Zoheb Rafique
Introduction: In my master of bioethics we were asked to develop a qualitative research proposal in second year as requirement for awarding the degree. My topic “Ethical Aspects of Doctor-Pharmaceutical Sales Representative Relationship” and my research question was “what is the Impact of promotional methods used by pharmaceutical companies on doctor’s prescribing behavior? In the research qualitative as well as quantitative methods are used, and in my research proposal qualitative approach was used. I was asked to prepare a literature review matrix formation of at least 20 articles from qualitative design or mix and I did it. We were also asked to apply one research design and method for my research. I did applied phenomenology and in-depth interview as my design and method. In other components I did mentioned that how I will collect the data and than analyze and interpret it. In this article I will justify the research design and method which I used in my research proposal.
Research Design: There are many different types of study designs and different research traditions are used in different studies such as narrative research, phenomenological research, grounded research, ethnographic research and case study research etc. I did used phenomenology as my research design.
Phenomenological Research: A phenomenological study design is one which describes meaning for several individuals of their lived experiences of a concept or a phenomenon. The Phenomenologists focus on describing what all participants have in common as they experience any phenomenon (e.g., grief is universally experienced). The basic and primary purpose of phenomenology is to reduce the individual experiences with a phenomenon to a description of the universal essence (i.e., a “grasp of the very nature of the thing,” van Manen, 1990, p. 177) (1). This human experience can be any phenomena such as insomnia, anger, being left out, grief, or undergoing (CABS) coronary artery bypass surgery (Moustakas, 1994) (2) . The researcher then collects data from those persons, who have experienced this phenomenon, and develops a comprehensive and composite description of the essence of the experience for all of those individuals. This description consists of “what” they experienced and “how” they experienced it (Moustakas, 1994). Any individual writing a phenomenology would be remiss to not include some discussion about the philosophical presuppositions of phenomenology along with the methods in this form of inquiry. Phenomenology has a very strong philosophical component to it. It draws heavily on the writings of the Great German mathematician Edmund Husserl (1859-1938). Phenomenology is popular in the social and health sciences, especially in sociology, nursing and the health sciences, and education. The philosophical assumptions rest on some common grounds: the study of the lived experiences of persons, the view that these experiences are conscious ones, and the development of descriptions of the essence of these experiences, not explanations or analyses.

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Types of Phenomenology: Two approaches to phenomenology are highlighted in this discussion: hermeneutic phenomenology (van Manen, 1990), and empirical, or psychological phenomenology (Moustakas, 1994). Van Manen has written an instructive book on hermeneutical phenomenology in which he describes research as oriented toward lived experience (phenomenology) and interpreting the “texts” of life (hermeneutics) (van Manen, 1990). Although van Manen does not approach phenomenology with a set of methods or rules, he discusses phenomenology research as a dynamic interplay among six research activities. Researchers first turn to one phenomenon, which seriously interests them (e.g., reading, running, driving). They reflect on essential themes, that what constitutes the nature of the lived experience. They write a description and explanation of the phenomenon, maintaining a strong relation to the topic of inquiry and balancing the parts of the writing to the whole. Moustakas’s (1994) psychological or transcendental phenomenology is focuses less on the interpretations of the researcher and more on a description of the experiences of participants. Moustakas focuses on one of Husserl’s concepts, epoche (or bracketing), in which investigators set aside their experiences, as much as possible, to take a fresh perspective toward the phenomenon which is under examination. The procedures, illustrated by Moustakas, consist of identifying a phenomenon to study, bracketing out one’s experiences, and collecting data from several persons who have experienced the phenomenon. The researcher then analyzes the data by reducing the information to significant statements or quotes and combines the statements into themes. Following that, the research develops a textural description of the experiences of the persons (what participants experienced), a structural description of their experiences (how they experienced it in terms of the conditions, situations, or context), and a combination of the textural and structural descriptions to convey an overall essence of the experience.
Procedures for Conducting Phenomenological Research: The major procedural steps in the process would be as follows:
• The researcher first determines if the research problem is best examined using a phenomenological approach. The type of problem best suited for this type of research is one in which it is important to understand several individuals’ common or shared experiences of a phenomenon.
• A phenomenon of interest to study, such as anger, professionalism, what it means to be underweight, or what it means to be a wrestler, is identified.
• The researcher recognizes and specifies the broad philosophical assumptions of phenomenology. For example, one could write about the combination of objective reality and individual experiences. These lived experiences are often “conscious” and directed towards an object. To fully describe how participants view the phenomenon, researchers must bracket out, as much as possible, their own experiences.
• Data are collected from all the individuals who have experienced the phenomenon. Often data collection in phenomenological studies consists of in-depth interviews and multiple interviews with participants. Polkinghorne (1989) recommends that researchers interview from 5 to 25 individuals who have all experienced the phenomenon (3).
• The participants are asked two broad, general questions (Moustakas, 1994): What have you experienced in terms of the phenomenon? What situations or contexts have typically influenced your experiences of the phenomenon? Other open-ended questions may also be asked, but these two, especially, focus attention on gathering data that will lead to a textural description and a structural description of the experiences, and ultimately provide an understanding of the common experiences of the participants.
• Building on the data from the first and second research questions, data analysts go through the data (e.g., interview transcriptions) and highlight “significant statements”, sentences, or quotes that provide an understanding of how the participants experienced the phenomenon. Moustakas calls this step horizonalization. Next, the researcher develops clusters of meaning from these significant statements into themes.
• Researchers also write about their own experiences and the context and situations that have influenced their experiences.
• From the structural and textural descriptions, the researcher then writes a composite description that presents the “essence” of the phenomenon, called the essential, invariant structure (or essence).
Challenges: A phenomenology provides a deep understanding of a phenomenon as experienced by several individuals. Knowing some common experiences can be valuable for groups such as teachers, therapists, health personnel, and policymakers. Phenomenology can involve a streamlined form of data collection by including only single or multiple interviews with participants. Using the Moustakas (1994) approach for analyzing the data helps provide a structured approach for novice researchers. On the other hand, phenomenology requires at least some understanding of the broader philosophical assumptions, and these should be identified by the researcher. The participants in the study need to be carefully chosen to be individuals who have all experienced the phenomenon in question, so that the researcher, in the end, can forge a common understanding.
Justification of Using Phenomenology in My Research Question: My research question relates to doctor-pharmaceutical sales representative relationship and I have to use one of the research designs for my qualitative research proposal, and I have chosen phenomenological approach as my research design. My question asks about the impact of various promotional methods used by pharmaceutical companies on doctors prescribing behavior. The pharmaceutical company spends millions of dollars annually on general practitioners, physicians, consultants and other heath providers. They use various promotional methods which I have described in detail in the synthesis. I will use phenomenological approach in my research because phenomenology deals with the lives experiences of several individuals. I will use interview as a method, and the research participants will be GPs and physicians in the OPDs of the government hospitals. The medical reps visits frequently to the OPDs and use their promotional methods. The assumption behind phenomenology is that there is an essence to shared experience. It requires a researcher to enter into an individual’s life world and use the self to interpret the individual’s or group’s experience. I will explore the experiences of the individuals (doctors), to whom the medical reps visit and offer various gifts, free samples etc. I have already discussed the various articles from the literature search and it shows that phenomenology is the best approach for my research question, because the participant experiences some common phenomenon. It can be happiness, irritation, greed, anger. The participants will describe their experiences in detail and share the feelings related to it. I will also use my own experiences in writing this study. I can take the interview from 20 to 50 participants and even more as shown in the matrix of 20 articles. The participants will be asked two general questions: 1. what have you experienced in terms of the phenomenon? 2. What contexts or situations have typically influenced or affected your experiences of the phenomenon? There are two types of phenomenological approaches, 1. Hermeutic phenomenology. 2. Empirical, transcendental or psychological phenomenology. I will use the psychological method in my study because it focuses on description of the experiences of the participants. I will describe my own experience with the phenomenon and bracket out my views before proceeding with the experiences of others. I will then analyze the data by reducing the information to quotes and statements and combine the statements into theme as shown in matrix of articles. Following this, I will develop a textural description of the experiences of the persons (participants) and a structural description of their experiences (conditions, situations, or context), and a combination of the textural and structural descriptions to convey an overall essence of the experience.
Research Methods: There are many types of research methods used by qualitative researchers to answer the research question. These include in-depth interviews, focus groups, unobtrusive methods, narrative analysis and life history, memory-work, ethnography and participatory action research etc. I used in-depth interview as my research method.
In-Depth Interviews:

In-depth interviews are good mean to understand the view point but both the interviewer and interviewee are not free from the impact of one another.
A good interview is like a good conversation i.e. a two-way conversation.
It is not very useful to describe in depth interviews as semi-structured, open ended version of fixed response survey interviews. They aim to explore the complexity and in-process nature of meanings and interpretations that cannot be examined in survey interviews.
The hardest work for most of the interviewers is to keep quiet and to listen actively.
Active listening can be divided into two fragments. First, the interviewer must listen what is said including all the emotions, body language and topic. In the second phase, the interviewer must keep in mind the process of interview i.e. the pre structured contents.
The interviewer must start conversation, especially on sensitive issues, with neutral statement to avoid embarrassment by the participant.
It is not necessary that interviewer should be of similar age, gender, race, class and sexual orientation to the people being interviewed. However, in case of very personal and sensitive issues, like marital rape, it is more appropriate to conduct interview by same gender and age.
Informed consent is very important component of each interview. However, in taped interview the verbal recorded consent fulfill the criterion of ERC.
Open-ended interviewing assumes that meanings, understanding, and interpretations cannot be standardized. So the phrasing of the questions and the order in which they are asked should be altered to fit each individual.
In-depth interviewing requires an ability to relate to others on their own terms.
Constructing a “theme list” is a good idea, however, the key to asking questions during in-depth interviewing is to let them follow, as much as possible, from what the participant is saying.
“Probing” aims to elicit information to fill in the blanks in a participant’s first response to a question. There are six different types of probes: elaboration, clarification, attention, completion, and evidence probes.
For managing an interview, each interview may require a letter of introduction, a personal introduction, consent from gatekeepers, phone calls to schedule the interview, travel arrangements for the interviewer and the interviewee, the booking of an interview room, a letter or a [phone call to confirm the interview time, the scheduling in of other appointments around the interview, and a thank you latter after the interview.
“Tape-recorded” interviews have many advantages. They provide detail and accuracy not attainable from memory or by taking notes. However, sometimes the data is excessive and burdensome for researcher with specific and limited aim.
While it is important to examine pre-existing theory, in-depth interviews allow new understandings and theories to be developed during the research process. However, they require a considerable investment of time and energy. It is more appropriate to use other less expansive methods when detailed data is not required on meanings and interpretations.
In in-depth interviews, participants may be more prepared to discuss sensitive methods which they would not otherwise talk about in front of other people, and which could not be examined using methodologies such as participant observation or focus groups.

Justification of Using In-Depth Interview in My Research Question: My research question is related to doctor-pharmaceutical sales representative relationship. I have to use one of the research methods for my research question and I will use the method of in-depth interview in my research question. My research question asks about the impact of various promotional methods used by pharmaceutical companies on doctors prescribing behavior. They use various promotional methods which I have described in detail in the synthesis of 20 articles. In-depth interview method has many features as follows. In-depth interviewing is a privilege. There is something satisfying and deeply rewarding about talking to another person for an hour or more in such a way that you come to understand a particular part of their life ‘in depth’. In-depth interview is like the half of a very good conversation when we are listening. The focus is on the ‘other person’s own meaning contexts. Good interviewing is achieved not only through method and technique, but also out of a fascination with how other people make their lives worthwhile and meaningful. Conducting a good in-depth interview is an art that cannot be achieved by particular methods or following rules. However, this is only half the story and there are many techniques, rules of thumb, skills, and practical guidelines that, if followed, will also facilitate a good interview. I will use In-depth interview as a method in my research question and my research participants will be physicians and general practitioners (GPs) of the medical OPDS of the government hospital. The medical reps visits GPs frequently in the OPDS, Wards and private clinics and they use various promotional methods and do manipulation to get benefit. Now as I have discussed in the synthesis that not all GPs are corrupt and there are many reasons behind their relationship to medical reps. I will use In-depth interview method because of the reason that different physicians have different views regarding medical reps and pharmaceutical companies and therefore a detailed interview will definitely give good results and will clarify the concept regarding this relationship. Other advantage of using In-depth interview is that they are an excellent way of discovering the subjective meanings and interpretations that people give to their experiences. In-depth interviews allow aspects of social life, such as social processes, to be studied that could not be studied in any other way. My research participants will be qualified doctors, so interview won’t be difficult to take and 45 to 60 minute interview will be enough per participant. The thing that I have to keep in mind is their biasness as majority of them gets huge benefits from pharmaceutical companies. I will ask the GPs and Physicians to share their experiences as how they are approached? How they are educated regarding new pharmaceutical products? What incentives they are being offered and in how much quantity? And finally what is the impact of the gifts from pharmaceutical sales representatives on the prescribing behavior of the doctors? After taking detailed interviews from the doctors I will gather the data and will compile it.
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