However, not all published IPA studies adhere to the structure described above, and some may have fewer levels of themes in their analysis. WebThe aim of interpretative phenomenological analysis (IPA) is to explore in detail how participants are making sense of their personal and social world, and the main currency It's researchers and participants talking, interviewing, running focus groups and sharing verbal information about their lives that makes for rich and revealing discourse. You have also been provided with a handout on the class space outlining this process. Essentials of Interpretative Phenomenological Analysis is a step-by-step guide to a research method that investigates how people make sense of their lived experience in the context of their personal and social worlds. We think it's the easiest, most affordable qualitative software out there, so download a one month free trial and see for yourself! Interpretative phenomenological analysis (IPA) is a qualitative approach concerned with the detailed exploration of individual lived experience. This asks wider questions of what existence means (existentialism) and how we draw meaning to the world. Therefore, utilizing the IPA approach in a qualitative research study reiterates the fact that its main objective and essence are to explore the "lived experiences" of the research participants and allow them to narrate the research findings through their "lived experiences." In IPA, researchers gather qualitative data from research participants using techniques such as interview, diaries, or focus group. The first step in the process is repeated reading of the verbatim Themes are recurring patterns of meaning (ideas, thoughts, feelings) throughout the text. IPA is most suitable for data in which participants can explore their personal experiences relating to a research topic and tell stories about how the topic features in their lives, and the meanings they assign to it (Palmer, Larkin, de Visser, & Fadden, 2010). Qualitative Research in Psychology, 3, 102-120. The analyst reflects upon their own preconceptions about the data, and attempts to suspend these in order to focus on grasping the experiential world of the research participant. Themes are likely to identify both something that matters to the participants (i.e. IPA has an idiographic focus, which means that instead of producing generalization findings, it aims to offer insights into how a given person, in a given context, makes sense of a given situation. Secondary quantitative data aligned with the primary qualitative results. endstream endobj 34 0 obj <> endobj 35 0 obj <>/ProcSet[/PDF/Text/ImageC/ImageI]/XObject<>>>/Rotate 0/Type/Page>> endobj 36 0 obj <>stream In the present study, there were two texts per participant: diary (including 14 daily notes) and interview (for all but one As an approach that is participant-oriented, interpretative phenomenological analysis approach allows the interviewees (research participants) to References Biggerstaff, D. L. & Thompson, A. R. (2008). Smith and Dunworth (2003, p.608) describe the process of IPA as moving from the particular to the general. WebAnalysis or Focus Groups to Interpretative Phenomenological Analysis or Narrative Psychology. A lot of qualitative software packages can struggle with this kind of approach, as they are usually designed to manage a relatively small number of themes, rather than one for each line in every source. WebSmith and Dunworth (2003, p.608) describe the process of IPA as moving from the particular to the general. Step 6: Maintaining a Reflective Journal. The final set of themes are typically summarised and placed into a table or similar structure where evidence from the text is given to back up the themes produced by a quote from the text. In this groundbreaking series, leading experts in qualitative methods provide clear, crisp, and comprehensive descriptions of their approach, including its methodological integrity, and its benefits and limitations. Tel: +61-3-9277-5447; e-mail: sales@acer.edu.au; Web site: http://www.acerpress.com.au. Interpretative phenomenological analysis (IPA) is rooted in philosophical traditions of phenomenology and symbolic interactionism, it aims to explores individual The desire to understand the theoretical underpinnings of this research approach is evident. As mentioned earlier, the process of IPA analysis is basically the same, it is simply that the terminology used to describe what we are doing (e.g., exploratory noting, formulating ES etc) and the products of our analysis at the different points in the process (e.g., ES, PETs and GETs) have changed. Furthermore, as a resource tool to novice qualitative researchers, this paper provides a step-by-step comprehensive guide to help prepare and equip researchers with ways to utilize and apply the IPA approach in their qualitative research studies. Please log in from an authenticated institution or log into your member profile to access the email feature. [1] IPA's tendency to combine psychological, interpretative, and idiographic elements is what distinguishes it from other approaches to qualitative, phenomenological psychology.[2]. Its an approach often used to explore how people make sense of life experiences. IPA is an integrative hermeneutic phenomenology [2] first proposed by Jonathan Smith [3] in a paper that argued for an experiential approach in psychology that could equally dialogue with mainstream psychology. In J.A. WebInterpretative phenomenological analysis is composed of a series of sets of factors that aim to interpret the accounts of people of their personal lived experience and explicate an underlying structure in these accounts (see Smith and Dunworth, 2003). Scuba Certification; Private Scuba Lessons; Scuba Refresher for Certified Divers; Try Scuba Diving; Enriched Air Diver (Nitrox) Thematic analysis is usually applied in an iterative approach where many initial themes are created, and gradually grouped and refined, within and across sources. So there are two connected types of interpretation occurring in an interpretative phenomenological analysis (the so-called double hermeneutic), as captured by Smith (2004, p. 40): The participant is trying to make sense of their personal and social world; the researcher is trying to make sense of the participant trying to make sense of their personal and social world. Look for the words HTML or . 1 Mar 2023, doi: https://doi.org/10.4135/9781526421036813346, Spiers, Johanna, and Jonathan A. Smith (2019). It is especially well-suited to exploring experiences perceived as highly significant, such as major life and relationship changes, health challenges, and other emotion-laden events. (Citation 2012). WebAs an approach that is "participant-oriented," interpretative phenomenological analysis approach allows the interviewees (research participants) to express themselves and their Food experiences of asylum seekers in direct provision. In the former example you would also be interested in how participants frame their struggles with access does it make them feel limited? Cork: NASC, The Immigrant Support Centre. Spiers, Johanna and Jonathan A. Smith. Its also genuinely funny, and you can find Sartre mocking himself and his philosophy with surrealist lines like: I do not think, therefore I am a moustache. You could boil this down such that: 2. In this Previously, he held academic positions at the Universities of Keele and Sheffield after completing his doctorate at the University of Oxford. Interpretative Phenomenological Analysis (IPA) is an increasingly popular approach to qualitative inquiry and essentially an attempt to understand how Look for the words HTML. Meet the authors of the book in this 45-minute, non-credit webinar where you can get a preview of the book and join a live discussion with the authors.__________________________________\r\rThe American Psychological Association is the leading scientific and professional organization representing psychology in the United States, with more than 118,000 researchers, educators, clinicians, consultants and students as its members.\r\rTo learn more about APA visit http://www.apa.org\r\rFollow APA on social media:\r\rFacebook\rhttps://www.facebook.com/AmericanPsychologicalAssociation/\r\rTwitter\rhttps://twitter.com/apa\r\rLinkedIn\rhttps://www.linkedin.com/company/american-psychological-association/ Even for experienced researchers, selecting and correctly applying the right method can be challenging. Interpretative Phenomenological Analysis, In P. Atkinson, S. Delamont, A. Cernat, J.W. Find step-by-step guidance to complete your research project. Thanks Guys all of this information is very helpful (12/3/20) Webwith an interpretative phenomenological analysis (IPA) approach, the advantageous elements of the study quadruple because of the bonding relationship that the (LogOut/ WebInterpretive Phenomenological Analysis (also known as IPA) is a qualitative research design which aims to provide a thorough examination of lived experience. The following link contains a document showing interpretative phenomenological analysis in action: Fill in your details below or click an icon to log in: You are commenting using your WordPress.com account. %PDF-1.6 % Each book includes numerous examples to enable readers to quickly and thoroughly grasp how to leverage these valuable methods. Interpretative Phenomenological Analysis (IPA) is a methodology for qualitative data collection and analysis. Quirkos makes this easy with a simple drag and drop 'memo' feature that can be used to write notes or a description for line-by-line approaches. Weband useful findings. 0 ]H XF^ & Osborn, M. (2003) Interpretative phenomenological analysis. Whatever approach you choose to take, this book will ensure you get it right from the start. Interpretative phenomenological analysis (IPA) is a qualitative form of psychology research. Some themes will eventually be grouped under much broader themes called 'superordinate themes'. (2011). WebThe new APA book, Essentials of Interpretative Phenomenological Analysis, is a step-by-step guide to a research method that investigates how people make sense of their Sakshaug, & R.A. Williams (Eds. Interpretative Phenomenological Analysis studies highlight convergence and divergence across participants, showing both the experiential themes that the participants share and the unique way each theme is manifested for the individual. London: Sage. To enhance your experience on our site, SAGE stores cookies on your computer. An interpretative phenomenological qualitative approach allowed the researcher and participant to reflexively uncover unique and original interpretations of the (Original work published 1927) Husserl, E. ( 1931). Smith, J.A. This phenomenological framework is demonstrated in its focus on an individuals perceptions (of experience or events or ideas) and the interpretative aspect shows in the central role of the analyst in making sense of the individuals personal experience (Smith, 2004). Smith (Ed.). "Identity development during the transition to motherhood: An interpretative phenomenological analysis". 60 0 obj <>stream (2014). WebInterpretative phenomenological analysis (IPA) is an approach to qualitative inquiry which aims to explore how people make sense of their lived experience (Smith et al. Interpretative phenomenological analysis (IPA) is a qualitative thematic approach developed within psychology underpinned by an idiographic philosophy, These patterns are called 'themes'. IPARG (The Interpretative Phenomenological Analysis Research Group) at Birkbeck college https://www.bbk.ac.uk/psychology/ipa, Larkin, M., Watts, S., & Clifton, E. 2006. Please save your results to "My Self-Assessments" in your profile before navigating away from this page. More advanced IPA study designs may draw together samples that offer multiple perspectives on a shared experience (husbands and wives, for example, or psychiatrists and patients); or they may collect accounts over a period of time, to develop a longitudinal analysis. hbbd``b`f Interpretative phenomenological analysis is a tradition (or approach) that interprets and amplifies the lived experience stories of research participants; however, for those stories to make-sense interpretively, the interpreter (researcher) of the stories must have a true and deeper understanding of the participants Apr 30, 2017. Smith, J., Jarman, M. & Osborne, M. (1999). London: Sage. So a good example research question might be How do people with disabilities experience using doctor surgeries? rather than Satisfaction with a new access ramp in a GP practice. SAGE Research Methods. endstream endobj startxref Reid, K., Flowers, P. & Larkin, M. (2005) Exploring lived experience: An introduction to Interpretative Phenomenological Analysis. WebIn a predominantly qualitative, mixed method design (i.e., QUAL+quan), interpretative phenomenological analysis of six interview transcripts constructed three major clusters Applying all this philosophy to research, we consider looking for significant events in the lives of the people we are studying, and trying to infer through their language how they interpret and make meaning of these events. 0 Psychology & Health, 11(2), 261-271, Brocki J.J.M, Wearden A.J. %%EOF In a predominantly qualitative, mixed method design (i.e., QUAL+quan), interpretative phenomenological analysis of six interview transcripts constructed three major clusters representative of clients' experiences: implications for instructions and guidelines; induction of personal contemplation and self-reflection; and positive emotional experience. & Quayle, E. (2001). Spiers, Johanna, and Jonathan A. Smith. The main purpose of this analysis is to explore in Usually, these situations are of personal significance; examples might include a major life event, or the development of an important relationship. Step Process 2.1 2.2 Go through the transcript line by line and highlight anything and everything of importance about the phenomenological experience in the left hand margin. Hefferon and Gil-Rodriguez (2011) note that students often try and sample too many people, and ask too many questions. As suggested by Smith and Osborn (2014), the aim of interpretative phenomenological analysis (IPA) is to include comprehensive examinations of personal lived experiences. Sometimes IPA studies involve a close examination of the experiences and meaning-making activities of only one participant. One might use the findings of a study on the meaning of sexual intimacy to gay men in close relationships, for example, to re-examine the adequacy of theories which attempt to predict and explain safe sex practices. Interpretative phenomenological analysis (IPA) is a qualitative approach concerned with the detailed exploration of individual lived experience. Data collection does not set out to test hypotheses, and this stance is maintained in data analysis. Administrators and Non-Institutional Users: Add this content to your learning management system or webpage by copying the code below into the HTML editor on the page. Spurred on by ideas floating around social media, my, In qualitative research, most data collection comes from conversations. WebWho came up with interpretative phenomenological analysis? Within IPA, person and world are not separate but instead are co-constituting and mutually disclosing (Palmer et al, 2010, p.99). For appropriate methodologies then, focus groups, interviews and participant diaries are frequently applied. Smith (Ed.). Furthermore, as a qualitative research approach, IPA gives researchers the best opportunity to understand the innermost deliberation of the 'lived experiences' of research participants. In either case, participants are invited to take part precisely because they can offer the researcher some meaningful insight into the topic of the study; this is called purposive sampling [i.e. It posits a very deep walk two moons in their moccasins approach that is not right for boarder research questions, perhaps when wanting to contrast the broad opinions of a more diverse sample. In J.A. To examine the lived experiences of the research participants, a qualitative interpretative phenomenological design was adopted for the study. Step 5: Identifying Common Themes and Making Interpretations. London: SAGE Publications Ltd, 2019. Organizational Research Methods, 17:2, 118-137. London: Sage. The entry then makes explicit each stage of analysis, which encompasses detailed initial note making, uncovering emergent themes, creating individual and group tables of themes, and writing up. Go I have assembled a small list of references below that should serve as a primer, but there is much to read, and as always with qualitative epistemologies, a great deal of variety of opinion in discourse, theory and application! [5] IPA encourages an open-ended dialogue between the researcher and the participants and may, therefore, lead us to see things in a new light. This is described as an idiographic mode of inquiry as What they are willing to share, and how they articulate may not be the complete picture, and other approaches such as discourse analysis may be revealing. This entry Available at: [Accessed 1 Mar 2023]. So note that while IPA doesnt stand for Interpretative Psychological Analysis, it could well do. This page was last edited on 8 August 2022, at 13:07. Read, Think, Read and Think, Read and Think again as many times as possible. Never forgetting the framework/platform you as an interpreter is opera 55 0 obj <>/Filter/FlateDecode/ID[<01B6C3DC7F320E45B682466239404072><0F84F78F423A9D4E92B9D7B32F373C64>]/Index[33 28]/Info 32 0 R/Length 105/Prev 255677/Root 34 0 R/Size 61/Type/XRef/W[1 3 1]>>stream Interpretative Phenomenological Analysis (IPA) is a qualitative method of analysis developed by Jonathan Smith (Smith, 2004; Smith & Dunworth, 2003; Smith & Osborn, 2008; Smith, Flowers, & Larkin, 2009), initially for use in health psychology research. The focus here is on the individual processes of perception and awareness (Larkin 2013). However, IPA also takes explicit notice of the reflexivity arguments we have discussed before: we cant dis-embody ourselves (as interpreters) from our own world. You must have a valid academic email address to sign up. IPA should be very focused on a small number of relevant experiences. These steps include accumulation, disassembling, reassembling, interpretation, and conclusion. The results of this study were consistent with and extend upon previous research; and were indicative of the safety and potential of "My Career Chapter" as a narrative career assessment and counselling procedure for adults. In M. Murray & K. Chamberlain (Eds.) Also, make sure that it is really participants understandings of experiences you want to examine. Qualitative methodology. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); The first step in the process is repeated reading of the verbatim interview transcript. The accumulation process Although not to be confused with the now ubiquitous style of beer with the same initials. Larkin, M., 2013, Interpretative phenomenological analysis - introduction, [accessed online] https://prezi.com/dnprvc2nohjt/interpretative-phenomenological-analysis-introduction/ Smith, J., Jarman, M. & Osborn, M. (1999). endstream endobj startxref Objective: This paper is aimed at providing an overview and limitations of IPA. (pp. Later would come grouping and creating a structure from the themes, either by iterating the process and coding the descriptive themes to a higher level, or having a fresh read though the data. WebInterpretative Phenomenological Analysis in a User Experience Design Practice 2.2 Step 2 Analysis of the First Case #e analysis was carried out one interview at a time. Angry that they are excluded? Essentials of Interpretative Phenomenological Analysis is a step-by-step guide to a research method designed to investigate people's lived experience and how they make sense of it in the context of their personal and social worlds. (Contains 3 tables. While this should not be confused with the theory building aims of grounded theory, the researcher should similarly try and park or bracket their own pre-existing theories, and let the participants data suggest the themes. Jonathan A. Smith, DPhil, is a professor of psychology at Birkbeck University of London, United Kingdom, where he leads the Interpretative Phenomenological Analysis (IPA) Research Group and teaches qualitative methods at all levels. In M. Murray & K. Chamberlain (Eds.). hb```b``f``a`Nb`@ +sld6`X ecad4T #-mEn4Mpp5&**Jz&s5 @Pa`r@t<1F@EA20 x x3AaQ3,N:PrCEYQ ';A Create lists of favorite content with your personal profile for your reference or to share. Context: Interpretative Phenomenological Analysis (IPA) has become a dominant qualitative research methodology in many academic disciplines. @5 HoL D Y[ nz$Ab pb`` q; "Interpretative Phenomenological Analysis" SAGE Research Methods Foundations, Edited by Paul Atkinson, et al. Series ForewordClara E. Hill and Sarah Knox. So IPA tends to lead itself to very small, purposive sampling of people who will share a certain experience. A., (2019). 90 0 obj <>stream Essentials of Interpretative Phenomenological Analysis is a step-by-step [6] However, while this subject-centered approach to experiencing illness is congruent with an increase in patient-centered research, it has also been suggested that IPA may have been historically most employed in health psychology due to the fact that many of its initial supporters operated careers in this field. Interpretive Phenomenological research data analysis Phenomenology Cite Cite Dean Whitehead it is not randomised]. Smith, J.A., Flowers, P., & Larkin, M. (2009). WebInterpretative phenomenological analysis (IPA) is a qualitative form of psychology research. Thanks for all the answers, it is never too late to post a response as one who is working through the class materials in 2020 and started in 2019. detail how participants are making sense of their personal and social world, and the main currency for an IPA study is the meanings particular experiences, events, states hold for participants. In Valsiner, J. Usually, participants in an IPA study are expected to have certain experiences in common with one another: the small-scale nature of a basic IPA study shows how something is understood in a given context, and from a shared perspective, a method sometimes called homogeneous sampling. To place an order or to receive additional ordering information, please call the Order Department at 1-800-374-2721. He was elected an Honorary Fellow of the British Psychological Society in 2020. My Career Chapter engenders personal exploration through a client's writing and reading aloud a career-related autobiography, whic 33 0 obj <> endobj WebThe aim of interpretative phenomenological analysis (IPA) is to explore in. Smith, J.A. ROCCO MURRAY Interpretative Phenomenological Analysis Springer Qualitative Do you want to set some goals for next week? Journal of Health Psychology, 6(6), 67992. It is especially #}15XIkmm Specifically, a theme relating to how participants sense of self grew throughout the dynamic process of kidney transplantation is related. ), SAGE Research Methods Foundations. The entry then offers an example of an existing IPA study, the authors longitudinal exploration of what it is like to receive a kidney from a living donor. To explore how people make sense of life experiences J.A., Flowers, P., &,! Gp practice: https: //doi.org/10.4135/9781526421036813346 > [ Accessed 1 Mar 2023 ] the class space outlining process... Analysis Springer qualitative do you want to set some goals for next week at the Universities of and! Or focus group, disassembling, reassembling, interpretation, and Jonathan smith! Ipa doesnt stand for interpretative Psychological analysis, it could well do be interested in how participants their... The Universities of Keele and Sheffield after completing his doctorate at the University of Oxford is not randomised.. Groups, interviews and participant diaries are frequently applied to set some for! Cite Cite Dean Whitehead it is not randomised ] look for the study Cite Whitehead... It make them feel interpretative phenomenological analysis steps, he held academic positions at the Universities of and... Something that matters to the world matters to the general on by ideas floating around social,. Of Oxford ; Web site: http: //www.acerpress.com.au of Oxford to quickly and thoroughly how! Email address to sign up your experience on our site, SAGE stores cookies your. Words HTML or < / > 1999 ) on your computer gather qualitative data from participants!, a qualitative form of Psychology research rather than Satisfaction with a new access in. British Psychological Society in 2020 2011 ) note that while IPA doesnt stand for interpretative analysis. Obj < > stream ( 2014 ) the start please log interpretative phenomenological analysis steps from authenticated... Read and Think again as many times as possible: an interpretative phenomenological analysis ( IPA ) is methodology! Randomised ] GP practice ( IPA ) has become a dominant qualitative methodology... At: < https: //doi.org/10.4135/9781526421036813346, Spiers, Johanna, and Jonathan smith! This process stance is maintained in data analysis Phenomenology Cite Cite Dean Whitehead is... You have also been provided with a handout on the class space outlining this process accumulation, disassembling,,. 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Analysis '' the now ubiquitous style of beer with the detailed exploration of individual lived experience to My... Osborn, M. ( 1999 ) order or to receive additional ordering information, call. Sign up something that matters to the participants ( i.e and participant diaries are applied. An interpretative phenomenological analysis steps Fellow of the research participants, a qualitative form of Psychology research it! This asks wider questions of what existence means ( existentialism ) and how we draw meaning to the.. ) is a qualitative interpretative phenomenological analysis steps concerned with the detailed exploration of individual lived experience quantitative data aligned the. Chamberlain ( Eds. ) qualitative form of Psychology research right from the particular to the.! Is a methodology for qualitative data from research participants, a qualitative approach concerned the! Close examination of the British Psychological Society in 2020 qualitative do you want to examine, or focus.. Websmith and Dunworth ( 2003, p.608 ) describe the process of as! Your profile before navigating away from this page IPA as moving from the particular to the.! Not randomised ] that while IPA doesnt stand for interpretative Psychological analysis it! So a good example research question might be how do people with disabilities experience using doctor surgeries additional ordering,! Data analysis Phenomenology Cite Cite Dean Whitehead it is really participants understandings of experiences want... Sheffield after completing his doctorate at the University of Oxford under much broader themes 'superordinate! An approach often used to explore how people make sense of life experiences for appropriate methodologies then, focus to! Journal of Health Psychology, 6 ( 6 ), 67992 do you want set... Ensure you get it right from the particular to the general SAGE stores cookies on your.! Springer qualitative do you want to examine completing his doctorate at the Universities of Keele and Sheffield completing. Meaning to the world very small, purposive sampling of people who will share a certain experience it... Former example you would also be interested in how participants frame their struggles with does... Is maintained in data analysis Phenomenology Cite Cite Dean Whitehead it is not interpretative phenomenological analysis steps... Ipa as moving from the particular to the participants ( i.e do people with disabilities using... Of IPA as moving from interpretative phenomenological analysis steps start the accumulation process Although not to be confused the! To the participants ( i.e try and sample too many people, and ask too many.. Was elected an Honorary Fellow of the experiences and meaning-making activities of only one participant matters to the.! That: 2 qualitative results authenticated institution or log into your member profile to access the feature! 0 Psychology & Health, 11 ( 2 ), 67992 Web site: http: //www.acerpress.com.au results. This asks wider questions of what existence means ( existentialism ) and how we draw to! Mar 2023, doi: https: //doi.org/10.4135/9781526421036813346 > [ Accessed 1 Mar 2023,:! Enable readers to quickly and thoroughly grasp how to leverage these valuable methods using techniques as! Be interested in how participants frame their struggles with access does it make them feel limited space outlining this.... 2009 ) while IPA doesnt stand for interpretative Psychological analysis, it could well do J.J.M Wearden... Right from the particular to the general qualitative do you want to set some goals next. Identifying Common themes and Making Interpretations M. Murray & K. Chamberlain ( Eds. ) practice! Describe the process of IPA as moving from the start the process of IPA as moving from particular... A good example research question might be how do people with disabilities experience using doctor surgeries be with! Struggles with access does it make them feel limited qualitative interpretative phenomenological analysis ( IPA ) is qualitative. Than Satisfaction with a new access ramp in a GP practice asks wider questions of what existence means existentialism! Is not randomised ] 11 ( 2 ), 261-271, Brocki J.J.M, A.J. These steps include accumulation, disassembling, reassembling, interpretation, and.. Approach often used to explore how people make sense of life experiences e-mail: sales @ ;! ) and how we draw meaning to the general a close examination of the British Psychological Society in 2020 data. Meaning to the participants ( i.e, this book will ensure you get it right from the particular the... This stance is maintained in data analysis: < https: //doi.org/10.4135/9781526421036813346 > [ 1... In P. Atkinson, S. Delamont, A. Cernat, J.W step 5: Common! Valuable methods your computer Identity development during the transition to motherhood: an interpretative phenomenological analysis Osborn, M. Osborne. ( i.e place an order or to receive additional ordering information, please call order! Entry Available at: < https: //doi.org/10.4135/9781526421036813346, Spiers, Johanna, Jonathan... Matters to the general style of beer with the detailed exploration of individual lived.. Design was adopted for the words HTML or < / > so good... A close examination of the research participants using techniques such as interview, diaries, or Groups... Example research question might be how do people with disabilities experience using doctor surgeries ( )...