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Logo of ijqhwInternational Journal of Qualitative Studies on Health and Well-being
 
Int J Qual Stud Health Well-being. 2009; 4: 130–132.
Published online 2009 September 1. doi:  10.1080/17482620903220230
PMCID: PMC2879968

Editorial

Karin Dahlberg, Co-Editor and P. D. Ashworth, Editorial board member

In a previous QHW Editorial (Hallberg, 2006) the importance of not following slavishly any rigid step-by-step “method” was emphasized. Where the goal is to illuminate individuals' sometimes enigmatic lifeworlds, thereby showing how health and well-being can be promoted, supported and restored, no inflexible and formulaic research technique is adequate. Research must be carried out by an open, lifeworld-sensitive approach where there is scope for genuinely empathic sensibility. Techniques must be chosen that are appropriate for the phenomenon under investigation. The research approach must be built on a strong foundation of ontology, epistemology and methodology. Of course, there are several human science research approaches that meet these criteria. Phenomenology is an example of such an approach.

Phenomenological philosophy gives to research a thorough understanding of what knowledge is, what proposed knowledge needs in order to be valid, and how a researcher gets access to such knowledge. Phenomenological research is interested in human meaning, e.g. the meaning of health, illness and well-being.

The research may on the one hand have a hermeneutical flavour, regarding the data as “text” for interpretation (there is a strong emphasis on the impact of language). Therefore, although phenomenological research is always close to experience, the hermeneutical researchers see themselves as having a heavy task—that of making sense of experience. It may be that external sources such as previously published research findings or existing theories are brought into the analysis. In such analyses the findings are summed up in a “comprehensive understanding” or a “main interpretation”, where the phenomenon is described in a way that includes the original empirical as well as external data sources.

If the research on the other hand is focused strongly on the experience as it is expressed in empirical data it is a “descriptive analysis”. Though the researcher obviously has a part to play in the description of experience, it is always emphasised that the description is of the research participant's experience and the researcher is a kind of midwife in bringing the experience to the light of day. Results of such analysis are mainly presented as a “general structure”, in which the essential meanings of the phenomenon as well as its other constituting meanings are described.

No doubt great care is needed in coming to a good description of the lifeworld and human meaning—bracketing presuppositions and “bridling” the forthcoming understanding so as to focus purely on the experience of the phenomenon. Nevertheless, the process of description is not so very controversial—maybe because something like it is shared by other approaches. Nevertheless, the idea of presenting a general structure, and in particular the idea that the researcher can arrive at essential meanings, is very much under debate. Consequently, we want to illuminate some of the characteristics of phenomenological empirical analysis in which the goal is a general structure.

Basically, all phenomenological research begins in the lifeworld, e.g. individuals' experiences of health or illness. However, some studies which announce themselves as phenomenological, do not go much further than listing some themes common to the research participants' accounts of their experience. In these instances, the work ought to be seen as “thematic analysis” rather than phenomenological research, despite having a foundation in the careful description of experience.

In truly phenomenological research, the individual instances of experience are reflectively worked on by the researcher, who may, for example, look for aspects of an experience, which—though they might not have been explicitly mentioned in interviews—are necessary components of that experience. In such analysis the deeper-lying meanings must be illuminated and not least must the relationships between the meanings, i.e. the pattern of meanings, be explicated (Dahlberg, 2006). The process of coming to an essential description of a phenomenon, therefore, involves “free imaginative variation”. The aim is to reach a statement of the phenomenon which is sufficiently clear for anyone who knows the general, essential structure of the experience to be able to say, when a new instance occurs, whether it is an instance of that very phenomenon or not. In this sense, the essence provides a phenomenological equivalent of generalizability.

The description of a general structure includes the essential meanings but it may also be right to present some particularities. To give a simple example, an essential meaning of “table” is its capability of offering a hard surface on a certain level above the floor. But in order to understand the table phenomenon it could be of importance to also present some of its individual meanings: a nice table could be one made of oak wood, which is a part of a classic dinner table set, while there are other tables made of plastic, e.g. good for outdoor use. The first described meaning is essential; without it an entity is not a table. Additionally, whether the table is of wood or plastic could be of aesthetic value-but is not an essential meaning; the material does not affect its “tableness” (Dahlberg, Dahlberg & Nyström, 2008). Further, according to Merleau-Ponty (1995) all meanings are infinite and expanding. Consequently, a general description or an essence is never complete.

Let us consider as an example, the phenomenon “participation”. The essential description is very likely to be incomplete (e.g. we may have made all sorts of cultural assumptions which would have to be revised if we were to apply the idea to Chinese culture). Nevertheless, the description of the essence of participation should be good enough to let us see (for example) what the necessary conditions are for patient participation in heath care. On the basis of these lifeworld conditions we could helpfully say that if such-and-such a feature were absent in an actual patient-professional relationship, then patient participation would not occur.

A paper describing the essence of participation (Ashworth, 1977) concluded that among the essential characteristics of this phenomenon were:

  • Attunement to the others' “stock of knowledge at hand”.
  • Emotional and motivational attunement to the group's concerns.
  • Taking for granted (and implicitly assuming the others take it for granted) that one can contribute worthily.
  • Being able to assume that one's identity is not under threat.

The paper mentions a lot of variants—especially ways in which participation breaks down. One example is being “cold shouldered”, where one is very openly made to feel an outsider, another is the feeling that one is being merely “humoured” rather than having one's views considered respectfully. However, these do not indicate necessary components of (non-)participation.

The four essential components of participation are generalizable. This is shown by the fact that it was indeed possible, on the basis of this essential structure, to develop detailed critical accounts of the conditions of patient participation (Ashworth, Longmate & Morrison, 1992). Similarly discussion of the technique of participant observation (Ashworth, 1995) was illuminated by the essential structure, and there is even an unpublished study for a voluntary organisation of the lack of member engagement in decision-making.

The debate sometimes seems to be between a Husserlian understanding on the one hand and a Heideggerian one on the other. Being part of the same tradition, the two philosophers sometimes emphasise different ideas but these differences do not have to be a problem for human science researchers of today. However, we see—from our viewpoint as members of editorial boards and by examining other research papers—people seemingly wanting to split phenomenology into two (or more) separate paths, often on the basis of misunderstandings of the philosophy. One such misunderstanding related to the topic of this Editorial is that the idea of essences is related to “essentialism”, which is wrong. If one thing is true of phenomenology, it is that it overcomes dichotomies such as materialism—idealism, or essentialism—constructivism. The main idea of the lifeworld negates all such attempts. The lifeworld is not material or ideal, if anything it is both at the same time. Better, the lifeworld is in-between these (Western) constructions of the world and can be said to intertwine the different aspects of the world. For example, with a phenomenological lifeworld approach we can see how patients' suffering can be related to biology but that at the same time we need to attend to the experiential side of the illness, if we want to support well-being.

The skilful and empathic use of such approaches as phenomenology to the situations with which this journal is concerned will generate research papers which allow readers, and through them students and patients, to grasp again the meaning of their and others lifeworlds. In a sense, we are already familiar with the important, even fateful, experiences in the realm of health and well-being, but they are for the most part overlain with theory and presuppositions and we have lost the lively contact with these aspects of human reality. Phenomenologically-based research brings us back to the human lifeworld, and the meaning of such-and-such an experience within it.

References

  • Ashworth P. D., Longmate A., Morrison P. Patient participation: Its meaning and significance in the context of caring. Journal of Advanced Nursing. 1992;17(12):1430–1439. [PubMed]
  • Ashworth P. D. The meaning of ‘participation’ in participant observation. Qualitative Health Research. 1995;5:366–387.
  • Ashworth P. D. The meaning of participation. Journal of Phenomenological Psychology. 1997;28:82–103.
  • Dahlberg K. The essence of essences -the search for meaning structures in phenomenological analysis of lifeworld phenomena. International Journal of Qualitative Studies on Health and Well-being. 2006;1(1):11–19.
  • Dahlberg K., Dahlberg H., Nyström M. Reflective Lifeworld Research. 2nd ed. Lund, Sweden: Studentlitteratur; 2008.
  • Hallberg L. Editorial. International Journal of Qualitative Studies on Health and Well-being. 2006;1(1):2–3.
  • Merleau-Ponty M. Phenomenology of perception (C. Smith, Trans.) London: Routledge; 1995/1945.

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