University PUBH6210 Assignment 2: Qualitative Research Critique Report

This report provides a comprehensive critique of a proposed qualitative study. It begins with an analysis of the study outline, identifying the Penchansky and Thomas framework and evaluating its suitability, while also suggesting the Health Belief Model as an alternative framework. The report then delves into ethical considerations, specifically informed consent and beneficence, providing justifications for their importance in the context of the study. Furthermore, the report critiques the proposed interview guide, highlighting its shortcomings and suggesting improvements such as incorporating open-ended questions and ensuring clarity. Finally, the report addresses reflexivity in the proposed study, emphasizing the need to mitigate bias and maintain strong relationships with participants. Overall, the report offers a thorough examination of the research design, ethical considerations, and methodological aspects of the qualitative study, providing valuable insights and recommendations.

Qualitative Research Critique
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1. Proposed study outline
Penchansky and Thomas framework
Access is interpreted as the degree of fitness between the user and the service, with
key interplay on better fit signifying better access. The theoretical framework by Penchansky
and Thomas has optimized access on accounts of different dimensions in terms of
accessibility, availability, acceptability, affordability, and adequacy towards the design of
service, its implementation, and evaluation process. These dimensions play a critical role as
an independent aspect and yet interconnected with each other which are key to achieving
success. Access as a usable source of care is fundamental in improvising the overall health
outcomes of an individual.
The framework entails five domains of As which entail Access, availability,
accessibility, accommodation, affordability, and acceptability. Access has wide usage in a
variety of settings access principles is underpinned on four principles; access is key to both
the age consumers and producers who are available in the interaction between consumer and
production chain. Individual factors of consumers often contribute to access and choice of
producers. Access is understood in terms of various dimensions which are described by ways
in which consumers and producers obtained services. The outline dimension offers a binary
relationship acting together in a continuum. Access dimensions are often interrelated in the
continuum of care, access in this sense are measured in terms of ‘more access’ or less
‘access’. Access dimensions are interrelated and influence each other. Further, the existence
of the dimension allows consumers and producers to make tradeoffs in between.
Further dimensions of access depend on various parameters such as time, space, price,
quantity, acceptability, awareness and information. While the dimension is described and
articulated well, they aid to conceptualize clarity, they are not separate from each other. The
dimension is an overlap on each other and offers tradeoffs among the consumers.
An access dimension has been viewed in terms of care through the other dimension of
the framework component. Availability offers reviews of the role of geographical locality,
being determinants as usual access of care, coupled with a further increase of primary care
services who meet the demand of the aged care services. Acceptability focuses on the
synthesis of the provider-patient communication process and the patient-physician

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relationship (Goodson, 2010). Accommodation entails the aspects of focusing on the growing
practices in advance care schedule. In order to make care affordable, there is a need to
accommodate the lower cadre patients or consumers. Affordability dimension reflects on the
personal reason aged persons or the consumers may opt out of the care continuum while
lastly, accessibility refers to focus synthesis on the key importance of making the locations to
be accessible and deliver prime care acting as a source.
The Penchansky and Thomas model inspired this study in the sense that its core
principle offers a beneficial effect on establishing the fit between the aged and care services
which is aligned to increasing the overall care for the elderly persons in nursing care homes.
The increasing demand of the older persons needing the demand for care services is key in
linking the fit between the aged care situational analysis and provision of care services.
Secondly, the dimensions of this model summarise the aspects which often the elderly face
when accessing care services and play a fundamental role in the overall assessment of how
they access to care services in the nursing homes. The challenges being experienced by the
elderly with regard to awareness might be well be answered using the frameworks five
dimensions thus obtaining the key objectives of the overall study (Saurman, 2016).
Alternative model
Health belief model
Health belief model developed by Rosestock offers definition on the expectancy
theory which is applied to influence action for prevention. The key fundamental component
in this model entail perceived susceptibility, perceived severity, perceived benefit, perceived
barrier, cues to action, self-efficacy and modifiable factors which include social demographic
data. The individual health state categorized as subjective requires to take action based on the
relative condition of his/her health. The elderly tend to take action due to their limited ability
to handle the daily actives thus than to act appropriately. This is determined by how they
perceive the likelihood of being susceptible to their particular state of being unable to
perform daily activities and this is debated by the severity of the old age status of developing
a further complication such as immobility (Champion & Skinner, 2008).
Aged person individual evaluation on the identified disability leads to advocacy on
behaviour terms in terms of feasibility and efficacies which estimate the individual potential
benefits of decreasing or limiting the challenges being faced towards reduction of the severity

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and severity of old age, which is weighed against the individual ability to access, affordability
in terms of financial ability, psychology factors and barriers linked towards the proposed
action, cues to action depicts the trigger of behavioural challenges faced by the older person,
which lead to either internal or external stimuli to act. Internal stimuli factors include the
perception of health states, regarding themselves as being unable to perform daily duties and
internal variables linked to interpersonal interactions such as mass awareness on the
availability of aged care services and how to access them.
Whilst driver’s issues affecting the demographic personal, structural and other social
factors in any given time can vary and alter individual perception and motivations, they may
not affect directly access to aged care services. Thus health belief can be used to assess the
older person’s belief of their state and the urge to seek for health and assistance due to their
declining state. The model is able to assess key features which might be seen as interference
towards access and key perception in accessing the aged care services.
Ethical considerations
Informed consent
Refers to ‘the ability of the participant to knowingly, voluntarily and intelligently and
in a clear manner give hi./her consent’(Manson & O’Neill, 2007).
Beneficence
In essence, it refers to engaging actions which enable befit and not doing harm.
Generally, it indicates, ‘the principle of beneficence which entails the professional role of
effective application of relevant research so as to improve, serve and promote the welfare of
the concerned subjects’ (Martela, Ryan & Steger, 2018).
Informed consent
Informed consent in aged care information acquisition is essential for this study.
Enabling full understanding by the elderly subjects often can prove to be an uphill task since
their lowered levels of cognitive ability and declined levels of mental synthesis. The elderly
need to fully understand their rights during the study process. For full determination of the
elderly person in the study, informing them is crucial so as to ensure that there carefully
aware of the study's intention. Further, they need to be clarified on their right to withdraw at

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any point in time (Grady, 2015).
The overall consent of the participant must be obtained with full awareness of the
implications which might be cased or related to it. Obtaining informed consent is
fundamental. Informed consent can at times prove to be an ethical issue with regards to
declined autonomy. In any way, informed consent needs to be obtained, protection of their
individual dignity and privacy is key as they are prone to loss of such aspects (Spatz,
Krumholz & Moulton, 2016).
Beneficence- Do no harm
The development of hypothesis in qualitative research may not be predicted at the
initial stages. According to Ekstrand & Ekstrand, (2016), if the research findings tend to lack
the beneficence effects on the subjects, then it portends to raise immense ethical perspective
on the researcher’s part. Further, Evans (2016) asserts that beneficence relates to the overall
benefits of the research to the subjects. None maleficent relates to a high level of sensitivity
which entails harm. Harm can be related to the occurrence of discomfort, physiological harm,
social and economic distress (Raymond, 2017). While trying to found out the key details
among the elderly, they tend to open old wounds, none Maleficent in this essence entails
preventing of this intentional harm and minimizing any potential harm to the elderly. The
degree of potential risks needs to be assessed for the elderly person with end line being the
cost-benefit analysis which is achieved through identification of risks and benefits.
Thus, beneficence and no Maleficent is key as an effective interplay with regard to
this study. The overall goal of the study should be geared towards patient benefits in
accessing the aged care services and obtaining optimal health care access. Often after
initiating this ethical perspective, debriefing the participant is key so as to explain the overall
aim of the study as this way will enable the elderly to feel at ease knowing that they benefit
from the overall goals and objectives of the study, thus funding beneficence ethical matrix
(Cohen-Almagor, 2015).
2. Technical design vis-a-vis Proposed interview guide
Contrasting features
The interview guide questions lack clear guideline and do not follow the technical

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design layout
Key questions asked to tend to lose focus especially with regards to the elderly and
their ability for normal cognitive ability
The questions are long lacking clarity and focus compared to study design content
Key proposal changes
Informal, conversational interview
The key questioning the proposed interview guide section need not be predetermined
so as to enable open-ended questions which are adaptable as much as possible to the elderly
person's nature and priorities. The interviewer needs to move with the flow. The questions
need to major on key aspects of aged care to the patient touching on general theme
ascertained in the technical design. The thematic key focus of entails the key basic
concerning aged care, experience, barriers, service provider access and overall experience.
The inclusion of problem-solving questions which elicit the problem-solving aspect which
allows more creative thinking.
The key improvement this on this aspect entails, asking more focussed questions as
the questions asked to tend to focus on various large areas which could have a significant
impact in thematic assessment during later stages in analyzing the qualitative responses.
General interview approach
This approach in adoption on the key questions asked necessitates for assessment of
general areas of information which are collected from the subjects, which enhances focus
compared to the conversational approach. This question designed focus on questions asked
but tend to allow some degree of freedom on the participants and thus flexible adaptability of
information solicitation process.
As a rule of the thumb, relevant information needs to be sought which aligns to the
framework in place. This information will be crucial as the framework aligns the key
questions asked and makes adjustments and alignments thus having a more focussed response
which is essential for analysis prospects (Harvey, 2015).
Standard open-ended interview questions

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Sorting the issue of long questions which tend to lose focusing the interview will be
mitigated through asking open-ended questions among the entire interview. Open-ended
questions will be key on the eliciting more responses rather than being directional on the
expected responses.
Open-ended questions further need to focus on key objectives of the study so as to
identify salient items and themes which are covered. Often the collection of this information
is undertaken until a saturation effect is reached. Saturation effect is the case in which
saturation is reached with the key relevant formulation of ideas and concepts are highlighted.
Attainment of saliency is able to achieve and provide a better guide for sample
frequency. Salience offers an assessment of the frequency of intention occurrence or the order
of mention of the items. The correlation between salience and saturation is key in achieving a
better and effective interview questions items (Galvin, 2015).
3. Reflexivity in the proposed study
The research design of any kind has to grapple with issues of bias and potential
distortion occasioned due to unintended influences from the research protocol and
participants as well. This critical aspect is key in qualitative studies where the interviewers
take extra effort in establishing strong relationships with the participants. The key
consideration for this is to ensure that there is undue prejudice (Berg, 2015).
Reflexivity addresses distortions and is a critical aspect in directing greater underlying
issue on the accuracy of research outcomes; this can be the social aspect of the interviewer-
interviewee. Reflection allows for interviewer thoughtfully consideration on the asymmetrical
relationship and offers ways of enhancing interaction which is often exacerbated by the
arising presumptions from the obvious available sources such as demographic variables or
other subtle cues such s economic status of the participants.
Reflection offers avenues for the interviewer-interviewee to offer interaction which
may lead to presumptions aspects which are key in overall research outcome. The key areas
where reflection could be initiated in the study entails;
- Experiences accessing aged care services:
- Experiences obtaining service providers

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Justification
Qualitative interviews are crucial in terms of meaning being produced in the particular
social, cultural or relational context. Reflection occurs and recognizes an interview as one of
the key aspects of the interview process. Thus the interpretation of the data will require
reflection on the entire context. Reflexivity allows for more research process on the focus of
inquiry and being open to preconception and being aware of the situational dynamism of
being key areas (Patton, 2015).
The reflection will be beneficial in this context on assessing the participant experience
on assessment of aged care services. This opportunity will allow the patient to be able to offer
their experience with regard to understanding the overall access to care services (Maxwell,
2013).
Further during obtaining services and providers is key in offering experience of the
general experience in access to care services. This will offer a reflection on the interviewer-
interviewee process. Focus on these aspects is key in ensuring that their final analysis and
further there is enrichment on the overall design through the provision of proving firsts hand
account of interviewer basis and the often found preconceptions which have a negative
influence on the eventual findings (Finlay, 2012).
Reflexive in these two areas offer an ongoing mutual sharing of the research agenda
and the underlying interaction of the relationship of the ongoing process. Research has
illustrated the fundamental tenets of reflexivity as the conscious revelation of the underlying
values and beliefs. The key underpinning of transparency is key and potential basis cannot be
ignored. Application of ethical principles during this process is essential (Creswell, 2014).
The underlying tenets of being a reflexive researcher are essential in a developmental
approach rather than an attempt to reviewing the overall pragmatic approach of the research
process. In the emerging context in the research process allows for the opening of the
phenomena being investigated for this case aged care access among the elderly. Engaging in
this reflexive exercise is able to aid in assessing the influence of study designs positioning
itself as a key aspect in the evaluation of the overall research process.

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