Quality in qualitative research

Clive Seale

Brunel University, UK

Quantitative research

The researcher counts phenomena that are known to exist, establishing their distribution, co-occurrence and causal links.

Methodological procedures are strongly specified.

Stages of research (planning, hypothesis formation, data collection, analysis) are sequential and separate.

Qualitative research

The researcher discovers new phenomena, often through re-interpreting ones that are thought to be already known.

Meanings are thereby investigated, disrupted and changed.Methodological procedures are loosely specified.

Stages of research are interactive, sequenced in unpredictable ways.

Learn from both traditions:

The quality of qualitative research is improved by using numbers

The quality of quantitative research is improved by attention to meaning and interpretation at all stages.

Avoid this kind of paradigm rivalry:

this book marks the end of an era. It signals a turning point in the history of qualitative research in American sociology. At the very moment that this work finds its place in the libraries of scholars and students, it is being challenged by a new body of work coming from the neighboring fields of anthropology and cultural studies. Post-Geertzian anthropologists (Marcus, Tyler, Clifford, Bruner, Turner, Pratt, Asad, Rosaldo, Crapanzano, Fischer, Rabinow) are now writing on the politics and poetics of ethnography. They are taking seriously the question How do we write culture? They are proposing that postmodern ethnography can no longer follow the guidelines of positivist social science. Gone are words like theory, hypothesis, concept, indicator, coding scheme, sampling, validity, and reliability. In their place comes a new language: readerly texts, modes of discourse, cultural poetics, deconstruction, interpretation, domination, feminism, genre, grammatology, hermeneutics, inscription, master narrative, narrative structures, otherness, postmodernism, redemptive ethnography, semiotics, subversion, textuality, tropes.

Denzin, N.K. (1988) Qualitative analysis for social scientists Contemporary Sociology. 17 (3): 430-2. (Book review of Strauss, A.L. (1987) Qualitative Analysis for Social Scientists. Cambridge: Cambridge University Press.)

Validity and Reliability in the quantitative tradition

1. Reliability / replicability

2. Internal validity / adequacy of causal statementsa. Measurement validity / adequacy of concept-indicator links (face, criterion, construct validity etc)

3. External validity / generalisability

Conceptual proliferation

A comprehensive review identified:successor validity, catalytic validity, interrogated validity, transgressive validity, imperial validity, simulacra / ironic validity, situated validity, and voluptuous validity. (Altheide and Johnson 1994, p.488).

But they missed:apparent, instrumental and theoretical validity (Kirk and Miller 1986)

And on reliability note:quixotic, diachronic and synchronic reliability (Kirk and Miller 1986)

Altheide, D.L. and Johnson, J.M. (1994) Criteria for assessing interpretive validity in qualitative research in Denzin, N.K. and Lincoln, Y.S. (eds) Handbook of Qualitative Research. Thousand Oaks: Sage. pp 485-499

Kirk, J. and Miller, M. (1986) Reliability and Validity in Qualitative Research Newbury Park: Sage.

Lincoln and Gubas (1985) translation of terms

Conventional inquiryNaturalistic inquiry

Truth value (Internal validity) Credibility

Applicability (External validity) TransferabilityConsistency (Reliability)DependabilityNeutrality (Objectivity) Confirmability

Lincoln, Y.S. and Guba, E. (1985). Naturalistic Enquiry. Beverly Hills: Sage.

Authenticity

fairness the research has represented a range of different realities

ontological authenticity - the research has helped members develop more sophisticated understandings of the phenomenon being studied

educative authenticity the research has helped members appreciate the viewpoints of people other than themselves

catalytic authenticity the research has stimulated some form of action

tactical authenticity the research has empowered members to act

Guba, E.G. and Lincoln, Y.S. (1994) Competing paradigms in qualitative research in Denzin, N.K. and Lincoln, Y.S. (eds) ) Handbook of Qualitative Research Thousand Oaks: Sage. pp. 105-117.

Legislators and interpreters

The typically modern strategyis one best characterised by the metaphor of the legislator role. It consists of making authoritative statements which arbitrate in controversiesThe authority to arbitrate is in this case legitimised by superior (objective) knowledge[access to which] is better thanks to procedural rules which assure the attainment of truth

The typically post-modern strategyis one best characterised by the metaphor of the interpreter role. It consists of translating statements, made within one communally based tradition, so that they can be understood within the system of knowledge based on another traditionfacilitating communication [and] preventing the distortion of meaning

The post-modern strategy does not imply the elimination of the modern one...[nor does] the post-modern mode constitute an advance over the modern one

Bauman, Z. (1987) Legislators and interpreters. Cambridge: Polity.

Realism + Idealism = Subtle realism

Criteria for subtle realists

1. Plausibility - is the account consistent with existing knowledge or does it challenge this?

2. Credibility Is there sufficient evidence for claims made. Strongest evidence needed for more central claims

3. Relevance how does it relate to practical concerns / value positions?

Hammersley, M. (1992) Whats Wrong With Ethnography: Methodological Explorations. London: Routledge.

How researchers can use methodological debate

Dont try to solve philosophical problems though research practice

Use paradigm positions as resources for thinking

Develop methodological awareness through exposure to a variety of methodological discussions.

Seale C.F. (1999) The quality of qualitative research. London: Sage.

Some skills for qualitative researchers

TriangulationSearching for negative instances / analytic inductionMember validation / participatory action researchGenerating grounded theoryKnowing when to do quantitative work (and how to do it)Use of low inference descriptorsReflexive reporting

Triangulation

DataInvestigatorMethod

An example of the triangulation of methods

Subject: social scientists attitudes to media coverage of their research. Methods: quantitative and qualitative research methods were combined, including a structured mail questionnaire survey and semi-structured interviews.

Result of comparison: the quantitative method (the mail questionnaire) suggested that the social scientists were generally positive about how the media covered their work, whilst the more qualitative (semi-structured) interviews revealed their views to be far more negative.

Therefore: data re-examined to understand this: whilst the social scientists were generally satisfied with the media reporting of their research, they were much more critical of specific instances in which they felt the media had represented their research in a negative light.

Deacon, D., Bryman, A. and Fenton, N. (1998) Collision or collusion? a discussion of the unplanned triangulation of quantitative and quantitative research methods, International Journal of Social Research Methodology, 1: 47-63.

Cicourels triangulationThe triangulation procedure varies with the research problem. When gathering information on language acquisition in the home setting we left a tape recorder for about one hour during lunch. A transcription of the tape was done by a typist who had been instructed to render a verbatim record. Then the transcript, the first version of this scene, was read by the mother while she listened to the tape; her comments produced another version of the interaction. The typist was next asked to listen again to the tape and to describe what she thought was going on, correcting her original transcript as she deemed necessary. In this elaboration and correction a different version of the scene was always produced. My phonetic transcription of the tapes created still another version...The reader could now say that we should have simply combined the different versions to produce the best one possible, but the point is that different versions could have been produced indefinitely by simply hiring different typists and providing the mother with different transcripts.

(Cicourel 1974, p. 124)

Transcription using the conventions of conversation analysis is like:

watching talk happen in slow motion

or

looking down a microscope

Doctor: yeah sure. Well you said youre not happy with the Modecate

Patient: Im not sure what Im happy with. Because its got its side effects. Its making me rigid and making me feel like Im drunk.

Doctor: A bit stiff and uncomfortable.

Patient: when Im late I walk better. Its in the mind and in your legs and your body.

Doctor: Can I make a suggestion then FirstName?

(PDP94 Modecate and Chlorpromazine)

1 Doctor: youve said youre not happy 2 Patient:[( )3 Doctor:[with the Modecate 4 Patient: Im not sure what Im happy with5 Doctor:we[ll6 Patient: [because its got its side effects7 Doctor:it8 Patient:it makes me legs um (0.4) rigid and 9 Doctor:it ma[kes them a bit stiff does it10 Patient: [( ) like Im drunk11 Doctor:right12 Patient:and you [no:: ( )13 Doctor: [and uncomfortable yeh yeh14 Patient:when Im late I walk better (0.6) its in the mind (0.3)15balancing your legs and your body16 Doctor: can I make a suggestion then Firstname

(PDP94 Modecate and Chlorpromazine)

Version 1 Doctor: Its very hard to be absolutely dogmatic about any predictions with these things. But despite all of those things, in the majority of people the disease does come back, even from the beginning. Patient: Yes, Doctor: And if it does come back, we can try other drugs which may control it for a little while, but generally all that you can try and do is control the symptoms.Patient: Yes Mm.Doctor: Uhm, the first time gives us the best chance for a longer survival, hopefully long term, but the odds are generally against that. But if [our emphasis] we do nothing for these sorts of diseases, it kills you within a couple of months.Wife: The breakdown could be that quick could it?Patient: MmmDoctor: Well actually its quite spectacularly fast.(Seale and Silverman 1997:381)

Version 21D:But er despite all of those things, in the majority2of people the disease does come back3(0.8)4D:even from the beginning.5P:Yes6D:And: (0.4) if it does come back we can try7other drugs which may control it for a little while 8P:mm um9D:but generally all that you can try and do is control10the symptoms.11P:Yes mm.12D:Uhm, the first time gives us the best chance13for a longer (0.5) survival hopefully long term14P:hhm15D:but the odds are generally against that.16P:Yes um (0.4)17D:But if we do nothing for these sorts of diseases it18kills you within a couple of months.19P:Yes(Seale and Silverman 1997: 382)

Overall, would you say that life:

Brings out the best in you? 1Treats you like everybody else?2Doesn't give you a chance?3

1I.overall would you say that life brings2out (0.2) the best in you3R.yes4I.treats you like everybody else=5R.=yes:5I.or doesnt give a chance7R.eh:?8(1.0)9I.what >do you think that< (0.2) life (0.2)10brings out the best in you11(0.5)12[or ( )13R.[yeah the best yeah yeah14I.right (0.5) so thats your (0.2) your15answer yeah [life .>br< life brings16R. [yes yes17I.out the best in you does it?18((some lines omitted))19I. okay (0.2) so of those three (o.2) you think20life brings out the best it doesnt (0.2)21treat you like everyone else an it (0.2)22it doesnt (0.2) not give you a chance23R.(hhh)=24I.=yeah?25(2.0)26R. (doesnt) give me a .h [hh ((sniff))27I. [okay28(1.0)alright (0.5) next one

(Houtkoop-Steenstra 2000)

1DocLets [have a listen at the back [then2Baby [aaaaaaaaa3Moth [just her chest I could4hear her wheezing it was carrying around [( )5Baby [aaaaaaaaaaaa6Docits all right [its allrigh ( )7Baby [aaaaaaa8Mothoh shell chuck every [( )9Baby [aaaaa10 Docoo::h look at tho::se ya hah HA:H you cant ( )11Moth[( )12Baby[mmmmmaaaaaaa13Docoh darling14Babyaaaaaaaaaaa AAAAAAAA [AAAAAAA]AAaaaaaaaaaa15Moth [ come o::::n]16[big breath17Baby [aaauuuuuuuuuuuuuuuuuuuaaa18Docheh okay19Baby .hhh AAAAAAAAAAAAAAA[AAaaaa uuuuu20Doc [theres a good girl21Baby.hhhh aaaaaAAAAAAAA[iiiiiiiiii22Moth [look at tha:t23Baby[aaaaaaa .hhhhh aaaaa24Moth [bunnee::: bunnee:::25Doc[whats that whats that aaa:: thats nice26Moth[aa:: thats nice27Baby[aaaaaaaa mmmmmmm [AAAAAAAAAAAAAA28Moth [the:re come o::n calm down 29Baby.hhhhh aaaAAAAA [AAA30Doc [oka:y31Moth[can you hear anything32Baby[aaaAAAAAA33Doc[its actually not sounding too bad

((from here on babys cries, which are continuous with short breaks for breath, are not transcribed))

34DocI think its just (0.5) shes so in pain with the teeth coming [throu:gh35Moth [yeh36Docthat thats whats causing the problem=37Moth=so you dont think shes ( )38Dochow long has she been poorly for now39Mothu:m very [wheezy for the last (.) she's had the cough for the last40 [krkrkrkrkrkrkrkrkrkkrkrkrkrkrkrkrkrkrkrkrkrkrkrkrk** 41Moththree or four days42Docright okay okay (1.2) I'll just have [another whiz around ( )43 [kr krrr kr**44Docand I'll just check her ears (1.0) see if she's brewing something in there (0.5)45a:llright darling heart (0.4) it's all right, sweet[heart46Moth [o:::h no::47Doc( ) (3.0)48thats a good girl thats fi:ne (0.2) thats a good girl (0.3)49Mothmy dea::r (heres a ) quick tissue50Docah the:::re51Moth aa: the:::re [my: the:::re 52Doc [theres a good [girl53Moth [there come on now54DocO:h what a good girl (0.7) okay thats fine as well (0.3) okay55what I'm going to do (0.2) is um (2.5) is I'm gunna give you some 56Calpol okay just to try and settle her temperature57Childyeh we got [Calpol ( )58Moth [right weve got a little bottle at homeDocokay so more

** krkrkrkrkrk is the sound of a mechanical toy which the child is playing with, perhaps a toy gun or car

Dct:I think it's just that she's so in pain with the teeth coming through, that that's what's causing the problem.Mum:You don't think she's (unclear - baby cries)Dct:How long has she been poorly for now?Mum:Um, very wheezy for the last she's had the cough for the last three or four days.Dct:Right, okay, okay. I'll just have another whiz round, and I'll just check herears, just in case she's brewing something in there. All right, darling heart,it's all right, sweetheart. Oh (baby cries again) That's a good girl, that'sfine. Good girl. There's a good girl. (baby carries on crying). Okay, that'sfine as well. Okay. What I'm going to do is I'm going to give you some Calpol in order to try andsettle her temperature.Mum:We've got a little bottle at home.Dct:I'll get you some more, okay, to settle her temperature nicely. And I wouldgive it another 24 or 48 hours, okay. I'll print you some further informationfrom

Three uses for deviant cases (qualitative research)

Deviant cases that provide additional support for the analysts conclusions, perhaps by showing participants acknowledging that an event is unusual.

Deviant cases that require modification of the analysts emerging ideas.

The deviant case is considered exceptional for good, explainable reasons.

(After Perkyl 1997)

Deviant case leads to modification of ideas

Original finding:

Jeffery, R. (1979) Normal rubbish: deviant patients in casualty departments'. Sociology of Health and Illness, 1 (1): 90-107

Study of typifications / stereotypes of staff concerning adult patients in hospital casualty departments

'Bad' patients have problems deemed to be trivial, or were drunks, tramps or victims of self-harm.

'Good' patients: have problems which allowed doctors to practice and learn new clinical skills, or test the professional knowledge-of staff.

Deviant case leads to modification of ideas (contd)

Deviant case:

Dingwall, R. and Murray, T. (1983) 'Categorisation in Accident Departments: "Good" Patients, "Bad" Patients and Children', Sociology of Health and Illness, 5 (2): 121-48.

Children in casualty departments rather than adults often exhibited the qualities of the 'bad' adult patients, being uncooperative for example, or suffering from mild or self inflicted injuries. Yet staff did not treat them harshly / consider them 'bad' patients.

Resultant modification The labels (eg: 'good', 'bad') applied by staff depend on whether patients are perceived as being able to make choices (children were not, adults were, on the whole). Children were thus 'forgiven' as they were understandably 'irresponsible'

Deviant cases give additional support

Seale CF. (1995) Dying alone. Sociology of Health and Illness 17, 3, 376-392.

Emerging generalisationPeople were mostly concerned to demonstrate their moral adequacy by emphasising that this was an unwelcome event, and that had they been able they would have wanted to be present at the death.

Deviant cases give additional support (contd)

Deviant cases Five people who said they had not wanted to be present at the death of a person who died alone:

For example, the wife of a publican said that her husband's long standing alcoholism had left her feeling little warmth for him; her reason for wishing she had been there was to save her employee the distress of finding the body.

In each case the deviation from the ideal of 'being there' was associated with some alternative strategy for defending speaker's action / feelings as morally defensible.

Conclusion These are alternative strategies for establishing the speaker's membership within the moral community, that do not contradict the notion that for most people this is achieved by saying they wanted to be present at the death.

Degrees of member validation in realist paradigm

WEAK VERSION

Quite commonly, researchers give people transcripts of interviews to check their accuracy.Bloor gave doctors his accounts of their decision rules to check for accuracy.Ball presented and discussed an interim report on school activities to the school - ran a discussion group on the report.Discuss the full report with the people whose situations it describes

STRONG VERSION

Nurses speak of surgeons as seeing themselves as above infection. An infection control nurse commented: You very seldom find both surgeon and anaesthetist with masks adjusted properly. Student nurses, on the other hand look as if they practice in front of the mirror, so perfectly straight are their masks. Nurses are told to wear them whenever in theatre... So perhaps it is simply an issue of status, and the degree of compliance with masking routine is inversely related to the position in the hierarchy... as has been seen in the above extracts, nurses are aware of the doubtful value of masks, yet it is the doctors who flout the rules, yet are silent over this matter. [Fox then quotes a doctor saying:] Nurses are very conservative and fairly rigid in their outlook. They are by far the best people for maintaining surgical sterility.

Fox, N.J. (1992) The Social Meaning of Surgery. Buckingham: Open University Press. p.26

Nurses speak of surgeons as seeing themselves as above infection.

An infection control nurse commented: You very seldom find both surgeon and anaesthetist with masks adjusted properly.

Student nurses, on the other hand look as if they practice in front of the mirror, so perfectly straight are their masks.

Nurses are told to wear them whenever in theatre...

So perhaps it is simply an issue of status, and the degree of compliance with masking routine is inversely related to the position in the hierarchy...

as has been seen in the above extracts, nurses are aware of the doubtful value of masks, yet it is the doctors who flout the rules, yet are silent over this matter.

[Fox then quotes a doctor saying:] Nurses are very conservative and fairly rigid in their outlook. They are by far the best people for maintaining surgical sterility.

Fox, N.J. (1992) The Social Meaning of Surgery. Buckingham: Open University Press. p.26

Wearing of protective clothing by doctors and nursing personnel in hospital

Times Percentages entered wearing roomCapGown Mask

Doctors 47 5 0 5Professionalnurses100 24 18 14Practical nurses*121 86 45 46Aides142 94 80 72Students 97100 100 100

* Practical nurses were of a lower grade than professional nurses

Roth, J. (1957) Ritual and magic in the control of contagion. American Sociological Review. 22: 310314. p.312, Table 2)

Establishing the typicality of a case

Take a case on the basis of it representing the future

Provide full details of context to inform judgements of transferability to other cases

Take a case typical of a cluster of characteristics

Study more than one case

- team research to study different cases

- chooses cases on the basis of broader statistical picture

Table 5.10 Good and bad schools' policy

Good school Score

No subjects taken by pupils at age 16 or younger where allocation is wholly determined by sex 1 Measures arc not taken to ensure a balance of the sexes in streams or bands 1 A rotational craft system operates 1 A course in women's studies operates 1 A member of staff or group of teachers have special interest/responsibility for promoting the policy 1The policy has been discussed in meetings of: Governors 1 Parent-teacher associations 1 Staff 1 Pupils arc informed in option booklets that all subjects arc open to both sexes 1 Total possible score 9

Bad schoolScore

Pupils at age 16 or younger are allocated to certain subjects on the grounds of their sex 1 Measures are taken to balance the sexes in streams or bands 1 No staff with interest/responsibility in the policy 1 Subject not discussed by:Governors 1 Parent-teacher associations 1 Staff meetings 1Pupils informed in options booklet that technical subjects are for boys, home economics for girls 1 Total possible score 7

Five schools selected for case studies

Midland Comprehensive 11-18 comprehensive; 720 pupils; Midlands; city centre catchment; Labour LEA; amalgamation of two single-sex schools; poor situation and catchment; 50 per cent of pupils non-European background; positive discrimination policy towards non-traditional choice, pioneered by headteacher.

Inner City Comprehensive 11-18 comprehensive; 850 pupils; London city centre catchment; Labour LEA; popular school with active equal opportunities policy promoted by dynamic headteacher and widely supported by staff.Northern Modern 11-16 secondary modern; 760 pupils; mainly council estate catchment; northern region; Conservative LEA; head least sympathetic to equal opportunities of all we visited.Smallchange Secondary 12-18 secondary modern; 720 pupils; in southern rural catchment; Conservative LEA; passive view of equal opportunities.Oldboys Grammar 11-18 grammar school in prosperous London suburb; 700 pupils; Conservative LEA; highly traditional atmosphere and emphasis on academic excellence; little concern with equal opportunities.

Sieber's (1979) study: sampling within a case

our own fieldwork... developed into a study of school boards, superintendents, and the leaders of the high school teachers. After conducting a survey, however, I was able to correct certain impressions that emerged from my elite bias. This can be shown quite simply. Prior to looking at the results of the survey, I predicted the proportion of teachers who would respond in particular ways to the survey questions. I then compared my predictions with the actual responses. It became obvious when observing these comparisons that I had unwittingly adopted the elites version of reality. For example, I overestimated the extent to which teachers felt that the administration accepted criticism. Here are the relevant questions and the statistics: "Do you think that teachers who are interested in administrative openings jeopardize their opportunities in this district by voicing criticism of present school policies and practices?" (% responding "definitely" and "possibly"):

PredictedObserved

System A 4060

System B 4065

Similarly, I had assumed that the teachers were more satisfied with evaluative procedures than was in fact the case: All in all, how well do you think the evaluation of teachers is done in your school?" (% responding "as well as possible" and "fairly well"):PredictedObservedSystem A Elementary............ 8065 Secondary............5036System B Elementary............8074 Secondary............7556Although to a lesser extent, I also overestimated the rank-and-file support for the leaders of the teachers association, with whom I had spent a good deal of time. In short, I had fallen prey to the elite bias, despite recent training in the dangers of giving greater weight to prestigious figures as informants. (1979: 1353)

Ways of using numbers to enhance qualitative research

1. The logic of triangulation2. Qualitative research facilitates quantitative research3. Quantitative research facilitates qualitative research4. Quantitative and qualitative research are combined in order to produce a general picture5. Structure and process6. Researchers and subjects perspectives7. The problem of generality8. Qualitative research may facilitate the interpretation of relations between variables

(Source: adapted from Bryman 1988: 131-151)

Qualitative research facilitates quantitative research

The guiding principle in the interviews was to get informants to talk about what was important to them when implementing statewide testing programs. These findings provided the outline for the development of the survey instrument. The interview data revealed five themes around which a series of questions were developed. The themes included: the contexts in which the districts operated, the responses the districts made to tests, the strategies they employed to carry out those responses, the uses to which the tests were put, and the effects of the tests. In addition to the major themes around which the questions were organized, the interview data also offered specific information for the wording of survey questions. Thus, the qualitative data in phase one of the study were designed to inform the development of the survey in phase two.

(Rossman and Wilson 1994: 322-323)

Quantitative and qualitative research are combined to produce a general picture

What was found in McKeganey's qualitative study

Five types of needle sharing:accidentaldue to necessity where, for example, no other means of injection were availabledue to intense needs in withdrawalwhen an injector believes another person to be cleanin settings where a social norm of reciprocal favours was strong.

Factors that seemed to affect propensity to share:Women more likely than men to share with sexual partners.Social distance of person shared withLength of drug injecting experience

Vignettes of needle sharing experiences

Borrowing Vignette 1I want you to imagine that you are with your steady partner. You have both just scored and you both have your own tools (needle and syringe). The two of you are in a stairwell of a block of flats preparing to inject but your needle has just blocked. Would you:1. Go away and try and get a new set of works (needle and syringe).2. Ask your partner if you could use his/hers saying that you can wash them out with the bottle of water in your pocket

Lending Vignette 1I want you to imagine that you are standing on a street corner. In your pocket you have a set of works that you used earlier the same day. Someone that you dont know very well comes up and says that he/she is strung out, that he/shes got drugs to hit up but no tools. He/she asks if you have a set on you. Would you:1. Tell him/her to get lost.2. Say that you cant let him/her have the works in your pocket.3. Give him/her a set of tools but tell him/her that they are your only set and you want them back.4. Tell him/her that he/she can use the works in your pocket but that you dont want them back.

(Source: McKeganey et al 1995: 1254-1255)

Borrowing vignettes (n=505)PartnerVery good friendAcquaintanceTotal*Yes (%)331 (65.6)193 (38.2) 64 (12.7)346 (68.5)No (%)148(29.3)308 (61.0)436 (86.3)141 (27.9)Other (%) 26(5.1) 4 (0.8) 5 (1.0) 18 (3.6)

*Total: yes= number prepared to borrow on at least one of the vignettes; no= number not prepared to borrow on any of the vignettes.

Lending vignettes (n=505)PartnerVery good friendAcquaintanceTotal*Yes (%)370 (73.3)398 (78.8)331 (65.6)435 (86.1)No (%) 99 (19.6)104 (20.6)172 (34.0) 63 (12.5)Other (%) 36 (7.1) 3 (0.6) 2 (0.4) 7 (1.4)

*Total: yes= number prepared to lend on at least one of the vignettes; no= number not prepared to lend on any of the vignettes.

(Source: McKeganey et al 1995; Tables 1 and 2)

Question about help with care and quantitative and qualitative replies.

'When you visited, did you help with (deceased's) care?

Hospice Hospital1967-69 47% 29%1977-79 85% 25%* 1994-95 49% 41%

* = reported as a statistically significant difference between groups.

Different reasons for helping with care

If she was having a meal and I thought she needed assistance I would help. I'm happy about my involvement. There was a happy fellowship and my family were happy with the services we received. (Hospice group)

I helped with various aspects of care, partly because I wanted to, and partly because the nurses were so busy. I shaved him brushed his hair, washed him. (Hospital group)

Yes sometimes he would be incontinent and his slippers would be wet, so he developed sores on his feet. I looked at that and dried his feet. I brought in food - ice cream and liquid feeds. I tidied him up in general. (The hospital) were rationing liquid food so I brought it in myself. I brought in ice cream too - in fact all his food. He never ate any of the hospital food. (Hospital group)