Methodological Modifications in a Longitudinal Qualitative Research Design

Abstract

This article explores methodological shifts in longitudinal qualitative research and illustrates how researchers can maintain methodological continuity while staying open to necessary modifications. We describe methodological modifications and changes that occurred during our longitudinal research process. These change processes were initiated due to general advances in the field of qualitative research methodology, personal research experiences gained during the research process, and preliminary analysis findings. The change processes complicated our methodological decision making and simultaneously refined study purposes and analytical intentions. The investigation of change over time, time in context, and time and texture also play a significant role in our examples and reflections in this article. We argue that careful analysis and accounting of methodological continuity, modification, and changes can strengthen the trustworthiness of longitudinal studies, an important goal considering the methodological complexity often associated with longitudinal qualitative research.

Keywords

research qualitative longitudinal studies research design

This article explores methodological and epistemological shifts in a qualitative longitudinal research (QLR) study. We acknowledge that such shifts are not unique to QLR and could take place in other research contexts. For example, researchers who have conducted panel studies have reported similar methodological issues and concerns as researchers conducting QLRs (see, e.g., Gravlee et.al. 2009; Jones et al. 2010). Thus, we do not imply that arguments presented here are unique to qualitative research, but qualitative research provides the context from which we draw our examples. We illustrate how researchers can establish methodological continuity yet stay open to methodological modifications and changes in research designs that represent “good practices.” Like Carter and Little (2007) and Simons et al. (2008), we argue for unique methodological solutions and iterative uses of methods that suit particular research situations. These methodological solutions are often results of processes in which methods and data, purposes, and practices inform each other.

Both methodological continuity and emerging modifications shape study goals, design, and constructed data as illustrated through examples drawn from our longitudinal study. Sometimes, methodological changes are subtle and minor, such as changes in recruitment strategies or revisions of interview questions. In other contexts (i.e., longitudinal research), methodological modifications can lead to major changes, including additional data collection points, construction of additional interview protocols, or alternative data analysis approaches. Whether subtle or major, modifications are frequently not systematically acknowledged in published research, and our article seeks to emphasize the benefits of such explicit reflection. Similar to our illustration of methodological modifications that will be put forward in this article, Yates (2003) referred to the “invention” of longitudinal studies as an ongoing and creative process. Using the online network Timescape (see http://www.cardiff.ac.uk/socsi/newsandevents/events/timescapes2010/index.html), scholars have widely and reflectively discussed different spatial, temporal, and ethical issues related to QLR.

Ongoing discussions and further analysis of methodological continuity and modification as well as reflections from within can be useful cognitive tools when dealing with ambiguity and complexity associated with QLR. Methodological modifications and shifts are commonly not well documented or discussed by researchers, especially in disciplinary-specific journals. However, avoiding or masking indicated methodological changes can adversely impact the validity of research and trustworthiness of findings (see, e.g., Faden et al. 2004; Karnieli-Miller et al. 2009). Thus, it is the researchers’ methodological responsibility to share their processes, including modifications and shifts that can also inform the work of other scholars.

In general, longitudinal designs have been conceptualized in various ways. Ritchie and Lewis (2003) defined longitudinal studies as approaches that involve more than one episode of data collection, and Epstein (2002) proposed that longitudinal design could include ongoing research in the same community for extended periods of time, with periodic restudies at some intervals or by returning to the same site after some time. Longitudinal studies are commonly characterized by investigation of change over time, time in context, and time and texture of experiences (e.g., Corden and Millar 2007; Holland 2010; Holland et al. 2006; Neale and Flowerdew 2003; Ritchie and Lewis 2003; Saldaña 2003). Holland et al. (2006) suggested that the focus on transitions, pathways, adaptations, impact of historical events, evaluation of specific policies, movements, and cumulative processes could represent some ways in which scholars might build on the extended time available in longitudinal designs.

From a methodological perspective, QLR also creates challenges related to need for continuity of research funding and is often accompanied by special ethical dilemmas and confidentiality considerations from prolonged engagement with participants (see, e.g., Grime and Richardson 2010; Holland et al. 2006; Miller 2010; Ruspini 2002). Researchers need to consider issues of harm, data privacy, and whether the prolonged presence of researchers in a particular community might place the community or any of its members at risk for financial, social, or academic problems.

Additionally, research personnel turnover and participant attrition are often considered the biggest challenges in longitudinal studies (see, e.g., Cotter et al. 2002; Ruspini 2002). Maintaining contact with participants over time can require extensive personnel and monetary resources to keep contact information up-to-date, motivate participants to enter new study waves, and track participants who have moved. To sustain rapport and close relationships with participants, researchers can benefit from community partnerships and local connections. In addition, Cotter et al. (2002), Ruspini (2002), and Seed et al. (2009) have suggested various techniques to reduce attrition such as continuity of research team and contact persons, keeping track of scheduling history, monetary and other incentives, interviewer persistence, personalized communication with the participants, or tracing techniques such as contacts through relatives or friends, or online databases.

Finally, the vast amounts of data collected over time present unique challenges to field access, data management, and analysis (Saldaña 2003; Smith 2003; Thomson and Holland 2003). With increasing data volume, it becomes more challenging to keep data organized, conduct in-depth analyses, keep analyses focused on research questions, or reduce vast amounts of data to particular segments or insights that can be presented in conference papers or published within the usual word limitations of contemporary journal articles (Fernald and Duclos 2005; Saldaña 2003). For example, in our study, we used secure server space to keep electronic data in one shared location, utilized case files to assemble data from each participating triad, and divided large data sets into smaller sections to facilitate thorough data analyses.

Thomson and Holland (2003) proposed that absence of analytical closure is one of the most challenging aspects of longitudinal research. In QLR, analytical possibilities might seem endless and data might not reach “saturation.” The lack of saturation can disturb analytic processes for researchers who believe that categories and labels will become redundant or need to saturate before they can be theorized or reported (see, e.g., Alasuutari 1995; Bogdan and Biklen 2006; Glaser and Strauss 1967). At the same time, however, lack of saturation because of a rich, complex, and possible contradictory data set can provide alternative analytical opportunities like presenting multiple voices, perspectives, and interpretations simultaneously, keeping interpretations and study conclusions in flux.

Researchers may be drawn to QLR not only because of its emphasis on historical situatedness but also because of its need for methodological flexibility and openness (see Holland et al. 2006; Thomson and Holland 2003). One of the major values of QLR is flexibility and potential for continuous conceptual and theoretical development and innovation throughout the research process. Next, we illustrate through our research examples how QLR can create unique methodological and analytical opportunities for inductive and participant-driven research approaches. We focus on how continuity and methodological modifications shaped our research project.

Conceptual Continuity and Methodological Stability

QLR processes and design may change considerably over time, but researchers can stay methodologically focused by adhering to certain structural and conceptual continuity in a research design. By conceptual continuity and methodological stability, we mean the consistent and repetitive use of theories, key concepts, and epistemologies. Conceptual continuity and methodological stability can also help researchers justify their design choices and methodological decisions and keep all design components and study phases interconnected and supporting specific epistemological goals.

In the next section, we briefly discuss aspects of conceptual continuity and methodological stability maintained in our study, including the qualitative study aims, the participant sample, and the primary data collection methods. These aspects of research were carried out as originally put forward in our grant application. Then, we focus on methodological modifications and changes that took place during the research process.

The following examples are drawn from our research study titled “ADHD detection and service use.” This study, funded by the National Institute of Mental Health (NIMH), used mixed methods in a parallel or complementary mixed methods design and included quantitative and qualitative research cores. Typical of parallel mixed methods studies, our qualitative research core was independent yet linked with the quantitative core (see, e.g., McMillan and Schumacher 2001; Tashakkori and Teddlie 2003 for more about parallel mixed methods designs).

The mixed methods study built on research with a random sample of 1,615 public school students who were screened for attention deficit/hyperactivity disorder (ADHD) in 1998 (Bussing et al. 2003). The qualitative research core combined constructivist and critical perspectives and was designed to describe elements and experiences that have helped or hindered help-seeking for ADHD for two underserved groups: girls and African American youth with ADHD. The original research plan called for an interplay between quantitative and qualitative research efforts, where the sampling framework of the original quantitative study provided the participant recruitment opportunity for the qualitative research.

The qualitative research phases consisted of QLR through a qualitative adaptation of experience sampling method (ESM; Koro-Ljungberg et al. 2008a), which was designed to yield data to inform focus group research and eventually influence the development of a treatment acceptability survey (see Figure 1). The treatment acceptability survey sought to simultaneously elicit ADHD intervention perceptions from four stakeholder groups: adolescents, parents, health care professionals, and teachers; the interventions to be included in the survey were to be derived through literature review (evidence-based practices) and results of our qualitative research (community-based practices) and were anticipated to include interventions through the medical sector, school, and home-based self-care (Bussing et al. 2012).

Figure 1.

Interconnectedness among various study phases.

The QLR reported in this article took place during the last 5 years of the10-year project. To increase study enrollment and retention, we sent personalized invitations, followed up written communication with phone calls to reestablish contact with our cohort, and provided small participant incentives for all modes of data collection. To ensure optimal participation and completion of the ESM, introductory face-to-face sessions were arranged prior to beginning the data collection, during which participants were informed about the study, its goals, proceedings, risks, and benefits, where parents and teachers gave informed consent and teens provided assent. We also contacted participating families twice weekly and teachers weekly for updates and to maintain close contact. To enhance participation in personal interviews, focus groups, and telephone interviews, we gave parents the option to schedule interviews at convenient times and places.

In our study, the qualitative research core conducted its own independent series of data collection and analysis events (see Figure 1). However, findings from the qualitative research core shaped the development of survey questions, forming an essential link between qualitative and quantitative cores of the project. Additionally, our research contained a summit meeting toward the end of the study where we presented findings derived from the qualitative and quantitative cores to our participants. Preparation for the summit called for an integration of findings from both qualitative and quantitative cores. All data collection and analysis events were carried out by various research team members, including a qualitative methodologist.

Methodological Continuities

First, the study aims provided theoretical continuity throughout the study. As outlined in the grant proposal, our aims guided our work conceptually, theoretically, and ethically because we needed to conduct the research according to the funded plan. Our main theoretical framework of health service utilization shaped the design of the entire study, and all research design choices focused on the goal of ultimately improving access to health care. We were committed to the theoretical framework of help-seeking and related main research concepts (i.e., help-seeking, treatment trajectories, utilization of health services, and reducing health disparities). The longitudinal design allowed us to study whether disparities in health service utilization by gender and race persisted over time.

We were also committed to participant-driven research methods such as the qualitative ESM, focus groups, feedback forums, and the summit meeting. We expected that such methods could activate participants and thus increase their involvement, commitment, and interest in research but more importantly because participant-driven research can lead to desirable changes in health care and education practices (see also Abma et al. 2009). It was important that participants served as advisors and partners who shared their experiences, evaluated our research plans, conducted community outreach, and helped us create findings relevant to them and their communities.

In the literature, the ESM has been described as a method that privileges the personal experiences and meanings of participants as it aims to collect data about both the context and the content of their daily lives (Csikszentmihalyi et al. 1993; Larson and Csikszentmihalyi 1983; Miner et al. 2001). In our study, the qualitative application of ESM lasted 3 months and was conducted with eight triads (each including a parent, teen, and teacher). Participants reported interactive and critical events associated with help-seeking for ADHD symptoms. Parents and teens reported their interactive event by prepaid cell phones, and teachers used the Internet to report their data to a secure website. Our original design proposed that findings gained from ESM will inform the development of questions for subsequent focus groups to study meanings constructed during social interactions (see Bloor et al. 2001; Morgan 2002, 2004). Homogeneous focus groups were to be held for those whose ADHD remained untreated and for those who had accessed some level of ADHD treatment, with parents and teens in separate groups, guided by questions from the focus group moderator (see also Koro-Ljungberg et al. 2008a).

As originally planned, the first wave of focus groups was to include homogeneous groups for mothers, fathers, teens, and teachers to create a “safe place” for participants to share their experiences of help-seeking related to adolescent ADHD among peers. The analysis of our first wave of focus group data highlighted the importance of effective home–school communication for help-seeking, and we decided to add a second wave of heterogeneous focus groups of mothers and teachers to gather primary data about home–school communication. During the second wave of focus groups, we convened two groups of seven to eight participants (three to four parents and four teachers) to promote effective dialog and exchange of ideas.

Feedback forums served as secondary data collection method to present analysis results and conclusions to participants and to obtain their feedback, to increase validity, and to reflect their preferences, needs, and values (member checking). The first wave of feedback forums occurred after the initial analysis of ESM data had been completed. We invited all ESM participants to join forums held at public libraries. Consistent with our original plan, we shared data stories and elicited participants’ reflections on similarities and differences between those data stories and their own experiences. We also presented preliminary findings and conclusions drawn from the critical event analysis of ESM data and asked participants to confirm or disconfirm our interpretations.

The final study phase, our summit meeting, was designed to share findings of the acceptability survey with study participants and to process potentially complex and unexpected survey findings. The summit took place in the public library and was attended by 36 participants, a mixture of teenagers, parents, teachers, school and health professionals, and study advisory board members.

Based on feedback derived during pilot testing (a modification to our research plan, described below) of format and content prior to the actual summit meeting, we first gave formal result presentations, followed by interactive guided poster walks during which small groups joined up and received individualized show-and-tell of relevant results in poster formats. After lunch, participants divided into self-selected small groups to discuss in more detail survey findings we considered puzzling. As also suggested during our pilot testing of summit proceedings, adolescents were offered their own group, which started out with a trust-building exercise before moving on to formal discussions.

Conceptual Changes and Methodological Modifications

Three types of changes and modifications occurred in our study: (1) participant-driven; (2) data collection-driven; and (3) analysis-driven (see Table 1).

Table 1.

Summary of Conceptual Changes and Methodological Modifications.

	Participant-Driven	Data Collection Method-Driven	Analysis-Driven	Implications for Research
ESM		Change in IRB protocol: From Palm Pilots to cell phones	Change in analytical foci: From predetermined analysis techniques to techniques that highlights participants’ experiences and constructed data	-Ideally, data collection and analysis methods are tailored for particular context and participant population -Data analysis plan is preliminary until all data have been collected -The importance of ongoing analysis and analytical reflection
Focus groups and feedback forums	1. Change in focus group sampling: Additional heterogeneous groups 2. Change in the purpose of the feedback forums: From information gathering and member checking to support 3. Added purpose for the feedback groups: To test and further develop survey questions			-Existing data should drive additional data collection phases -Participants’ involvement in research design decisions can facilitate engagement and “buy-in” -Ongoing evaluation and reflection on gained knowledge can help researchers stay focused on their study aims but also to be responsive to issues emerging from the study context

Note. ESM = experience sampling method.

The first change initiated by participants and their data prompted us to modify our sampling strategy during the subsequent focus groups. Analysis of our first-wave focus group data highlighted the importance of effective home–school communication in the ADHD help-seeking process. As a result of this finding, we wanted to create a focus group environment in which participants could begin discussing, exploring, and potentially improving their home–school communication strategies. Therefore, we added a second wave of heterogeneous focus groups of mothers and teachers to gather primary data about home–school communication. Unlike earlier focus groups that prioritized participants’ sense of safe space to share their experiences with peers, heterogeneous focus groups promoted dialog, exchange of ideas, and establishment of parent–teacher relationships. These additional focus groups deviated from the original research plan but enabled us to further explore participants’ experiences, conduct theoretical sampling, and focus our analytical attention to areas that participants’ highlighted as important.

Originally, we had also planned to collect participants’ feedback on our preliminary findings during group activities. We referred to these group interviews as feedback groups. It was our intention to ask clarifying questions, questions about additional details about their experiences and possibly negotiate some interpretive differences or differences in group members’ experiences. However, during the feedback groups, the participants became more active. They asked questions of each other and their dialog moved beyond existing data and researchers’ interpretations. Due to this change, we were able to ask clarifying questions, but this did not become main purpose of the meeting as we had anticipated. These feedback groups functioned more as support groups and participants introduced additional topics and areas of discussion rather than verifying our findings or interpretations.

We added an additional purpose to the feedback groups because we wanted to optimize the relevance of the survey questions being developed for the quantitative core. Because the focus group data analysis was informing the development of our acceptability survey, we tasked the feedback groups for feedback on several aspects of survey development such as how to word and describe interventions most clearly, how to optimize survey length and item selection, and how to identify items that were confusing, overlapping, or unnecessary from the participants’ perspectives. For these reasons, we decided to use the second feedback group to member check preliminary focus group findings and provide participants with some examples of survey questions for review, feedback, and improvement suggestions.

Analysis-driven changes also took place. For example, we had originally planned to use open coding and domain analysis to conduct a preliminary analysis of ESM and focus group data. It was also our intention to use critical incident analysis and political analysis with ESM and some parts of the focus group data to add additional analytic layers and to triangulate different data analysis methods. However, during the analysis process itself, we allowed data insights from preliminary coding and reading to guide us toward additional data analysis methods (see also Simons et al. 2008). For example, while reading about and studying mothers’ experiences of mothering a child with ADHD, the strong presence of different sociopolitical discourses called for additional discourse analysis. Thus, rather than conducting domain analysis or political analysis, the use of discourses analysis enabled us to follow data leads and highlight aspects of data that women and mothers’ shared with us and viewed as important. Similarly, when we analyzed ESM data, we noted ways in which African American teenagers used language to create and/or hide certain identities or aspects of identities. This prompted us to learn more about African American rhetoric traditions and how these traditions shaped the stories and narratives teenagers shared. As an implication of data analysis, we saw the benefit of paying more attention to the teen-constructed narratives and culturally situated talk. Narratives and culturally situated talk became tools to connect with teenagers’ experiences and possibly improve communication between health care providers and teens by illuminating the ways teens construct their personalized realities of ADHD (Koro-Ljungberg et al. 2008b, 2011).

Another example of analysis-driven changes dealt with the scope of findings to be presented at the summit meeting. We had originally planned to present general study findings gathered during the preceding years at the summit meeting. Instead of presenting results from all analyses and findings, we decided to focus on the acceptability survey findings, concentrating especially on data insights that were puzzling or contrary to our expectations or contradicting extant literature. The presentation of findings derived from all previous study phases would have been too complex and possibly overwhelming for summit participants. We also learned in previous feedback meetings that only a limited amount of content can reasonably be processed at a given time and determined that it would be unproductive to try to share too much in one meeting.

One of the methods-driven changes and modification were initiated by our local Institutional Review Board (IRB). In our original grant application, we had planned to use Palm Pilots as data collection tool for teens and parents to document their experiences, selecting appropriate breaks during their daily activities to write notes and responses regarding help-seeking events. The IRB voiced concerns about computer security and the lack of immediate access by the research team to potentially safety-critical data (communications about potential threats to safety). As a result, we changed our design to use cell phones for teen and parent communications. Calls were placed to a dedicated confidential answering machine that was listened to and triaged on a daily basis.

As another example of methods-driven modifications, we decided to add a preparatory pilot “collaborator” meeting prior to our summit meeting. The summit preparation meeting was not originally included in our grant proposal. This decision to consult with the participants during the preparation phase was informed by experiences gained in our community advisory meetings, when we used the assistance of advisory board members to help us shape format and content of study results brochures for our participants.

About 3 months before the final summit meeting, we organized a small pilot preparation meeting that included seven participants from previous study phases. The function of the collaborator meeting was to gain feedback on our planned summit format that was to include a formal presentation and guided poster walks. We conducted a mock summit experience for our collaborators and gained valuable suggestions for improvement that we used to modify our final summit materials (i.e., changes to poster setup and content, ideas on how to engage and involve teenagers). The feedback we obtained in the pilot summit helped us bridge differences in researcher and participant discourses related to study results.

Discussion

As a result of the methodological modifications and changes illustrated above, our study design become more complex but more focused. We and our study participants began to ask different questions and we noted that data were being read, studied, and interpreted differently from the original conception. In our study, the main or primary research questions did not change but we added numerous additional research and analytical questions. Even though QLR is continuously guided by its historicity and past, data analysis and interpretations take place in the present. In this way, researchers might be caught in a bind and continuously pulled between past events and prior methodological choices and the analytical and interpretive present.

For example, methodological decisions and conclusions can be based on urgency to conclude, publish, and present but they cannot be separated or created without the relationship to the past, a past that included prior study phases and participants, goals, research team members, and professional ambitions. This temporality (connectedness to particular time) provides continuity and historical context in which a study is located. For example, researchers could consider “What was before and what comes after?” Spatiality (connectedness to particular space) reflects the situatedness of knowledge and culturally specific context that will also shape research designs. For example, researchers might ask “How do different discourses and cultural forces shape the study?”

Additionally, qualitative researchers can struggle to balance longitudinal objectives and immediacy associated with social context of the study. To carry out inductive research designs, participants often provide the initial stimuli for conceptual or methodological changes and modifications. When participants’ needs, experiences, expectations, or realities change, methodology often reacts and responds to these changes. As illustrated in our empirical examples, interactions with data and study participants can lead to opportunities for methodological change and transformation.

Changing circumstances in the field (e.g., IRB stipulations), experiences gained during the research process, and preliminary data analysis findings initiated modifications that complicated and added to our study design while simultaneously clarifying the focus and researchers’ intentions. Similar to Kelly’s (2007) study, our participants assisted us to reconsider and revise our methodological decisions and researcher roles. We were also puzzled with ethical questions associated with intrusion associated with ESM and, despite the common procedures and policies, we considered each participant as an individual with unique needs and circumstances. For example, we understood that participants might not participate at all or might reduce their participation during weekends and holidays.

We were also sensitized to the fact that some parents and teachers had pressing personal issues that limited their participation. And, due to ethical concerns regarding data privacy and phone use at schools, we supported situated and personalized procedures how and when teens were to make calls. Additionally, our field experiences and interactions with participants guided us to limit some aspects of data collection (i.e., data collection points focusing on member checking only) and add others (e.g., additional focus group about communication strategies and summit preparation meeting). This methodological flexibility and responsiveness enabled us to make our study more relevant to the participants and their communities.

Finally, QLR enables individual to shape and construct their own research biographies and participant profiles. During their active and longitudinal involvement, participants can put forward certain aspects of their experiences and portray themselves in a particular light. As a result of participation in our study, participants were continuously asked to reflect on and think about their relationship with ADHD. These reflections brought help-seeking to the forefront in participants’ lives and enabled families, teens, and teachers to adjust their practices and approaches. Many parents also reported that they had learned much about ADHD, their children, and themselves through the participation and ongoing relationships with the research team.

Similarly, we had various opportunities to reconsider our roles, ethics, aims, and research purposes. Long-term relationships with the participants, data, and study context created unique sociocultural dynamics where we and our study became a central part of participants’ lives and everyday activities. The boundaries between research and friendship, professional and personal ethics, academia and local school and neighborhoods became blurred. We believe that conceptual and practical complexities, including methodological modifications and changes that are likely to occur during QLR, require increased attention and reflexivity. Openness to modifications and methodological changes can strengthen the trustworthiness, validity, and applicability of longitudinal studies because many methodological changes are inevitable and should be carefully reflected on and accounted for when describing research processes.

Footnotes

Declaration of Conflicting Interests

The author(s) declared potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Regina Bussing has been a consultant for Shire Pharmaceuticals, and receives research support from NIMH, AHRQ, Otsuka, Pfizer Inc, and Shire.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This research was supported by NIMH RO1 MH57399.

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