Larry had stuttered almost his entire life, despite numerous flirtations with treatment during his childhood and early teen years. When we met Larry, he was almost 76 years old and still very disfluent-based on the SSI-3 test that we administered, Larry's stuttering rated as "severe." The speech sample that we carefully analyzed told us that Larry was disfluent on almost 18% of the words he used in conversational speech. We also measured the duration of his disfluencies, recorded the types of disfluencies, and noted the grammatical and phonetic contexts in which they most frequently occurred. In short, we performed quite a thorough examination of Larry's speech-and what it told us was that Larry had a severe stuttering problem.
But Larry hadn't come to us for treatment. He'd actually come to talk to our fluency class about what it was like to be a person who stuttered. And, even more surprisingly, he was doing it simply because he loved to talk to people! All of a sudden, we were presented with a perplexing conundrum. All of our "numbers" told us that Larry had a "severe" stuttering problem, yet here he was voluntarily doing something that typically terrifies persons who stutter.
As Larry began telling us about his life, it became clear that he had always liked to talk, and that he'd never let his stuttering stop him from doing anything. One of the stories he told us was about when he tried to join the air force as a pilot during WWII. During his physical, the doctor noticed Larry's stuttering and was about to reject his application. Of course, Larry wasn't about to let that happen, so he said to the doctor, "Doc, am I going to talk to the enemy, or fight them?" Somehow, he talked the doctor into letting him through and he ended up flying bombers over Europe-until he was shot down and taken to a POW camp, where he used his stuttering to his advantage to get through the interrogation. On his return to the United States, Larry continued to fly and eventually ended up becoming a prominent figure in local politics.
Like many of our clients in audiology and speech-language pathology, Larry didn't seem to fit the objective, "quantitative" data about him we'd so carefully gathered. Sometimes, like Larry, clients with seemingly "severe" problems cope very well, whereas, at other times, clients with seemingly "mild" problems appear barely able to function.
Although quantitative approaches to gathering information about clients always will be important, such approaches are limited in certain ways and typically do not reach beyond the surface features of a client's problem. To get deeper information, qualitative approaches to gathering information are needed both in the clinical and research domains of our professions.
A Definition of Qualitative Research
Jack Damico and Nina Simmons-Mackie, two of the prominent qualitative researchers in the field of communication disorders, have provided this working definition: "qualitative research refers to a variety of analytic procedures designed to systematically collect and describe authentic, contextualized social phenomena with the goal of interpretive adequacy" (see Damico & Simmons-Mackie, p.132).
Qualitative research, then, is not one single method, but a number of different research traditions, all of which are "analytic" in nature and "systematic" in their execution. Additionally, qualitative research always "describes" actual phenomena in their natural settings, reflecting the position that social phenomena are often too complex to adequately fit into pre-determined categories or be accurately measured outside their natural contexts.
Finally, qualitative research focuses on adequate interpretation of "social phenomena." Given that human communication may be regarded as a "social phenomenon," this suggests that the goal of qualitative research, as applied to communication disorders, is to describe and explain human communication in terms of its meaning in the lives of people living in their specific social contexts.
Four Different Qualitative Research Traditions
There are many different qualitative research designs-too many even to briefly describe all of them in this forum. Consequently, we have selected four qualitative research traditions that we believe relate to the field of communication disorders.
In a biographical study, individuals and their experiences are described in detail. Subjects of biographies are usually chosen because they have achieved extraordinarily high standards within a certain field, possess unique characteristic(s), or have experienced unique events. The "story" might be verbally told to the researcher or it might be constructed through researching documents and archival material.
In communication disorders, a biographical study may be effective both as a research method and as a clinical tool. In this sense, the client and clinician would, in essence, co-author the biography through clinician-facilitated questioning and joint exploration into meaningful aspects of the story. The mutual investigation of the client's past can be used to more fully understand how a speech, language, or hearing disorder has affected the client's life. By examining an individual's life history, the clinician and client can discover times when the client overcame or successfully lived with the disability. This may help to gain a better perspective on the functional limitations or handicapping conditions of a specific communication deficit.
As a result, goals for treatment can be developed and progress can be richly documented as clients continue to tell their story. Such stories also represent exceptionally rich data that may be further analyzed and/or put together as a collection of life stories that relate the common experiences of individuals dealing with similar communication problems. Ken St. Louis (2001) has published just such a book, called "Stories of Stuttering," about the experiences of people who stutter.
Whereas the biographical study documents one individual's life and experiences, a phenomenological study describes the meaning of the lived experiences for several individuals about a particular phenomenon. In a phenomenological study, researchers attempt to find common themes that permeate all or most of the descriptions of the phenomenon, enabling them to construct a picture of its essential structure.
In the field of communication disorders, this might include exploring the experience of participating in treatment, the characteristics of a "good" clinician from the perspective of clients, or the experience of living with a speech, language, or hearing disorder. A few of these types of studies are beginning to emerge in our professional journals, but there are many of these types of questions that have yet to be studied in the context of communication disorders.
An ethnographic study is a description and interpretation of a cultural or social group or system. In this type of study, the researcher observes a specific group's learned patterns of behavior, language, customs, and ways of life. As a result, an ethnography typically involves prolonged observation of a group, often with the researcher becoming a participant in the group he or she is studying. As the researcher becomes immersed in the day-to-day lives of the group, he or she observes behavior, documents specific language, records stories, and uncovers cultural themes within the society. Usually, the resulting ethnographies are written in a story-like, narrative manner.
Within the field of communication disorders, there are numerous potential groups with whom ethnographic studies might prove useful, such as persons with hearing loss, persons who stutter, families of children with autism, and ethnic minority groups whose outlook on communication disorders might be very different from that of the dominant Euro-American culture in which we live.
The case study may be the most familiar design for researchers in communication disorders. Although case studies have frequently been conducted throughout the history of our discipline, most of the researchers involved in these studies have failed to take advantage of the potentially rich data source they had at their disposal (i.e., the client). Most case studies in communication disorders have focused their attention specifically on the assessment and remediation of an individual's speech, language, or hearing problem and ignored the overall context of the "case" in which a real person is trying to maintain a social and emotional connection to the world.
Sources of data for a case study may include observations, interviews, audiovisual material, documents, and reports. Furthermore, these data sources should be considered within the social and cultural contexts in which the person lives. For example, a case study of a patient receiving a particular treatment for aphasia should assess outcomes not only by the individual's score on a standardized aphasia battery but also on assessment of the individual's social and emotional functioning.
The "Wh" Questions
In qualitative research, the "wh" questions are useful in that they help lead us into the rationale and planning of a qualitative study. Answering the questions "why would I want to do a qualitative study?" and "when do I select a qualitative approach?" provide us with clear implications for who our participants should be and where our study should take place.
"Why" and "When"
One of the primary strengths of qualitative research is that the information gathered reflects what the participant experiencing the phenomenon in question believes to be important, rather than reflecting what the researcher believed was important to measure or to include on a questionnaire or scale. This is, perhaps, one of the fundamental differences between quantitative and qualitative research. If a researcher believes that such "local," individual knowledge is valuable, then engaging in qualitative research would be a logical choice.
Personal characteristics also may play a role in a researcher's choice to engage in qualitative research. Researchers who like to be more involved with their participants, like to engage in "inductive" reasoning (i.e., going from specific to general), like to write in a more "narrative" form, and don't require strict guidelines or specific procedures, might find qualitative research rewarding.
As with any type of research, the design of a study should be driven by the questions being asked. Even if an individual is "willing" to engage in qualitative research, a strong rationale for choosing a qualitative design still needs to exist. Typically, research questions that ask "how" or "what" may be well suited to qualitative inquiry. In communication disorders, examples of such questions might include: "How do persons with mild aphasia adapt their social functioning?"; "What are the coping strategies used by parents of autistic children?"; and "What are the dominant experiences of a person who stutters?"
Additionally, some topics require more in-depth exploration than current research provides. Such topics would be ideally suited for qualitative investigation because qualitative research can provide a more detailed view of the topic, which often generates new questions that might be investigated using quantitative designs. Many areas in communication disorders could fall into this category as many of our studies fail to ask participants/clients to tell us their "story."
"Who" and "Where"
The "who" and "where" questions of research are answered quickly once a qualitative design is chosen. If a qualitative research design is to be undertaken, the participants for the study must have at least one quality: They all must have experienced or be experiencing the phenomenon in question. Unlike quantitative research in which a highly homogeneous sample is sought, qualitative researchers often try to obtain the most diverse sample possible. By extracting common, underlying themes from a diverse sample, the qualitative researcher can have greater confidence that the observed themes are related to the phenomenon and not to some other variable common to the participants.
By definition, a qualitative study must take place in the most naturalistic environment possible. This sometimes poses problems for researchers because they have virtually no control over the environment in which the study is being conducted. Detailed record keeping regarding the setting of the study and how it changes is a hallmark of qualitative research, as all data are interpreted within the context of the environment in which they were collected.
The Next Step
Our encounter with Larry impressed upon us the need to look beyond the surface features of a client's disorder and try to understand the deeper impact of the problem on a more global scale. For us to do this as a profession, our research and clinical practices need to include methods for systematically gathering and analyzing information that relates to the experiences our clients deal with on a daily basis. We believe that means including qualitative approaches in both research and clinical endeavors. Sure, there are checklists and scales out there that do a good job of surveying similar material, but shouldn't our clients be the ones who decide what is important about their experiences? After all, whose life is it, anyway?