Vice-President, Market Street Research, Inc.
Market Street Research, Inc., based in Northampton, Massachusetts, provides quantitative and qualitative marketing research and analysis services for heath care, finance, technology, manufacturing and education clients.
Chapter 11: Quantitative Understanding of Content—Content Analysis
Research In Practice: Reaching Out To Hispanics Living With Paralysis
In late 2006, Vanguard Communications began work with the Christopher and Dana Reeve Foundation’s Paralysis Resource Center (PRC) to educate Hispanics about the wealth of information, resources and services available for people with mobility-related disabilities, as Hispanics were generally underrepresented in the PRC’s call volume. After conducting a series of communications research activities including focus groups and a media analysis, Vanguard and the PRC collaborated to develop the Vivir Sin Límites (meaning “limit-free living”) Hispanic outreach campaign.
As the team began its work to design a campaign that would reach Hispanics, it was clear that a few key research questions needed answers. How are people living with paralysis portrayed in the U.S. Hispanic media? Where do Hispanics living in the U.S. get their health information? What resonates with these audiences and what would motivate them to call the PRC? To answer these questions the team conducted a two pronged research effort consisting of a comprehensive media content analysis and focus group testing.
The media analysis helped establish a baseline from which to compare future media coverage and determine effective strategies for positioning the PRC as the premier source of information about paralysis. The analysis focused on the way people living with paralysis are portrayed in the nation’s top English- and Spanish-language print publications including newspapers and Hispanic-focused magazines.
A major finding of the media analysis was that paralysis was rarely discussed in depth. Coverage usually focused on paralysis as a result of a violent crime or an accident. The reality of what it’s like to live with paralysis was never discussed and portrayals of those with paralysis were rarely inspiring or hopeful. Based on these articles, it was clear that readers were provided with little information about the realities of paralysis, including that people with paralysis live healthy, productive lives. To educate Hispanics about the many ways people with paralysis can be independent, productive and active, the images and messages selected for the campaign needed to showcase diverse personal stories of those who are living independent, productive and active lives with paralysis.
To ensure that this message and image concept would resonate with Hispanics, draft themes, messages, slogans and images were tested in a series of focus groups with Hispanics living with paralysis and with Hispanic women who are close friends or family of a person living with paralysis. Focus group participants had highly positive reactions to messages and images that showcased a life that is not limited by a person’s physical disability. In particular, visual images such as a person with paralysis engaged in educational pursuits or sports best supported the Vivir Sin Límites message. The focus groups also indicated that Hispanics seek their health information in Spanish-language magazines and newspapers, health Websites and radio and television programming.
Based on the outcomes of this research, the team conceptualized a positive Vivir Sin Límites campaign, incorporating inspiring accounts of people with paralysis living highly productive lives. The campaign was kicked off at a national media event in Washington, DC, featuring Hispanic individuals with paralysis who shared personal stories of how the PRC helped them to live independent and productive lives. The launch highlighted an array of materials available to Hispanics in English and Spanish, including a comprehensive Web site and a toll-free, bilingual help line. Other campaign materials included a brochure, fact sheets, a bookmark and a bilingual resource guide about living with paralysis.
To promote the campaign launch and the PRC as the premier source of information for Hispanics on paralysis, outreach was conducted to Hispanic print publications, television and radio outlets and online resources. Media outreach efforts produced more than 3 million audience impressions, including an interview on the top national Spanish-language morning television program, Univision’s Despierta América. The PRC also experienced increased call volume, achieving one of the primary objectives of the outreach campaign.
Contributed by Vanguard Communications
Vanguard Communications is a public relations and social marketing firm based in Washington, D.C.
Chapter 12: Qualitative Understanding of Content—Rhetorical and Critical Analyses, and More
Research In Practice – Qualifying Individual Influence on Social Networks
More than 1,800 million people worldwide use online social networks such as Facebook, Twitter, Linkedin (Tech Cocktail, 2012). Today, nearly four in five active Internet users visit social networks and blogs and Americans spend more time on Facebook than they do on any other website (Nielsen, 2011).
The existence of social networks has clear implications for marketing and communications professionals. Traditional communication strategies based on reaching targets with general, collectively appealing messages have quickly become obsolete. The individual has gained in prominence as segmentation techniques and business analytics tools offer the opportunity to tailor offerings and messaging to each individual. Stakeholders and influencers can now address their praises and concerns directly to the organization involved, which means companies must now have a structure in place should they want to engage in a constructive dialogue.
This change in the model of communication – from mediated to direct – means that companies need to change their traditional ways of action and adapt to the new, more participative online environment. They need a successful social media strategy with three essential phases:
Listening: the organization must “listen” to what is being said in the blogosphere about itself and identify the key actors in those conversations; those who can – positively or negatively – influence its market and publics. During the “listening” stage the organization needs to answer some basic questions: Who are the most relevant online influencers on the company-related topics? Who are the individuals with whom the organization should establish an online relationship as a priority? Who else is talking about the organization and could affect public perceptions of it?
Participation: for corporations it is critical to be part of online conversations, particularly with those individuals who are key influencers in the buying process or in creating public opinion about the corporation’s brand, products or services. Corporations must adapt their tone and messaging to the blogosphere, and create a specific organizational structure to do so.
Leading: once the organization has become a recognized actor in the blogosphere and has strengthened its relations in the online world, it can enjoy the benefits of the relationships built with many of the influencers. It will be recognized as a trusted member of the online community and can lead on relevant topics and issues.
How Research Helps To Take Business Decisions about Social Media Use
The communications department of a leading technology company in Spain decided to analyze its 2.0 environment in order to identify the individuals and online communities that were or potentially could exert a higher influence on public perceptions of the company. The final objective was to keep influencers informed about the company’s key business strategies and persuade them to share those with their circles of influence, both in the real and in the virtual worlds.
To address the first phase of its social media strategy (“Listening”), the communications department conducted an overall scanning of the blogs, forums, and social networks being published in Spanish to identify and rank the most relevant sites and bloggers. For this exercise, several content analyses tools were used, such as Radian6, Google Blogs, Technorati, Blogpulse, IceRocket, and BoardReader. The team focus was on five of the key business topics for the company in order to identify the most active individuals talking about such topics. The research combined social media filtering tools such us the ones mentioned above as well as a manual process with members of the communications team validating the content identified by the filtering tools – which at the time still lacked a certain degree of accuracy – to identify, analyze and classify content.
Results of this online scan and content analyses included a compilation of public data about the most relevant blogs and influencers as well as a graphic representation of the reach of their individual networks and the degree of influence they exerted online.
To determine the degree of influence of each influential that was identified, the number of followers each had was considered, but the communications team also undertook a qualitative analysis of those followers. This is, the qualitative relevance of each individual’s network to the organization’s objectives was more important than simply taking into account the total numbers of followers (many of whom may not have any interest for the company). The Klout score – an index that measures the breadth and strength of an individual’s online influence – was taken into consideration, but other aspects such as offline activities and roles of the individual followers (for example, if he or she was a leading member of an association or business institution) were taken into consideration also.
At the conclusion of this research, the company had a precise map of online influencers whose comments and opinions could affect not only public opinion about the company, but also the buying pattern of some of its clients.
As a result of these analyses, the company put in place several actions. For example, it created an interdisciplinary team of marketing and communication professionals to coordinate and execute the company’s social media strategy, and more resources were aligned toward execution of social media tactics, including a major involvement of the marketing and public relations agencies.
Some of the immediate actions included the design of a social media dashboard where the communications team members could see at a glance all the contents being published about the company and its industry in the online media, blogs and twitter. The communications director assigned more resources to dynamize the company’s Twitter account by engaging in existing conversations, fostering dialogue around new topics, and attracting new, qualified, followers.
The company also undertook an internal analysis to identify who in the organization could best establish direct relationships with some of the influencers identified. Since some of the topics being discussed in the online communities were of a technical and or professional nature, it was advisable that the relationship was led by the technical or professional sides of the company – while the communications department could act as information broker of those relationships.
A few months later, a deeper analysis using social media analysis tools such as SocialBro and Tweetreach was conducted on the company’s Twitter site to verify the quality – in terms of online and offline influence – of the company’s followers on that site.
Individuals with an existing relationship with the company’s Twitter account (both “followers” or “being followed”) were first identified and labelled as “influencers” or not. Once identified, influencers were classified on the basis of those who already followed the company on Twitter and those who did not (but who were being followed by the company). Another variable considered was if they were members of any media or think-tank organization (eg. journalists) or not.
This phase of the research concluded that there were several individuals that – although great influencers – were not following the company’s Twitter account. A combined online and offline campaign was designed to reach them. This included following their personal activity on Twitter so as to retweet and respond to their posts – calling, therefore, their attention and becoming relevant to them – as well as inviting some of them to personal briefings and on-site events where face-to-face interaction made possible further online communications with many of these actors.
Full citations for the articles referenced in this case study are under “References” at the end of this chapter.
EDITOR: NOTE ACCENT IN FOLLOWING NAME -
Contributed by Alfonso González-Herrero.
Dr. González-Herrero is a corporate communication professional and a faculty member of the Universidad Rey Juan Carlos, Madrid, Spain.
Twitter ID: @aglezherrero
Tech Cocktail (2012). How many users do the big social networks have? Retrieved January 29th 2012 from http://techcocktail.com/users-major-social-networks-2011-10#.TyZwXYHLmmg
Nielsen. (2011). Social media report Q3 2011. Retrieved January 9th fromhttp://blog.nielsen.com/nielsenwire/social/
Chapter 13: Qualitative Understanding of Communication Behavior—Interviews, Focus Groups, and Ethnography
Research in Practice: Promoting Clean Energy
I estimate that I must have stared through the one-way mirror at a focus group over 500 times during my 30-year career in advertising. Despite the familiarity of the routine, I’m never bored. In fact, I never fail to learn something surprising!
An example of this occurred in 2003, when some clients I was consulting for, the Clean Energy States Alliance and SmartPower, needed more insight on a perplexing situation:
Clean Energy suppliers had gone into a number of markets to try to get consumers to switch to a renewable energy company as their electric power supplier, for a surcharge of $6 to $10 a month on their electric bill. An encouraging number of consumers had told them: “I love the idea of clean energy, and I’d pay a little more each month to support it.” Yet, when they’d go into a market, despite running a lot of advertising showing belching smokestacks and coughing children, very few people signed up. We needed to identify the disconnect between what consumers told us and what they did. We had hired a small, bright New York City agency, Gardner-Nelson, to execute a campaign for us. They urged us to conduct some focus groups.
So we recruited six groups in Connecticut and Massachusetts from among consumers, business and “opinion leaders.” Operating on the theory that if you want to find out how someone feels about something, take it away from them, we gave each participant a pencil and paper and asked them to imagine fossil fuels on earth have died. Their task was to write an obituary.
What we found was surprisingly counter-intuitive: People were far less critical of fossil fuels than we had imagined. While they recognized the problems of pollution, they saw fossil fuel as a necessary evil because it can be relied on to power our world.
Here’s a sample excerpt:
“Fossil Fuel died after a long, slow illness called greed. . . . Currently, the world is adjusting . . . to solar and wind mill sources. These are several kinks to be worked out and roadblocks to conquer. Will we ever be warm again? Miss you fossil fuel.”
— Massachusetts Opinion Leader
Surprisingly, in every obituary, fossil fuels had died because we used them up. Not a single respondent said fossil fuels died because they were bad, or because people figured out better energy solutions.
We also discovered that our respondents were unexpectedly knowledgeable about clean energy. They knew how it was made but didn’t see it as being up to the job. It was seen as “eccentric”, with “kinks to work out.”
One way to encourage people to react at an emotional level is to take away their rational tool kit: their vocabulary. So we next asked respondents to imagine that all the energy used to power their world is clean, gave them paper and colored pencils, and had them draw what a “clean energy world” would look like and date the pictures.
In almost all the drawings, clean energy was seen as “weak” and not capable of powering our world. Everyone drew multiple types of clean energy: solar panels, hydro, even sail-powered cars! The dates on the drawings were revealing: their worlds were either in the past (1700s) or decades away (2050, 3000).
We also learned that people thought of clean energy as science fiction. The crux of the respondent attitude: clean energy wasn’t seen as ready. They believed clean energy would require huge sacrifices. They didn’t think it was strong enough, or could be harnessed in sufficient quantity to replace fossil fuels.
Another important theme to emerge from the discussion was self-sufficiency. It was clearly present in probing what would cause our respondents to “act.” And dependency on foreign sources was an underlying fear.
Our conclusions based upon these focus groups: our campaign needed to be built around two key ideas. 1. Clean energy is more real and more powerful than you think. 2. It can help make us self-sufficient for our energy needs.
The agency developed a creative brief based upon this research that was quite different from the previous “good for the environment” efforts. Self-sufficiency was developed in the longer copy units. But we also devised a series of single-minded 15-second TV spots to express the first idea. Each started out with a surprising statistic: “America now makes enough clean energy to power every home in 11 states,” “America now makes enough clean energy to power every factory in New York, New Jersey, Pennsylvania, Massachusetts, Connecticut, and Rhode Island.” Each ended with the line: “It’s real. It’s here. It’s working.” Our logo then appeared with the words: “Clean Energy. Let’s Make More.”
Without the innovative design of our focus groups, we never would have arrived at that campaign. And by the way, today, that advertising is real, it’s here, and it’s working!
Contributed by Richard Earle
The late Richard Earle had a 30-year advertising career at six New York agencies, including Saatchi & Saatchi, where he was Executive Vice President, Group Creative Director. He supervised major campaigns for Procter & Gamble and Johnson & Johnson, and worked on over 50 national brands. He is the author of “The Art of Cause Marketing: How to Use Advertising to Change Personal Behavior and Public Policy” (McGraw-Hill, 2002).
Chapter 14: Research Results In Print and Online—Writing and Presenting for Scholarly and Other Publics
Research in Practice: Using The Grounded Theory Method to Research Oncologist’s Grief
If I could give one piece of advice to students about research, it would be to do what you love, research what you are genuinely curious about, and look into your own life for the questions you want answers to.
In my own case, I wanted to know if oncologists grieved when their patients died. I was interested in this because my own mother died of cancer and we had formed quite a close attachment to her oncologist. I wondered if her oncologist felt the same way about us. I was also curious because I am a psychologist who studies grief and loss. In every situation I am in, whether it is personal or professional, I am always wondering and asking about the swirling emotions that affect our interpersonal communication, behaviors and thoughts.
Since no one else had ever asked oncologists about grief before, I decided to use the Grounded Theory (GT) method in my research design. Grounded Theory is a very good methodological choice for topics that we don’t know a lot about. The idea with GT is to try to get an in-depth understanding of a phenomenon rather than breadth. The one consistent principle in GT is that you come to your subject under study open-minded. You “bracket” your pre-conceived notions about what you are researching and you allow the data to emerge from your analysis without imposing your own theories, ideas, or ‘baggage’ onto the participant’s words.
I came to the study with what the Buddhists like to call “beginners mind”. Although I knew about oncology because of my mom’s experience, and although I knew about relationships and attachments because of my interest in human behavior, emotion, and communication I did not know a lot about what it was like to be an oncologist who loses patients they were close to, and ultimately this naiveté served this study well.
I interviewed twenty oncologists across three different study sites and asked a lot of questions about what it is like when patients die- questions about how it feels to lose a patient – what happens when patients die - how do oncologist’s cope with those losses - and how does it affect their lives personally and professionally. Because I did not know the answers to these questions in advance, I asked a lot of follow up questions in order to make sure I understood what they were telling me. Some of these questions appeared “naïve” to them. For example, I asked oncologists to clarify why, for example, it was unprofessional to show emotion. What seemed obvious and intuitive to the oncologists was interesting and new to me and this is precisely the nexus where the best research findings are uncovered. By questioning what seems obvious and unworthy of comment, we uncover the deepest and most interesting insights about what it means to be human.
The analysis of the data involved a laborious process that is part of the GT approach. Transcripts are coded line by line for themes that emerge organically from the data rather than being pre-conceived by the researcher. Then all the themes in one transcript are compared to all themes in the other transcripts. Through this process, one is able to summarize what themes are most important across the transcripts. One caveat is in order: some qualitative methodological approaches count the frequency of the themes and associate significance with the themes that have come up most often. The reality is, however, that the number of times someone says something does not necessarily mean it is more important than something that was said only once or twice. In our study for example, a bit over half of the oncologists described self-doubt as part of their experience of grief, while only about 1/3 talked about guilt as part of their mourning. This does not mean that self-doubt is more important than guilt in understanding oncologist’s grief. Even if only one person talks about something in your GT study, it might be the most important thing to know about the experience you are researching. GT is about gaining depth and understanding into a phenomenon. Generalizability in a qualitative study is not predicated upon frequencies.
If you do a good GT study, your findings should have face validity with the community you are studying. While we had twenty participants in our study, I am confident that our research uncovered what it is like to be an oncologist working at a major academic medical center who experiences patient loss. Is it generalizable to every oncologist in the world? No. Of course not. But this is also the case for large samples using quantitative methods. A quantitative study using statistical methods may have more participants in their research cells, but that study is only generalizable to the population from which the participants were drawn(often, that is undergraduate students taking research courses!) and this point is often left out of the final report.
The validity and the generalizability of our own study findings was apparent by the enormously positive and encouraging response we got from hundreds of healthcare professionals around the globe who had read an article I had written for the New York Times about this work and who wrote to me to tell me how much the article resonated with them.
Hearing from oncologists who did not participate in our study that our findings reflected their day-to-day experiences and resonated deeply with them was profound evidence of the generalizability and validity of our study. If you do a GT study well, you do not need hundreds of participants to get at the “meat” (or for the vegetarians like me – the “tofu”) of the matter.
One final word about this case study. One of the most remarkable aspects of a good research project is the power it has to make an impact in people’s lives. Unfortunately, a lot of the time academic research is left in the academic sphere. Research, especially on humans, should never be solely about your own needs, whether that be for the purpose of getting a good grade in your methods class, or whether you are a pre-tenure professor trying to pad your CV with publications.
Researchers have the ethical responsibility to translate their knowledge for the lay public. It is important to publish your work in academic, peer-reviewed journals. It is important to get the feedback from your colleagues who keep you on your toes and when the peer review process goes well, improve your thinking and your work. However, it is also extremely important to make your work useful for others outside of academia. Some people do that by using their research to inform and effect policy changes for the populations they care about. Other researchers use their work to inform evidence-based practice. In my case, I choose to translate my work for wide dissemination by publishing in the mainstream media. This is important in my particular research area. I consider myself to be an activist for grief (and for love). I have written extensively about why it’s important to grieve because I think it is important for our humanity to be able to acknowledge and make space for loss.
With this study, I chose to disseminate my work in the New York Times, as a JAMA podcast, the Toronto Star, inHealthDay News on and CBC Radio. Our work pointed to the fact that making space for grief could improve quality of life for physicians and quality of life (and death) for patients and I felt this was an important message to get out there.
You can read the details of my scholarly work and see how it translated into news stories by visiting the Granek references below.
Dr. Leeat Granek is an assistant professor in the Sociology of Health Department at Ben Gurion University of the Negev. She is a critical health psychologist whose work is in the area of psycho-oncology, grief, loss and mourning. She can be reached at Leeatg@gmail.com.
Granek, L. (2012). Disciplinary wounds. Has grief become the identified patient for a field gone awry? Journal of Loss and Trauma, 18(3), 275-288. DOI: 10.1080/15325024.2012.688708
Granek, L. (2013). The complications of grief. The battle to define modern mourning. In E. Miller (Ed.),Complicated Grief: A critical anthology. Washington, D: NASW Press.
Granek, L. (2010a). “The cracks are where the light shines in”: Grief in the classroom. Feminist Teacher, 20,1, 42-49.
Granek, L. (2010b). Grief as pathology: The evolution of grief theory in psychology from Freud to the present.History of Psychology, 13,46-73.
Granek, L., Krzyzanowska, M., Tozer, R. & Mazzotta, P. (2012). Difficult patient loss and physician culture for oncologists grieving patient loss. Journal of Palliative Medicine, 15(11). DOI: 10.1089/jpm.2012.0245
Granek, L., Krzyzanowska, M. Tozer, R., & Mazzotta, P. (2013). Oncologists strategies and barriers to effective communication about end of life. Journal of Oncology Practice, 9(4):e129-35. DOI: 10.1200/JOP.2012.000800
Granek, L., Mazzotta, P., Tozer, R., & Krzyzanowska, M. (2012) What do oncologists want? Suggestions from oncologists on how their institutions can help them deal with grief over patient loss. Supportive Care in Cancer, 20(10), 2627-32. DOI: 10.1007/s00520-012-1528-2
Granek, L., Mazzotta, P., Tozer, R., & Krzyzanowska, M. (2013). Oncologists’ protocol and coping strategies in dealing with patient loss. Death Studies, 37(10):937-952. DOI: 10.1080/07481187.2012.692461
Granek, L., Tozer, R., Mazzotta, P., Ramjaum, A., & Krzyzanowska, M. (2012). Nature and impact of grief over patient loss on oncologists’ personal and professional lives. Archives of Internal Medicine 172(12), 964-966.
JAMA Podcast: May 21st, 2012. Nature and Impact of Grief over Patient Loss on Oncologists' Personal and Professional Lives. JAMA Podcast: Author Interviews.http://archinte.jamanetwork.com/multimedia.aspx#AuthorInterviews
New York Times Op-Ed: Sunday Review Section. Published on Sunday May 27th, 2012 “When Doctors Grieve”: http://www.nytimes.com/2012/05/27/opinion/sunday/when-doctors-grieve.html
CBC Radio Syndicated Morning Shows: May 31, 2012. Dr. Granek did 20 interviews and one link on Metro Morning is provided here as an example. http://www.cbc.ca/metromorning/episodes/2012/05/31/can-oncologists-grieve/
Toronto Star Report. May 31st, 2012. Ontario oncologists struggle with grief when patients die, study shows: http://www.healthzone.ca/health/articlePrint/1203206
Health Day News. May 23rd, 2012. Cancer Docs Often Deal With Own Grief, Doubts When Patients Die.http://consumer.healthday.com/Article.asp?AID=664990
Slate Magazine: Granek’s articles can be found here: http://www.slate.com/authors.leeat_granek.html