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Template Analysis

Source:

KING, N. 2007. Template Analysis. Huddersfield: University of Huddersfield. Available at:

http://www.hud.ac.uk/hhs/research/template_analysis/ [Accessed 19th September 2007]

KING, N., 1998. Template analysis. IN G. Symon & C. Cassell (Eds.), Qualitative Methods and Analysis in Organisational Research. London: Sage. pp.118-134.

Introduction

I've taught and written about qualitative methods in psychology and allied disciplines for

over ten years, and used them extensively in my own research. In particular, I have argued

that a style of thematic analysis referred to as the "template approach" or "template analysis"

has much to offer, especially - though not exclusively - for relatively inexperienced qualitative

researchers. However, although there is a very large literature on thematic approaches in

general, there is relatively little that specifically focuses on the use of the template style, the main sources being book chapters by Crabtree and Miller and myself.

First and foremost, this site aims to be a resource that those using - or thinking about using - a

template approach to qualitative data analysis can turn to, both to learn more about this

kind of analysis generally and for guidance on specific aspects of the approach. Much of

the content will, I hope, be especially useful to those with relatively little experience of this

kind of data analysis, BUT there is also material aimed at more experienced researchers. I

want to contest the argument I've quite often heard, that approaches like template analysis

are a good way of introducing people to qualitative data analysis, but are too limiting for more sophisticated uses.

Overview of main contents

What is Template Analysis? A concise description of what the approach consists of,

and how it relates to other types of qualitative data analysis.

The technique in detail - A step-by-step practical guide to using the approach. Linked

pages provide extra detail on particular steps in the process.

FAQs: Short answers to some of the most common questions I am asked about the

approach.

Examples: Real examples of how the approach has been used; my own and others'.

Literature: Includes methodological literature on template analysis and similar

approaches, examples of papers and reports presenting studies using the approach,

and some more general references to qualitative methods in psychology and other disciplines.

What is Template Analysis?

Basic description of approach

The term "template analysis" refers to a particular way of thematically analysing qualitative

data. The data involved are usually interview transcripts, but may be any kind of textual

data, including diary entries, text from electronic "interviews" (e-mail), or open-ended

question responses on a written questionnaire. Template analysis involves the development

of a coding "template", which summarises themes identified by the researcher(s) as

important in a data set, and organises them in a meaningful and useful manner. Hierarchical

coding is emphasised; that is to say, broad themes (e.g. "Responses to illness") encompass

successively narrower, more specific ones (e.g. "Changed relationships", "Changed

relationships with health professionals"). Analysis often, though not always, starts with some a

priori codes, which identify themes strongly expected to be relevant to the analysis.

However, these codes may be modified or dispensed with altogether if they do not prove to

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be useful or appropriate to the actual data examined (see FAQs and The Technique: Themes

and Codes for more). Once any a priori themes are defined, the firsts step of the analysis

proper is to begin reading through the data, marking in some way any segments that

appear to tell the researcher something of relevance to the research question(s). Where

such segments correspond to a priori themes, they are coded as such. Otherwise, new

themes are defined to include the relevant material and organised into an initial template;

normally this is done after initial coding of a sub-set of the data – for example, after reading

through and coding the first three of fifteen transcripts in a study. This initial template is then

applied to the whole data set, and modified in the light of careful consideration of each

transcript. Once a final version is defined, and all transcripts have been coded to it, the

template serves as the basis for the researcher’s interpretation or illumination of the data set, and the writing-up of findings.

Philosophical position

Before carrying out any research project, the researcher should have a clear idea of the

philosophical position the work is coming from. In most quantitative research, however, the

assumptions and prescriptions of the hypotetico-deductive approach are taken for granted,

as are their implications for research design and methods of data analysis. A psychologist

writing up an experimental study is unlikely to feel the need to philosophically justify the use

of a control group or the appropriateness of using confirmatory statistical tests to make

judgements about causality. In contrast, qualitative research encompasses a range of

philosophical positions that have differing implications for how research should be carried

out and how data should be analysed. It is therefore important for qualitative researchers to carefully consider the philosophical stance of their work.

It is well beyond the scope of this site to present a lengthy essay on philosophical issues in

qualitative research. Nevertheless, some discussion of them is necessary, in order to make

clear why template analysis should or should not be used in particular ways. (For an excellent

introduction to this area, see the opening chapter of Willig, 2001). If this is new territory for

you, there are three concepts you particularly need to familiarise yourself with, and to understand how they relate to each other: epistemology, methodology and method.

Epistemology

Epistemology refers to the assumptions we make about what it is possible for us to know and

how we can obtain this knowledge. A key area of epistemological debate in qualitative

research is the extent to which any method can provide access to the personal world of the research participant.

Methodology

Methodology refers to the general approach taken to carrying out a piece of research.

Analytical induction (Johnson, 1998), Interpretive Phenomenological Analysis (IPA: Smith,

1996) and discursive psychology (Willig, 2001) may all be seen as methodologies.

Method

Method refers to the particular techniques used to collect and analyse data. Narrative

interviews, semi-structured interviews, repertory grids, participant observation, and the use of pre-existing texts can all be used as qualitative methods of data collection.

In terms of how these concepts relate to each other, we can see a hierarchy whereby

epistemological assumptions shape methodological approaches which in turn inform the

choice of method. The relationships are not wholly deterministic – especially not that

between methodology and method. For example, a relativist epistemological position

underlies several methodological approaches (e.g. discursive psychology, Foucauldian

discourse analysis, Q-methodology) which might use a number of different methods of data collection (interviews, recordings of "natural" conversations, analysis of pre-existing texts).

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The choice of a method of data analysis needs to be guided by the methodological position

of a piece of research, and its underlying epistemological assumptions. Some analytical

methods are directly linked to particular methodologies; thus if you are using classical

Grounded Theory you will necessarily employ the sequence of open and axial coding it

specifies. Other methods may be used within a variety of methodologies, but precisely how

they are used will differ from one to another. Template analysis falls into this latter category; it

can be employed to analyse any form of textual data from many (but not all)

methodological and epistemological positions. It can be used in research that takes a similar

realist position to mainstream quantitative psychology, in seeking to "discover" the underlying

causes of particular human phenomena. In contrast it can also be used within a "contextual

constructivist" position (Madill et al, 2000), which assumes that there are always multiple

interpretations to be made of any phenomenon, and that these depend upon the position

of the researcher and the specific social context of the research. If you were using TA to

analyse data from a realist-oriented study, you would need to be concerned with the

reliability of the coding process (see The Technique: Quality checks and Reflexivity). Also, it is

likely that you would include quite a few a priori codes, reflecting areas highlighted in

advance as important to addressing your research question (see Technique: Themes and

Codes). If you had taken a contextual constructivist position, you would want to find ways of

examining issues of reflexivity and the nature of the researcher-participant relationship. You

would also need to use the technique in a flexible way, that helped you to consider multiple

interpretations of the data, and discouraged you from closing down to one "best" reading too early.

The Technique

My description of the technique assumes your data is in the form of interview transcripts.

However, the approach can be used with any kind of textual data – for example, detailed participant observation field notes.

1. Define a priori themes (Themes and codes) if this is appropriate to your methodology

(see What is template analysis? for more on the philosophical assumptions underlying qualitative research).

2. Transcribe your interviews, and read through them to thoroughly familiarise yourself with them. (Transcription)

3. Carry out initial coding of your data. Identify those parts of your transcripts that are

relevant to your research question(s). If they are encompassed by one of your a priori

themes, "attach" the code to the identified section. If there is no relevant theme, modify an existing theme or devise a new one. (Themes and Codes)

4. Produce your initial template. You may choose to wait until you have carried out

initial coding on all your transcripts, but commonly the initial template is developed

after a sub-set of transcripts has been coded. Group the themes you have identified

in the selected transcripts into a smaller number of higher-order codes which describe

broader themes in your data. You can have as many levels of coding as you find

useful to distinguish, but remember that too many levels may make the template less

clear than it should be. (Producing Your Initial Template) You may carry out this

coding by hand on the printed transcripts, or electronically using a CAQDAS program (see Using Computers for more on this).

5. Develop your template by applying it to the full data set. Whenever you find that a

relevant piece of text does not fit comfortably in an existing theme, a change to the template may be needed. (Developing Your Template)

6. Use your "final" template to help you interpret and write up your findings. (Interpreting and Writing-up)

7. At one or more of the coding stages described above, you should carry out some

kind of quality check to ensure that your analysis is not being systematically distorted

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by your own preconceptions and assumptions. You may also want to include

procedures that help you achieve reflexivity in your analysis. (Quality Checks and Reflexivity)

Defining themes and codes

"Themes" are features of participants’ accounts characterising particular perceptions and/or experiences that the researcher sees as relevant to the research question.

"Coding" is the process of identifying themes in accounts and attaching labels (codes) to index them

Researchers will generally choose to define features as themes where they recur several

times in the data set, within and/or across transcripts. This is not, however, a hard and fast

rule. If a single comment made by one participant is particularly helpful in elucidating their

account, you may want to devise a theme that encapsulates it and include it in your template.

It is important to recognise that themes in qualitative research are not hiding in the data,

waiting to be "discovered" by the researcher. Rather, they arise from the engagement of a

particular researcher with the text, as he or she attempts to address a particular research

question. As such, they are pragmatic tools to help the researcher produce their account of

the data. When deciding whether and how to define themes, keep this pragmatic intent in

mind; ask yourself the question, "if I code the text in this way, is it likely to help me build my

understanding of the data?" (For a discussion of the philosophical issues regarding the

relationship between text, analysis, and the participant’s experience, see What is TA? For a discussion of how to judge the quality of thematic coding, see the Quality Checks page).

Using a priori themes

In template analysis it is common to identify some themes in advance – usually referred to as

"a priori" themes. Usually this is because a research project has started with the assumption

that certain aspects of the phenomena under investigation should be focused on. A recent

example form my own research is a qualitative evaluation of the Gold Standards Framework

for community palliative care. This framework – known as the "GSF" – specifies seven key

issues regarding the organisation and delivery of care that practitioners need to address. It

therefore made sense for us to use those seven issues as a priori themes when analysing GPs’

and District Nurses’ accounts of their experiences with the scheme (see King, Bell, Martin &

Farrell, 2003). Another justification for using a priori themes is that the importance of certain

issues in relation to the topic being researched is so well-established that one can safely

expect them to arise in the data. For example, a researcher investigating patient

experiences of chronic illness may feel that "uncertainty" may be safely used as an a priori theme, given its prominence in the literature.

The main benefit of using a priori themes is that they can help to accelerate the initial coding

phase of analysis, which is normally very time-consuming. There are, though, some important

dangers associated with their use, which you need to bear in mind. Firstly, by focusing on

data that fit the a priori themes, you may overlook material that does not relate to them.

Secondly, you may fail to recognise when an a priori theme is not proving to be the most

effective way of characterising the data. To guard against these pitfalls, it is crucial to

recognise a priori themes as tentative – equally subject to redefinition or removal as any

other theme. In the GSF study, mentioned above, we removed two of the original seven a

priori top-level themes and included them along with others under a new top-level theme. I

would also suggest that you should restrict the number of a priori themes as far as possible; if

you start with much of the initial template already defined, the danger of it having a blinkering effect on your analysis will be considerable.

Transcription

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Template analysis does not require the kind of highly detailed transcription used in discourse

analysis or conversation analysis, where intonation is recorded precisely, pauses timed to

partial seconds, and so on. Some may argue that it does not require full verbatim

transcription at all – seeing it as sufficient to transcribe word for word those passages directly

addressing the research question and recording the rest in summary form. I tend to disagree

with this position, largely because I think that it is not usually possible to be sure which parts of

an interview are relevant to the research question until quite some time into the analysis. I

also find it useful to include information beyond just the participant’s words, where it aids my

understanding of their account – pauses, laughs, an ironic tone in the voice, and so on. I

always record the researcher’s questions in full. To illustrate the kind of transcription I like to

use, I have included below an extract from a recent interview which is part of an ongoing study of people’s experiences of ghosts and apparitions.

Example of transcription

N is me, W is "Wendy", the participant (a pseudonym, of course). Square brackets are used

for interjections, overlaps and paralinguistic aspects such as pauses – [p] – and information about intonation. Capitals indicate emphasis.

N. Right, OK. So, what – I know you’re recalling this from some time, but what do you think

made it frightening? Because it’s different from the first experience, you don’t discuss any fear at all. What was there in the second experience that made you and your friend…

[W. talking over: I think that’s because I was older…]

.rather than run and scream?

W. I knew more then! [amused tone]

N. Was it YOU or was it…

W. I don’t think it was the FEAR of what it was, it was just a reaction. I think when I was a child

you more accept, you don’t you know, you’ve not read at that point, you’re still learning

about the world, so you just accept things as [p] that’s how it is. But now for me, when I was

older, because of course at school you talk about ghosts, you know, you read things like that.

And looking at it, it looked like a ghost and it just kind of…because I’d never seen anything

physical when I was a child, perhaps if I had when I was a child it might have scared me. But

then seeing a figure, older, it really did kind of jolt me a bit. And it wasn’t so much that the

figure was threatening, it was just [p] what I’d seen, it was me interpreting it as a ghost, and then just kinda thinking "aaaah!" and running

Producing your Initial Template

When to produce the initial template?

In devising your analytical approach, a key issue to consider is the stage at which you should

produce your initial template. You could do so after carrying out preliminary coding on just

one transcript, or you could wait until you had done so on every transcript; in all most studies,

it is produced at a point between these two extremes. The danger of producing the initial

template early is that you may find it interferes with your attempts to approach fresh

transcripts with an open mind. You can become over-sensitised to material that "fits"

relatively neatly into the template, and neglect that which is difficult for the template to

encompass. The advantage is that the initial template can help you to focus on areas of

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greatest relevance to your research question(s), and avoid becoming bogged down in what may be redundant or repetitious coding.

Your decision about how soon you produce the initial template needs to take two things into

account. Firstly, and crucially, you need to think about your overall methodological position.

If your approach strongly emphasises the need to remain open to the data and avoid pre-

suppositions – as, for example, in phenomenological studies – then you should hold back

from creating the initial template until you have carried out preliminary coding on all

transcripts, or at least a substantial proportion of them. If your methodology is driven by the

need to answer quite specific theoretical or practical questions – as in many realist-oriented

evaluation studies – then you are probably best advised to produce the initial template at a

fairly early stage. A good rule of thumb is that you have probably reached an to appropriate

point when your preliminary coding is no longer producing many new themes that are distinctly different from those identified previously.

Secondly, you need to consider the practical constraints on your project in terms of time and

resources. If you have a large number of interviews and a tight deadline to meet, then

moving quickly to the initial template stage may be the only way to get it done. Of course,

such practical concerns should not override the methodological integrity of your research.

However, this is most likely to be a problem where you have not thought through your design

carefully enough – for example, recruiting too many participants for a phenomenological study where you have very limited time available.

How comprehensive should the initial template be?

This is largely a matter of personal preference, and the needs of particular projects. On the

whole, I feel it is best not to attempt to produce too comprehensive a template initially. The

danger is that if you invest too much time and effort in creating an elaborate initial template,

you may be reluctant to make substantial changes to it later. I have certainly caught myself

seeking excuses to avoid making changes to coding that would "mess up" my nicely

organised initial template! Some of the computer packages available to assist with

qualitative analysis can help you avoid this tendency, because they make it very easy to re-

arrange the structure of the template as you go along. The "node explorer" feature in NVivo is a good example of this (see Using computers).

When producing your initial template, it is important to cover the main thematic areas

emerging from your preliminary analysis. However, I don’t think you need to be too

concerned with fine distinctions at third, fourth or even lower levels of the coding hierarchy.

The exception is where you feel that a very narrow and specific theme is especially

important in helping you make sense of the data. In such a case, you should include a more detailed thematic structure for the relevant part of the initial template.

Developing your Template

Once you have your initial template, your task is to develop it until you feel it gives as good a

representation as possible of the themes you have identified in the data. This is done by

applying the template to each transcript in turn, coding all relevant segments on it, and

modifying it if there is material relevant to the research question which the template does not

adequately cover. If (or more likely, when) you make significant changes to the template,

you will need to adjust the coding of transcripts already coded on the previous version. This

iterative process of coding, modifying the template, and re-coding could in theory go on

indefinitely. There is no stage where you can say with absolute certainty that the template is

"finished", because there are always other ways of interpreting any set of qualitative data.

However, you still need to make a pragmatic decision about when to stop the development

process, otherwise your project will never get written up. I find that it is usually not too difficult

to apply a law of diminishing returns, whereby you recognise that the small gain in the quality

of your analysis is not worth the cost of yet further revision to the template. It is easier to make

this decision when you are not working on your own, and can discuss it with a colleague or

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supervisor. This may be a stage where a formal quality check is useful (see Quality Checks and Reflexivity).

Modifications to a template usually take one or more of the following forms:

1. Inserting a theme - If you identify an issue in the text of relevance to the research

question, but not covered by an existing code, you will need to define it as a new theme and add a code for it.

2. Deleting a theme - You may find it necessary to delete a theme because the

material it covers is better included under a different code (or codes). You may also

find that an a priori theme turns out not to be useful, and chose to remove it from the

template. An initially-defined code may be deleted at the end of the process of template construction simply because the researcher has found no need to use it.

3. Changing the scope of a theme - Where you find that a theme is either too narrowly

defined or too broadly defined to be useful, you can re-define it at a lower or higher level.

4. Changing the higher-order classification of a theme - You may decide that a theme

initially classified as a sub-category of one higher-order theme fits better as a sub-category of a different higher-order theme.

For more detail on these ways of modifying the template, with examples, see King (1998).

Interpretation

A common mistake made by inexperienced qualitative researchers is to think that

interpreting findings is simply a matter of summarising the interview contents indexed under

each theme. This is likely to result in a very flat, descriptive account that does little to bring

participants’ experiences to life. In any case, most templates include dozens of themes

(when you include all levels of coding); to summarise them all would only be possible in a

document of thesis length, and would be in danger of invoking stupefaction rather than

insight in the reader. You must remember that the template is not the end product of the

analysis, but only a tool to help you produce an interpretation of the data that does as much

justice as possible to its richness within the constraints of a formal report, paper, or dissertation.

The way you interpret your data should be shaped by the aims of your study and the nature

of the data itself; there is no set of hard-and-fast procedural rules to follow. However, from my

own experience and that of others, I can offer some suggestions for strategies you might try, and draw attention to some of the pitfalls to avoid.

Listing themes

It is often helpful to compile a list of the themes occurring in each transcript – something that

most CAQDAS programmes (see Using Computers) can achieve quite easily. (If coding by

hand, make sure you do it clearly and legibly – colour-coding top-level themes can help).

Such lists can help you give an overview of your thematic coding and may reveal interesting

patterns, which warrant closer attention. You need, though, to be careful not to slip into

using them in a positivistic way, as if themes were variables on which to compare sub-groups

of participants. Especially, be very wary of assuming that the frequency with which themes

occur is necessarily any kind of indicator of their salience. The fact that a theme is particularly

common – or rare - may point to something worth closer attention, but in qualitative analysis

it must never be taken as any kind of "evidence" in and of itself. The process of listing themes is about raising questions, not answering them.

Prioritising

Interpreting data in a template analysis approach must involve making judgements about

the salience of particular themes to the understanding you are attempting to build of the

phenomena under investigation. If you fail to do this, you will simply be overwhelmed by the

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amount of detail in your findings, and not be able to develop a coherent account from

them. To prioritise, I often find it helpful to look at themes in the context of individual

participants’ accounts, as well as examining the data across participants. Ask yourself which

themes seem to get to the heart of a participant’s "story" in the interview transcript. Some

may seem important because the participant keeps returning to them; others may stand out

because of their strong emotional content. Going back to look closely at individual accounts

is valuable because it can help you avoid one of the main pitfalls of thematic analyses; the

tendency to focus too much on what is common across cases, and lose sight of the context in which themes are identified in individual accounts.

Openness

The opposite pitfall to that of failing to prioritise is that of narrowing the focus of your

interpretation too soon. This may happen, for example, when you allow your initial research

question to guide you so strongly that you disregard all themes that are not obviously of

direct relevance. If a theme that does not appear to be relevant to your research question

stands out as clearly important to your participants, it could mean that your research

question itself was blinkered by your own unacknowledged assumptions. You may need to

revise or add to the question(s) your research was seeking to address. Even if you do not feel

this is necessary, the emergence of such strong – though tangential – themes might be helpful to discuss as part of the contextual background to the main focus of your analysis.

It is easier to avoid the trap of prematurely narrowing the focus of your analysis if you are

working with others who can challenge you and ensure that you reflect on the process. I return to this point on the Quality Checks and Reflexivity page.

Writing up Your Study

How you go about writing-up a study based on TA will of course be constrained by the

requirements of different kinds of publication. For journal articles, as well as word length limits,

you must take account of any constraints in terms of format, and you are always well-

advised to look at the style of qualitative papers the journal has published in the past.

Although many more journals take qualitative papers now than in the past, some expect

them to conform much more to the standard quantitative style and structure than others.

You generally have more freedom with book chapters, and can negotiate with editors over

what they need from your contribution. For theses and dissertations, you should consult

supervisors and course documentation for guidance; again looking at previous examples of similar projects is a good idea.

Within the constraints imposed on you, there are three broad approaches to presenting your analysis which you could adopt:

1. Individual case-studies, followed by a discussion of differences and similarities between cases.

Pros:

Gives the reader a good grasp of the perspectives of individual participants.

Ensures that the discussion of themes does not become too abstracted from participants’ accounts of their experience.

Cons:

Tends to take up a considerable amount of space, so difficult to use where word limits are tight.

The reader can get bogged down in all the individual detail and find it hard to see the wider picture.

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2. An account structured around the main themes identified, drawing illustrative examples from each transcript (or other text) as required.

Pros:

Good way to produce a clear and succinct overview of the most salient findings from the thematic analysis.

Useful when word limits are tight.

Cons:

Can encourage over-generalisation.

Can lose sight of the individual experiences from which the themes are drawn.

3. A thematic presentation of the findings, with a small number of full case-studies to illustrate key themes.

Pros:

A useful synthesis of the previous two approaches.

Cons:

Can be hard to decide on criteria on which to base selection of cases.

Whatever approach you take to presenting findings, a key element is the use of direct

quotes from participants. These should generally include some shorter quotes (up to a couple

of sentences) to clarify particular points, and longer quotes that give the reader a flavour of

the original accounts. I usually use pseudonyms rather than code numbers to identify the

participant I am quoting from, as this gives a more personal feel. Try to use pseudonyms

appropriate to the age and social background of the participant – an 85 year old working class yorkshirewoman is, after all, unlikely to be called "Kylie"!

One final point: I firmly believe that writing-up should be seen as a continuation of the

interpretative process. In my experience, the process of accounting for your analysis to your

readers deepens your own understanding of your data; you may find that even at this stage you need to further refine theme definitions or your template structure.

Quality Checks

In quantitative studies, reliability and validity are accepted as key criteria for assessing the

quality of research. Most qualitative writers are not comfortable applying these concepts to

their field, as they are based on assumptions about the researcher as detached, objective

observer, and are essentially related to measurement. There is no single set of criteria that

researchers agree should be used for all qualitative studies; instead, a variety of criteria have

been suggested, differing according to the methodological and epistemological positions of

different approaches. Some writers argue against the use of any fixed criteria at all. It is

beyond the scope of this site to examine the debate in this area; for good discussions of it,

see Murphy et al (1998), Seale (1999) and Willig (2001). What I will present here are

suggestions on how to use some of the common kinds of quality check within a study employing template analysis.

Independent scrutiny of analysis

There is a whole range of ways in which qualitative researchers use some form of independent scrutiny of their analysis as a way of checking its quality. These include:

Members of a research team coding a sample of data separately, and then

discussing similarities and differences in order to agree revisions to themes.

The same process as above, but using an outside "expert" (or experts), selected on

the basis of knowledge of the methodology and/or the substantive topic.

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Defending your analytical decisions to a constructively critical " expert panel."

Sometimes statistical calculation of inter-rater agreement is used in relation to independent

coding in thematic analysis. In fact, I used this strategy in the analysis of some of the data in

my Ph.D. While I can forgive myself on the basis of it being my first tentative steps into

qualitative research, within a strongly quantitative environment, I would not recommend this

approach now. It is based on at least an implicit assumption that one can objectively judge

one way of defining themes as " correct", which flies in the face of the notion that texts are always open to a variety of readings.

In template analysis, independent scrutiny can be used at various stages. I almost always use

it at the stage of developing the initial template. Usually I do this by asking research team

members to each carry out preliminary coding on a sample of transcripts. We then circulate

our independent coding and set aside two or three hours to compare, contrast and discuss,

with the aim of agreeing an initial template then and there. If you are working on a project

on your own, you could try to find one or more outside experts to do this with you, but they would need to be very well-briefed on the aims and methodology of your study.

Independent scrutiny is useful and relatively easy to incorporate into the process of

developing the template. Members of the research team and/or outside expert(s) can be

given sample transcripts and asked to code them using the current version of the template,

noting themes they found difficult to employ, aspects of the texts not covered by the

template and any other issues that strike them in the process. Discussion of such observations can then lead to further revisions of the template.

Finally, independent scrutiny can be used when you are interpreting the analysis for your final

write-up. Here, the " expert panel" approach may be useful. They can be given your

template and selected coded transcripts, and then asked to interrogate your interpretation –

for example, by requesting that you explain why you preferred one reading of an aspect of the data over another.

It is vital to recognise that none of the above approaches is about asking someone else to "

confirm" that your analytical decisions are " correct". Rather they are all ways to help you to

reflect on the process, by forcing you to think about alternatives that you might have

overlooked, or dismissed without proper consideration. If, on careful reflection, you do not

agree with suggestions made by an independent scrutiniser of your analysis, you are under no obligation to act on them.

Respondent feedback

Another strategy for evaluating the quality of analysis is to ask those who participated in the

research to comment critically on the analysis. In more realist types of qualitative research,

this is known as "respondent validation", but given the problems with the concept of validity

noted above, I prefer the term "respondent feedback". In a template analysis study,

respondent feedback can be used at several stages in the analytical process – in effect

mirroring the ways in which independent scrutinisers can be used. At an early stage,

participants could be asked to comment on the initial template as applied to their transcript.

Later, they could also be asked to critically examine drafts of interpretive writing that relates

to their interview. However used, respondent feedback is only likely to be effective if the

study and the analytical process have been clearly explained to participants, and material presented in a reader-friendly form.

Although quite widely used, there are some difficulties associated with respondent feedback

that you should bear in mind when considering whether to use it. Firstly, the respondent may

have motives for agreeing with the analysis that have little to do with its quality. In most

studies the researcher is in a position of relative power in relation to the respondent, by virtue

of his or her professional expertise, as well as through their role in the relationship as the

questioner. Given this, the respondent may feel uncomfortable criticising the researcher’s

interpretation (Willig, 2001). Even when the power imbalance is not significant, a respondent

may endorse the analysis in order to be helpful to the researcher. Secondly, the use of

respondent feedback to corroborate the researcher’s analysis assumes that people are able

11

to examine an interpretation of some aspect of their experience in a rather detached

manner, and judge whether it is " right". This contradicts the assumption underlying much

qualitative research that people cannot simply stand back from their own" lifeworld" and assess it objectively.

Creating an audit trail

Writers on qualitative methods commonly recommend that researchers compile an " audit

trail" of their analytical process. This is a documentary record of the steps you undertook and

the decisions you made in moving from the raw transcripts to your final interpretation of the

data. In a thesis or dissertation, you are able to include a detailed audit trail, perhaps

summarised in the main text and supported by extensive appendices. Here, the audit trail

should be integral to the assessment of your work. A report for an external agency may not

require such detail, and a journal article or book chapter is unlikely to allow sufficient space

for it. Nevertheless, even if it is not published for readers to see, I would argue that keeping an

audit trail is still good practice as it helps you to gain an overview of how you reached the

interpretation that you produced. It is an antidote to the unfortunate practice of presenting

qualitative findings as if they simply "emerged" fully-formed from the data, like mushrooms from manure!

Template analysis lends itself well to the production of an audit trail. It is relatively

straightforward to display successive versions of the template, accompanied by

commentary on what changes were made at each stage and why. Where space allows, I

would always also include at least one coded transcript (or extracts from several), and often

would include other materials drawn on in the analysis, such as your memos, notes, or case

summaries. If you are producing the audit trail for others to read – as in a thesis or dissertation – it is of course crucial to lay it out and annotate in a way that helps the reader through it.

Reflexivity

Qualitative research requires reflexivity on the part of the researcher. By this is mean that as a

researcher, you need to reflect on the nature of your involvement in the research process,

and the way this shapes its outcomes. Reflexivity is required throughout the research process

– for instance, in trying to be aware of how your own assumptions about the phenomenon

under investigation might influence the way you formulate your research question, and the

issues you highlight in your interview topic guide. I will concentrate here, though, on adopting a reflexive stance in your data analysis.

The techniques for quality checking described above can all be seen as ways of

encouraging reflexivity; they get you thinking about what it is you bring to the analysis.

Comments from independent scrutinisers or respondents help you to reflect on and questions

the assumptions you may be making; keeping an audit trail forces you to be explicit about

the decisions you are making and to reflect upon how they led you on a course towards

your findings and conclusions. However, although quality checks can help to bring reflexivity

to the fore, you should not see it as something to be "dealt with" only at certain set points in the analysis. Rather, throughout the process you need to pay attention to your own role in it.

For me, one of strengths of Template Analysis is that it encourages you to be explicit about

the analytical decisions you make, and to ground them in the texts you are analysing – in the

end, you always needs to be able to show where in the data you developed a certain

interpretation from. In this way it is an approach that facilitates reflexivity. It is therefore

important to keep successive versions of your template, ideally with some commentary to

remind you at the end of the study of the thinking behind the way you developed it. These

might be incorporated within a "research journal", where you record your thoughts and

feelings about doing the analysis. For example, you may note that on reading through a

particular transcript, you feel very sorry for the respondent because of some misfortune or

injustice they describe. You could then reflect on how your feeling might impact on the way

you understand the text, and the themes you used to encapsulate this. Perhaps you are

12

over-emphasising the powerlessness of the participant because you have created an image of them as an "object of pity"?

Example: Carers' experiences of out-of-hours palliative care services

Background

This study was part of a wider project examining developments in out-of-hours palliative care

in the Calderdale and Kirklees area of West Yorkshire (see King, Thomas, Bell and Bowes,

2003). "Palliative care" refers to medical and nursing care offered to people with life-limiting

illnesses, with the purpose of alleviating suffering and maximising quality of life, rather than

attempting to cure the condition. Our research - supported by the former Calderdale and

Kirklees Health Authority and the University of Huddersfield - was concerned with community

palliative care, provided to patients in their own homes. The main professional responsibility

for such care rests with General Practitioners and Community Nurses, though a wide range of

other professions may be involved, as well as social care workers. However, crucial to

effective palliative care in the home is the care and support provided by informal Carers - usually spouses and/or other close family members.

The focus of our study was on informal Carers' experiences of the support offered to them in

the "out-of-hours" periods, when the patient's regular GP and Community Nurses were off

duty (i.e. evenings / nights, and weekends). This has been an area of concern in community

palliative care, because poor co-ordination and communication between daytime and out-

of-hours services can undermine support arrangements for patients and carers. In the worst

cases, patients may be left in pain or discomfort through lack of access to drugs out-of-hours,

or may be admitted to hospital and die there, despite their strong wishes to die at home. In

May 2000, Calderdale and Kirklees Health Authority introduced an out-of-hours protocol for

community palliative care, providing professionals with guidelines for good practice and setting up a series of new mechanisms to help them achieve this.

The aim of our study of Carers' experiences was to identify the kinds of problems they

encountered in out-of-hours periods, and examine their perceptions of the services they

used. We hoped this would shed light on whether the out-of-hours protocol was addressing

issues of concern to Carers as well as Practitioners. As part of a wider evaluation project, this

study can be seen as taking a limited realist approach We assumed that the stories

participants told us provided insight into the experiences they had had as Carers, but we

recognised that they could not simply be read at face value; an interpretive judgement

considering contextual aspects - including the context of the interview situation itself - was needed.

The Carer interviews were all carried out by Dennise Bell. Analysis was undertaken jointly by

Dennise and me.

Overview of Method

For the sake of brevity, I will not give a full account of the methodology here; if you are interested in more details, e-mail me for a copy of the report cited above.

Carers were selected to provide a sample that varied in terms of the out-of-hours service

used by the practice, the age of the patient at death, and whether an out-of-hours

handover form had been activated for the patient (an important part of the new out-of-

hours protocol). A total of fifteen Carers was interviewed; seven from Huddersfield and four

each from Calderdale and North Kirklees. Ten of the Carers were wives of the deceased,

three were daughters, and two were husbands. Deceased patients ranged from 50 to 80

years of age at their time of death. Interviews were taped (with consent) and the transcripts analysed using template analysis.

13

The analytical process had the following steps; the links take you to pages fully describing each step.

Producing case summaries

Creating the initial template

Developing the "final" template Writing-up

The last page of this area of the site presents some of my reflections on this process:

With the benefit of hindsight

Producing case summaries

One of the dangers of thematic approaches like template analysis is that they can result in a

loss of the sense of the individual person in the examination of themes occurring across a

group of accounts (see "Pitfalls" for more on this). One device I often use to help me keep in

mind the individuality of accounts is to produce summaries of each transcript early in the

analysis. These summaries do not try to systematically include every theme identified in the

transcript, but rather try to provide a condensed version of the person's account, highlighting

those elements that seem most important in understanding their story. Summaries may

include reflections on the style of the account as well as the content - for example the use of

metaphors, or the general tone of the piece - stoical, optimistic, matter-of-fact, or whatever.

Reflexive comments may also be included, such as how the interviewer or the data analyst

(if a different person) felt about the account, the nature of the interaction between interview

and participant, and so on. The degree of focus on aspects of the data other than the story

content will vary according to the general methodological approach taken by the

researcher. A realist case study with a large number of interviews would tend to be less

concerned with aspects other than content than a small, in-depth phenomenological study, for example.

The limited realist epistemology of our Carers study meant that our summaries were mostly

concerned with story content, but we did include other aspects where they appeared to

offer something important to the interpretation, as will be evident in the example I am giving

here of "Phyllis". This was the longest summary, because the interview raised some especially important issues in relation to our research aims.

Example of a Case Summary

CARER INTERVIEW 3: 'PHYLLIS'

Date of death: Nov 2000

Age: 78

Carer: wife of deceased

No out-of-hours handover form in place

Patient's illness (throat cancer? - not made explicit) began c.Aug 1999, with difficulty

swallowing. Confirmed as cancer at [name] hospital, then went to [other hospital]. Offered

choice of chemo/radio, operation or no treatment. Pt adamant that he didn't want chemo.

Had operation shortly after Xmas, "100%" successful though had heart problems in hopsital

after op. and had to go into intensive care and stay in longer. (Carer describes this as

"cardiac arrest" but also as "not a heart attack - breathing difficulties"). Also had to have a

tracheotomy for which carer had to give permission. When came home made slow but

steady progress for about 3 months, but then began losing weight again and diagnosed with

secondary cancer in his liver. Carer told that there was nothing more that could be done -

she didn't tell pt this but was sure he knew anyway. Pt was adamant that he wanted to stay

at home - disliked hospitals, and carer refers to a very long stay in his youth as at least part of

the explanation for this. Pt cared for at home - rapidly became very ill, and couldn't eat solids

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at all. Received high level of support from District Nurses and night sitters, and also from own

GP. Carer stresses excellent support given, but is very upset still about events on patient's final

night. DNs twice insisted on turning patient against carer's will, to avoid bedsores, with result

that patient became very uncomfortable. Carer then persuaded to go to bed, but in this

period patient died. Carer returns to this part of story repeatedly in the interview. After death, Carer visited regularly by DNs, and senior DN still calls in on her.

Pt expressed strong preferences re. treatment and care - not wanting chemo, wanting to be

cared for at home once no further active treatment was offered. Carer saw her role as to do what he wanted, though also expressed own preference for caring for him at home.

Carer does not feel she can go against advice of "experts" - eg re. request for permission to do tracheotomy (pg2); contributes to her upset re. pts final night (see below).

Repeatedly stresses how "wonderful" local DNs and her GP were, in amount of attention and

support they gave to pt and her. DNs visited regularly, arranged night sitters. Practice also arranged for prescriptions and dietary items to be delivered to carer.

Carer describes caring for husband at home as "hard work mentally". DNs etc were able to

help with the physical work involved. She found her inability to provide food which the

patient could/would eat frustrating and upsetting - singles this out as an area where she

would have liked more advice and help, though she does note that dieticians visited patient when first discharged from hospital.

Able to rely on "terribly good neighbours" to sit for her if she needed to go out during day.

Seems to have got good level of night sitter cover. Particularly appreciated fact that she got

to know some of the sitters well over repeated visits - one in particular. Does describe them as

"very different" in how they worked, and though praises them generally suggests some discomfort re. younger sitters' ability to cope (pg 13).

Carer didn't tell patient negative prognosis when secondaries diagnosed, and doesn't think hospital told him - but states that "he knew" anyway.

Used OOH DNs several times, but OOH GP only once (weekend) - he was well-informed about patient. No complaints about these services.

Much of interview dominated by story of what happened on patient's final night and carer's

feelings about it. She is clearly still very upset about it ("I live it every night", "it will haunt me till

the day I die" etc). Note that it wasn't until interview seemed to be near end, and interviewer

probed repeatedly re. problems, that Carer raised this episode. She repeatedly states that

she doesn't want to blame or condemn anyone, but is frustrated, upset - and perhaps angry

- that on two occasions that night her requests not to turn the patient were over-ridden by

DNs. Statement by DN on second occasion when pt turned against her wishes that "I've had

my instructions" upset carer; although uncomfortable challenging their expertise she feels

they were too inflexible. Explanation later by senior DN that they have to avoid bedsores

because "If a patient dies with bedsores, it causes quite an outcry apparently" is not

challenged in carer's account and wasn't at the time - but clearly hasn't reconciled her to

what happened. Her feelings about the suffering caused to him by turning are compounded

by fact that the night sitter was late that night (and appeared to have been called in from a

"Saturday night out"), and - more importantly - carer was persuaded to go and rest, and patient died while she wasn't by his side.

Carer received frequent post-bereavement visits from DNs, and the senior DN still

occasionally calls in to see how she is. She appreciates these visits very much, because they help her feel a sense of connection to her late husband.

Overall impression:

Carer felt generally very well-supported, but in her recollections of her husband's illness, her

experiences on his final night dominate, and appear to have led to lasting distress. There is

an impression of her being pulled in opposite directions by her feelings about that period. On

one hand she feels gratitude for the personal care and support DNs gave her and her

15

husband (and continue to give her), and she sees herself as unable to challenge their

expertise. On the other hand, she is clearly aware that the situation on his last night was

handled in - to say the least - an inappropriate fashion, with staff more concerned to "follow

instructions" (portrayed as mainly there to protect them from criticism re bed sores) than to

listen to her and what she knew to be best for her husband. The lateness of the night sitter

only compounded matters. Carer is also upset because she was not present at her husband's

death but this seems to be less of an issue than the way he was "tossed about" by nurses turning him.

Her gratitude to DNs for general level of care, and her unwillingness to challenge expertise,

left her in an impossible dilemma on night of husband's death. Her hesitancy in raising these

key aspects of her experience as a Carer suggest a continuing sense of conflict in her

feelings towards the OOH DNs - she seems to feel guilty about complaining of their poor

treatment of her and her husband on his last night.

Creating the initial template

While we did not explicitly define any preliminary (a priori) themes to include in the initial

template, we were conscious of the need to draw parallels between Carers' perceptions of

services and those of Practitioners. We were therefore particularly alert to issues touched on

in Carer interviews which related to important themes in the Practitioner analysis, which was

then at an advanced stage. For instance, we were very interested in what Carers had to say

about the information they were given on how to access help in a crisis out-of-hours. There

was clearly a danger that such an approach would lead us to overstate some aspects of the

data and neglect others. To minimise this risk, beyond simply being aware of the danger

throughout the analysis, we used the strategy of carrying out the initial open coding on a

small number of transcripts independently. We were then able to question each other about

why we had selected certain segments of text to code in certain ways, making it more likely

that we would recognise any attempts - perhaps unwitting - top shoe-horn the data into

themes that were convenient for the overall project, but which misrepresented these

participants' accounts. We then worked together to cluster the themes from open coding

into a hierarchy of themes on an initial template.

Example of transcript page with hand-written open coding:

Initial Coding

This extract occurs after Phyllis has been talking about problems that occurred on the night

her husband died, including nursing staff not listening to her and the night-sitter arriving late.

My initial open coding is shown hand-written in the margins.

16

17

Example of the initial template

Developing the "final" template

[Note that I have used inverted commas in my references to the "final" template because it is

always possible to find ways of modifying your coding as you return to the data. The version

here is the one included in the study report (King, Thomas, Bell and Bowes (2003)) . I am soon

going to begin work on a journal article based on this study; it is quite possible that I may

make changes to the template as I look at the material again for a new purpose. Remember

that the template is not the end product of a study - it is a tool to help you produce your report, paper, dissertation or whatever.]

The coding of the initial data using the initial template was largely carried out by Dennise.

We used a matrix layout to display this for ease of reference. I then went through each

transcript in turn, looking out for material we were not successfully encompassing with the

existing template, and changing the template when necessary. These changes included the

full range of types of modification discussed in my chapter on template analysis (King 1998), and which are outlined in the section describing the technique.

Some of the main changes from the initial template were as follows:

Much more detailed coding at the lowest level - This reflects the diversity of themes

emerging from a close reading of the full set of transcripts.

Merging of the "Sources of Support" and "Impressions of Services" top level codes, into

a new "Quality of out-of-hours care and support" code - By specifying sources at the

second level it was possible to make the issues relating to specific services more

apparent as third level codes. I also recognised that the initial coding did not focus

closely enough on out-of-hours issues.

Inclusion of a "General Carer Support Issues" code, with "Bereavement care" as a

second level code - On reflection, I realised that bereavement care - though an

extremely important issue - was not directly relevant to the aims of the research,

which were explicitly concerned with out-of-hours care and support where a patient

was receiving palliative care at home. It is in the nature of qualitative research that

the focus of a project can change in the light of findings, and I certainly did not want

to lose the valuable material relating to bereavement; at the same time, out-of-hours

issues needed to be central to our report. I therefore included bereavement care as

one of a number of areas raised by participants as important to their experiences as Carers, but tangential to the main aims of the study.

CRISIS CONTACT

INFORMATION

Provision of contact numbers

Carer's understanding of how to use

SOURCES OF SUPPORT Access to. GPs District Nurses

Social services Out-of-hours services

Night-sitters

Communication with.

IMPRESSIONS OF SERVICES Happy with. GPs

District Nurses Social services

Out-of-hours services Night-sitters Services in general

Dissatisfied with.

ACCESS TO DRUGS &

EQUIPMENT

Drugs left in home

Delivery from pharmacy Availability of equipment

DEATH AND BEREAVEMENT Support at time of death Bereavement support

Effects on Carer and family

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The "final" template

Final Coding

1. CRISIS CONTACT INFORMATION 1. Sources provided

1. Out-of-hours DNs

2. GP out-of-hours service

3. In-hours PHCT

2. Feelings about information 1. Reassurance

2. Confusion 3. Annoyance re. lack of information

2. QUALITY OF OUT OF HOURS CARE

AND SUPPORT

1. Out of hours District Nurses 1. Excellent service

2. Failing to listen

3. Call-out times

2. Out-of-hours GPs 1. Limited use of

2. Satisfaction with service 3. Well-informed about patient

4. Uninformed about patient

3. Other out of hours staff(night-sitters,

social services)

1. Confusion re. roles

2. Availability/lack of night sitters 3. Valued service

4. Importance of continuity 5. Concerns re. ability of younger staff to

cope

6. Reliability of service 7. Inflexibility of social services home care

provision

4. In-hours PHCT members (DNs, GPs) 1. Appreciation of availability out of hours

2. Personal commitment of staff

5. OOH staff in general 1. Good support 2. Access issues

3. DRUGS AND EQUIPMENT OUT OF HOURS

1. Access to drugs 1. Left in patient's home 2. Problems with patient self-

administration

3. Reassurance from knowing how to access in emergency

4. Arrangements for delivering prescriptions

5. Problems in collecting prescriptions

2. Access to equipment 1. Use of syringe drivers

2. Equipment delivered out of hours 3. Appreciation of access out of hours

4. Late and/or inappropriate provision of

equipment

4. GENERAL CARER SUPPORT ISSUES 1. Problems re. secondary care 1. Good clinical care 2. Long journeys

3. Waiting times

4. Poor communication with patient/carer 5. Poor communication with primary care

6. Insensitivity in dealing with

patients/carers

2. Role of Macmillan Nurses 1. Confusion re. role 2. Surprise at lack of "hands on" role

3. Social services support 1. Delays in receiving benefits 2. Delays in installing equipment

3. Insensitivity in dealing with bereaved carer

4. Bereavement care 1. Offered by PHCT 2. Counselling arranged

3. Continuing relationship with staff post-bereavement

5. Removal of drugs / equipment 1. Distress caused by failure to remove 2. Prompt action to remove by DNs

6. Overall quality of in-hours care &

support

1. Good access in-hours

2. Excellent support from PHCT

3. Poor support from individual staff

19

This is the same extract that you saw as an example of open coding. Here it shows the

coding on the "final" version of the template. Using numbers to indicate themes - rather than

a written title - makes the coded transcript much easier to read. As you get familiar with your

template, you will learn the theme numbers and not need to constantly look them up to

identify them. I suggest that if you are carrying out your analysis by hand, you use this

approach. Most packages for computer-assisted analysis will automatically number codes in some way.

Writing-up

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As I noted in the section describing the template technique, writing-up the findings of a study

can be considered as the last stage of the analysis. I always find that in the process of

drawing together the material, new insights and connections emerge, and the relative

importance of different themes to my interpretation becomes apparent. It is never just a

matter of going through the themes one by one and summarising material coded under

each - apart from anything else, given the size of most templates I've seen, such an approach would result in an interminably long report.

In the report on this study, we divided the findings into two sections. Section one presented

findings relating to the first three top level themes of the template in turn. (The fourth theme

we reluctantly cut from the final draft, simply because of word-length constraints, as this did

not directly address out-of-hours issues). We used the second level themes as sub-headings

for the second and third top level themes, but did not explicitly refer to the third level coding

(though the full template was provided in an appendix). In writing this section, I quite often

turned to case summaries, to help me identify particularly pertinent illustrations of important

issues. The tone of this section was fairly descriptive, and used direct quotes extensively. Our

aim was to try to help our readers see the issues we had prioritised from the perspectives of our participants, with minimal interpretation from us.

Extract from the Final Report

This is one of the longer sub-sections in the report, reflecting the prominence of the topic in

participants' accounts. The rather long quote from Phyllis was used because this was a

crucial example of what could go wrong in the care provided by out-of-hours nurses; by putting it in her own words I feel the incident has the strong impact it warrants.

The second section comprised a comparison between the accounts from Carers whose

Practices had used an out-of-hours handover form and those whose Practices had not. This

made considerable use of the case summaries as well as thematic coding, to identify cases

where the care and support provided appeared to have fallen short of "best practice" standards.

We highlighted what we felt to have been the main lessons learned in separate discussion and conclusion sections, which included a consideration of possible limitations of the study.

5.2.1 Out-of-hours district nurses

The district nurses were the most commonly mentioned group of out-of-hours staff, and were

consistently praised for the quality of care they gave and their attitudes towards carers and patients.

I told the nurses if it was possible to come back because I couldn't sleep that

night and they came back...and they says 'Are you alright?...and if you think you

need us again, ring us up, we'll be straight here, no problem', and I thought that was very good of them because they were really fantastic nurses. [Thelma - wife]

In a small number of cases, there were incidents which might reasonably be judged as

indicating a less than optimal quality of care by district nurses, though even here they were

reported as isolated events rather than representative of a general pattern of inadequacy.

By far the most alarming was the case of Phyllis, who cared for her 78 year old husband as he

died of cancer. On the night of the patient's death, on two occasions, visiting district nurses

appeared to have ignored her strong wishes that the patient should not be turned (since she

knew from her experience that his breathing would be seriously impaired). She describes what happened when the second group of district nurses called;

Well they came and they said 'we're going to turn him on to his side', and I said

'he can't breathe on that side' and I was getting a bit worked up I think about it. I

said 'he can't breathe on that side'...and she said 'well I've had my instructions

that he has to be turned over' and I knew it was about bed sores, but he hadn't

any bed sores at all...Well they turned him over and of course he was dead

weight because he'd had this injection and it upset me a lot and I live it every

21

night [becomes upset] and I'm sorry to have to talk like this...They turned him over

and straight away he started gasping for breath and they left him sort of, it wasn't

long, I don't think it would have been two minutes, and they said 'I see what you

mean' and they turned him back. And in my mind I saw him being turned over

and turned back and turned over and turned back, and I knew he was so poorly. [Phyllis - wife]

The carer's distress was compounded by the fact that the district nurses persuaded her,

against her better judgement, to go to bed, and her husband subsequently died while she

was asleep. Phyllis clearly felt uncomfortable criticising the nurses, especially as she was

extremely happy with the care provided throughout the rest of his illness. From an outside

perspective, while it would be unfair to criticise the staff for the fact that the patient died in

her absence, their failure to listen to the concerns of the carer and her intimate experience

of the patient's condition, seems to have undone much of the good work of primary care practitioners over the course of her husband's illness.

Several carers remarked on the length of time it took for out-of-hours district nurses to get to

them after a call (generally citing a figure of one to two hours), but almost always they

appreciated that staff were busy and did not express strong dissatisfaction with this. The one

case where the carer had evidently been angry about response time was as a result of her

being misinformed about the likely wait, compounded by feeling that a receptionist at the out-of-hours service had been "quite nasty" to her;

Like I say, they [district nurses] were brilliant, and I realise that they can't be

everywhere at once. I think really it's, when you phone up you need to be given

a better idea of just when they're going to be there. There's no point saying 'oh

fine, they're on their way' and then half an hour later - you can then make a

decision can't you, whether you think you're going to wait for them or whether you think you're going to try something else. [Karen - daughter]

FAQ

What is meant by the terms "theme" and "code"?

"Themes" are features of participants’ accounts that characterize particular perceptions

and/or experiences, seen by the researcher as potentially relevant to the research question.

Usually researchers choose to define themes where an interesting feature recurs across and/or within interviews (or other textual data sources).

"Coding" is the process of identifying where themes occur in accounts and attaching labels (codes) to index them.

Can you have more than one template for a single study?

Yes, especially when your study includes distinct groups and you feel that their different

perceptions and experiences may not be adequately captured though the same structure

of themes. It may be that having initially produced separate templates for different groups,

you judge that there is enough in common to merge them – as happened in our study of

District Nurses’ and GPs’ perceptions of developments in community palliative care (King,

Thomas and Bell, 2003). Alternately, you may feel it is most appropriate to keep separate

templates as the basis for examining the data from each group. Another reason for using

more than one template could be that you want to carry out two or more quite distinct

analyses of the same set of data.

How do I know when I’ve reached the final version of my template?

You can never absolutely reach a "final" template, in the sense of it being one that is

incapable of revision to useful effect. But on pragmatic grounds, you can apply a law of

diminishing returns to recognise when the amount of time and effort involved in recoding the

22

data to the nth iteration of the template is simply not repaid in terms of meaningful

enrichment of your understanding. I cannot tell you in the abstract when you will reach this

point, though in my experience it is usually quite easy to recognise. As a very crude rule of

thumb, it is unlikely that if you have only made one set of substantive revisions to the initial template you will have achieved a "good enough" final template.

Can you have too many, or too few, levels of hierarchical coding in a template?

There is no hard and fast rule as to the most or least number of levels you should use.

However, in practical terms I find between three and five levels usually works out well –

depending on how large and complex a data set you have. Too few levels and you are

likely to end up with a superficial analysis. Too many and you can lose one of the main

advantages of a template approach; its ability to help you – and your readers – gain an overview of the themes identified in your analysis.

When I write up a study that used TA, do I need to refer to every theme included in the template?

No; in fact in most circumstances you would be ill-advised to try to. Deciding which are the

most salient themes is a key part of analysing and interpreting your data. You will find there

are some themes that you need to devote considerable attention to, and others which you

may not need to refer to at all – especially in a relatively short piece of writing like a journal article. See the pages on The Technique: Interpretation & Writing-up for more on this.

Do templates have to be produced in a linear "list" form?

No, you can produce them in whatever format you find most helpful. The big disadvantage

of a purely linear format is that it is hard to show relationships between themes on it. The

alternative to the linear "list" that I have seen most often is a "mind-map" style of layout. This is

good where you want to indicate that a particular lower-order theme relates to more than

one higher-order theme. A hypothetical example shows how the mind-map layout can

display this more efficiently than a linear list. Imagine that a researcher has carried out a

study of people’s experiences of drinking hot beverages. She has used "type of beverage" as

a top level theme, with specific examples of hot drinks discussed by her participants as

second level. She then has a range of experiential themes which relate to various combinations of beverages. In a conventional list format the template might look like this:

1. Type of hot beverage

1.1 Tea

1.1.1 Refreshing

1.1.2 Habit-forming

1.1.3 Old-fashioned

1.1.4 Comforting

1.2 Coffee

1.2.1 Refreshing

1.2.2 Habit-forming

1.2.3 Trendy

1.2.4 Cure for hangovers

1.3 Hot chocolate

1.3.1 Old-fashioned

1.3.2 Comforting

1.3.3 Soporific

In a mind-map format, it would appear like this

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Which format you prefer is largely a matter of taste, but in the above example it is certainly

the case that the mind-map removes the need to repeat the third-level codes. Incidentally, if

you are using NVivo to help you with your analysis, the Model Explorer function is very useful for producing mind-map style templates (see the Using Computers page for more on this).

A couple of final points are worth bearing in mind regarding template format. Firstly, a

template is not a theoretical model; it is a representation of the way you have gone about

coding the data to identify themes in it. There is a danger with formats like the mind-map

that you blur the distinction between template and model, and end up with something that

does not function well as either. Of course it is absolutely fine to produce a template and

then subsequently develop it into an explanatory model. Secondly, when you come to write

up your study, you will almost certainly have to do so in a traditional form, such as a paper,

report, or dissertation. One advantage of a well-designed linear template is that it can serve as a useful readymade structure for your Findings section.

Literature

Thematic analysis of qualitative data

Crabtree, B.F. and Miller, W.L. (1999) ‘Using codes and code manuals: a template organizing

style of interpretation’, in B.F. Crabtree and W.L. Miller, (eds.), Doing Qualitative Research, 2nd edition. Newbury Park, California: Sage

Johnson, P. (1998) ‘Analytic induction’, in G.Symon and C.Cassell (eds.) Qualitative Methods and Analysis in Organizational Research. London: Sage.

King, N. (1998) ‘Template analysis’, in G.Symon and C.Cassell (eds.) Qualitative Methods and Analysis in Organizational Research. London: Sage.

Miles, M.B. and Huberman, A.M. (1994) Qualitative Data Analysis: An Expanded Sourcebook. Beverly Hills, CA: Sage.

Smith, J. (1996) Beyond the divide between cognition and discourse: using interpretative phenomenological analysis in health psychology. Psychology and Health, 11, 261-71.

Examples of research using template analysis

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Kent, G. (2000) Understanding the experiences of people with disfigurements: An integration

of four models of social and psychological functioning. Psychology, Health & Medicine, 5 (2): 117-129.

King, N., Carroll, C., Newton, P. and Dornan, T. (2002) ‘You can't cure it so you have to

endure it’: The experience of adaptation to diabetic renal disease. Qualitative Health Research, 12 (3): 329-346.

King, N., Bell, D., Martin, N., & Farrell, S. (2003) Gold Standards Framework, Phase 2:

Qualitative Case Study Evaluation – Final Report. Primary Care Research Group, School of Human and Health Sciences, University of Huddersfield.

King, N., Thomas, K., Bell, D. and Bowes, N. (2003). Evaluation of the Calderdale and Kirklees

Out of Hours Protocol for Palliative Care: Final Report . Primary Care Research Group, School of Human and Health Sciences, University of Huddersfield.

King, N., Thomas, K. & Bell, D. (2003) An out-of-hours protocol for community palliative care: practitioners’ perspectives. International Journal of Palliative Nursing 9 (7): 277-282.

McDowall, A. & Silvester, J. (2006). How do managers conceptualise training and

development? Paper presented at British Psychological Society, Division of Occupational Psychology Annual Conference, Glasgow January 2006.

Ray, G.J. (2002) An Investigation into the role perceptions in a group of male and female managers. Unpublished PhD Dissertation. The University of London.

General texts on qualitative research

Seale, C. (1999) The Quality of Qualitative Research. London: Sage.