Strengths and limitations
This research aimed to create a holistic approach to understanding
optimum Odon Device use through adopting case study research. An AVB is
a complex intervention and this makes studying the use of the device
challenging. A complex intervention can be defined as having a number of
interacting components which can act independently or interdependently
to influence outcomes. Qualitative case study methodology uses multiple
data sources from multiple cases to study phenomena: enabling the
researcher to assess differences and similarities through the
methodology of systematic cross comparison. Recently, qualitative case
study methodology has been used to explore technique in surgical
procedures however, there are no published examples of case study
methodology being used to investigate any novel devices. Triangulation
of case study findings from observations and interviews sped up the
process of device investigation by being able to promptly confirm
modifications for optimum device use. Operator interviews were
particularly beneficial in optimising techniques for device use.
Combined with rapid analysis, findings could be disseminated rapidly to
operators. By using this methodology and incorporating data from all
stakeholders and observations we were able to gain a balanced and
comprehensive assessment of the use of the device. Participant
observation was selected, enabling the researcher to play an active role
in the setting if needed and become immersed in the environment. This
allowed exploration of reality and contextual factors in real time.
However, participant observation may be influenced by the interpretation
of the individual researcher. It could be argued that participant
observation is actually good practice as reflects standard practice of
team working and learning. Interviews with operators were undertaken for
all but one case. These were of crucial importance in understanding
optimal device use. Little new data transpired from observation and
women’s interviews after eight cases, so data collection focused on
operator interview going forward. The flexibility of case study
methodology allowed data collection to respond to initial findings and
to focus on the most informative mode of data collection.
Case studies within the ASSIST Study were finite. Observations were
undertaken where possible, however due to the unpredictable nature of
AVBs it was not possible to attend all assisted births. Indeed, none of
the more complex attempted AVBs performed in the operating theatre were
observed.