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A critical evaluation of the use of interpretative phenomenological analysis
(lPA) in health psychology
Joanna M. Brocki
a
; Alison J. Wearden
a
a
School of Psychological Sciences, University of Manchester, Manchester M1! vPl, UK
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Psychology and Health
February, 2006, 21(1): 87108
A critical evaluation of the use of interpretative
phenomenological analysis (IPA) in health psychology
JOANNA M. BROCKI & ALISON J. WEARDEN
School of Psychological Sciences, University of Manchester, Manchester M13 9PL, UK
(Received 4 May 2004; in final form 23 June 2005)
Abstract
With the burgeoning use of qualitative methods in health research, criteria for judging their value
become increasingly necessary. Interpretative phenomenological analysis (IPA) is a distinctive
approach to conducting qualitative research being used with increasing frequency in published
studies. A systematic literature review was undertaken to identify published papers in the area
of health psychology employing IPA. A total of 52 articles are reviewed here in terms of the
following: methods of data collection, sampling, assessing wider applicability of research and
adherence to the theoretical foundations and procedures of IPA. IPA seems applicable and useful
in a wide variety of research topics. The lack of attention sometimes afforded to the interpretative
facet of the approach is discussed.
Keywords: Interpretative phenomenological analysis, health psychology, qualitative methodology
What is interpretative phenomenological analysis (IPA)?
Interpretative phenomenological analysis (IPA) has been developed as a distinctive
approach to conducting qualitative research in psychology offering a theoretical foundation
and a detailed procedural guide. As such, it has been utilised in a burgeoning number of
published studies (Chapman & Smith, 2002). The intellectual origins of IPA and the
history of its development as a new technique for qualitative health psychology are
beyond the scope of this article. The interested reader is referred to Smith (1996) and
Smith, Flowers and Osborn (1997) for an exploration of the historical and theoretical
foundations to the approach. It is sufficient to note here that the approach has its origins
in those fields of inquiry, such as phenomenology and symbolic interactionism, which
Correspondence: Joanna M Brocki, School of Psychological Sciences, University of Manchester, Coupland1
building Oxford Road, Manchester M13 9PL, UK. Tel: 44 161 275 2693. Fax: 44 161 275 2588.
E-mail: joanna.brocki@student. manchester.ac.uk
ISSN 0887-0446 print/ISSN 1476-8321 online 2006 Taylor & Francis
DOI: 10.1080/14768320500230185
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hold that human beings are not passive perceivers of an objective reality, but rather that they
come to interpret and understand their world by formulating their own biographical stories
into a form that makes sense to them. The aim of IPA is to explore in detail the processes
through which participants make sense of their own experiences, by looking at the respon-
dents account of the processes they have been through and seeking to utilise an assumed
existing universal inclination towards self-reflection (Chapman & Smith, 2002; Smith
et al., 1997). Thus, IPA research has tended to focus on the exploration of participants
experience, understandings, perceptions and views (Reid, Flowers, & Larkin, 2005). The
processes referred to here include all these aspects of self-reflection, and refer to the
way in which IPA assumes that participants seek to interpret their experiences into some
form that is understandable to them.
IPA is phenomenological in that it is concerned with individuals subjective reports rather
than the formulation of objective accounts (e.g. Flowers, Hart, & Marriott, 1999), and
it recognises that research is a dynamic process (Smith, 1996). Whilst the researcher
attempts to access the participants personal world (p. 218) insofar as this is feasible,
IPA acknowledges that access depends on and is complicated by the researchers own
conceptions . . . required in order to make sense of that other personal world through a
process of interpretative activity (pp. 218219) (Smith, Jarman, & Osborn, 1999). The
term interpretative phenomenological analysis is therefore used to signal the dual facets
of the approach (Smith et al., 1999) and the joint reflections of both participant and
researcher form the analytic account produced (Osborn & Smith, 1998; Smith et al.,
1997). Smith (2004) describes IPA as phenomenological in its principle focus on the
individuals experience (Smith cites Giorgi A. & Giorgi B., 2003) and strongly connected
to the interpretative or hermeneutic tradition (Palmer, 1969) (p. 40) in its recognition of
the researchers centrality to analysis and research. It is acknowledged that interpretations
are thus bounded by participants abilities to articulate their thoughts and experiences
adequately (Baillie, Smith, Hewison, & Mason, 2000) and, it would follow, by the
researchers ability to reflect and analyse.
The particular relevance of IPA to health psychology
It has been suggested that IPA may have particular relevance for health psychology (Smith
et al., 1999) and the vast majority of published work using IPA has been in this field. With a
move away from a simple biomedical model of disease and illness, where an observable
bodily process is held to map onto a predictable illness experience in a fairly simple way,
there has come an increasing recognition of the constructed nature of illness. Health
psychologists have realised the importance of understanding patients perceptions of and
interpretation of their bodily experiences, and the meanings which they assign to them
(e.g. Leventhal, Nerenz, & Steele, 1984). IPA allows us to explore these subjective experi-
ences, and helps us to describe and understand the respondents account of the processes by
which they make sense of their experiences. According to Smith (1996), this type of
approach has, until recently, suffered neglect in mainstream health psychology. In the
past, health psychology has primarily employed quantitative research approaches
(Chamberlain, Stephens, & Lyons, 1997). Advocates of IPA argue that studies employing
qualitative methodology might usefully supplement typical quantitative studies in this
discipline, either collaboratively, elucidating operating processes within models
(Thompson, Kent, & Smith, 2002 highlight the need for research in this area to explore
process, rather than adjustment outcome), or more usefully and meaningfully addressing
particular research questions (Smith, 1996). Johnson, Burrows and Williamson (2004)
88 J. M. Brocki & A. J. Wearden
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contrast research concerned with prevalence or cause and effect (p. 363), to approaches
exploring meaning and context, suggesting that the latter better allow for the exploration
of complexity and make fewer (possibly ill-founded) assumptions prior to commencing
research.
Smith (1996) describes a split in social psychology between traditional quantitative
paradigms and alternative epistemological and methodological approaches (p. 261),
specifically between social cognition and discourse analysis (Smith, 1996). IPA is suggested
as potentially compatible in this regard with both approaches (Clare, 2003). In comparison
with content analysis, which seeks to produce a quantitative analysis of discrete categories
from qualitative data, in IPA the importance of the narrative portrayal remains paramount,
with the final analysis providing a detailed interpretative analysis of themes. IPA starts with,
but should go beyond, a standard thematic analysis. For example, Warwick, Joseph, Cordle
and Ashworth (2004), in a study of the social support received by women with chronic
pelvic pain, firstly listed expressions relating to support experiences and categorised them
according to pre-defined categories derived from the literature. During the interpretative
phase of their analysis, they revisited the data, and this time analysed how the expressions
categorised earlier reflected respondents individual and unique experiences. This led to the
extraction of a second, different, set of themes. Both sets of themes were then incorporated
into a narrative about the womens experiences.
Whilst, like discourse analysis, committed to qualitative methodology, IPA is also
concerned with cognitions. Willig (2001) argues that this concern with cognitions may
not be compatible with some aspects of phenomenology, which she contends to be
concerned with non-propositional, pre-cognitive knowledge, although other definitions of
phenomenology include more cognitive elements. However, the challenges that discourse
analysis makes to the assumptions of the cognitive approach (e.g. Potter & Wetherell,
1987) sit uneasily with health psychologys assumption of a relationship between beliefs
about health status and behavioural change and cognition and physical state (Smith et al.,
1997; Smith, 1996).
Johnson et al. (2004) present an analysis of the impact of bodily changes during
pregnancy which utilises aspects of both IPA and Foucauldian discourse analysis.
Their argument for connecting the two approaches is made on the grounds of pragmatic
theory the choice of approach should be based upon the goals of the research (p. 364).
They also argue that the two approaches share a number of important features making them
compatible, including the assumption that the same phenomenon can be constructed in
different ways (p. 364). Larkin and Griffiths (2004) suggest that a primary focus on experi-
ence (phenomenology), with a later focus upon a wider range of epistemological
approaches (p. 219) is an approach to analysis adhering precisely to the principles of IPA.
Whilst IPA has primarily been used in the health psychology arena, it has been used in
other research areas, albeit more infrequently. The main reason for this, aside from its
particular suitability to the area already discussed, is likely to be more an accident of
birth those who introduced IPA happen to work in this area. Smith and Osborn
(2003) describe IPA as especially useful when one is concerned with complexity, process
or novelty (p. 53). Although this certainly fits the research purposes of much of health psy-
chology, this description may also appeal to other areas of psychology research. Perhaps the
application of IPA methodology in a restricted area of research is also due to the limited
usage of qualitative methodology in psychology generally (Munley et al., 2002) and the
corresponding proliferation of qualitative methods in health research (Yardley, 2000).
Additionally, another reason for the use of IPA in health research might be that people
are interested in hearing others illness narratives, satisfying an innate need to learn about
The use of IPA in health psychology 89
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the lives and experiences of others. Illnesses occur over time and it is over time that the pro-
cesses in which IPA is interested unfold.
Why undertake a review of IPA research?
Whilst there is an increasing corpus of studies utilising IPA in health psychology, a review of
how this methodology has been applied has not been undertaken previously. The present
article seeks to look at how and when IPA has been used in published studies in the
arena of health psychology. As well as serving a useful archival function, it is hoped that
the extent to which published papers conform with the stated ideals of IPA will be
established. The following areas will be reviewed: methods of data collection, sampling,
assessing wider applicability of research and adherence to the theoretical foundations and
procedures of IPA.
For the purposes of this article, a literature search was carried out in March 2004, and
then updated in November 2004, using the Web of Science database (19452004) to
identify published studies using IPA and classified as health-related. The search term inter-
pretative phenomenological analysis identified 55 articles and a further seven articles were
obtained following up references. Two articles were meeting abstracts, three articles
provided reviews rather than new empirical work and four articles were not considered to
be health-related. One article used a grounded theory approach rather than IPA. The
remaining 52 articles have been used in this review. A brief overview of the studies reviewed,
their topic of investigation and the participants involved in the research is provided in
Appendix 1.
How were data collected?
Semi-structured interviews
Smith and Osborn (2003) describe semi-structured interviews as the exemplary method for
IPA and the vast majority of work published using IPA follows suit (46 of the papers
reviewed here with a further three studies using both interviews and focus groups).
Alexander and Clare (2004) describe their interview process as collaborative, emphasising
that the participants were the primary experts (p. 82) and this sort of approach is
certainly in keeping with the aims of IPA research. In the majority of studies, interviews
were conducted face to face with Turner, Barlow and Ilbery (2002) using telephone
interviews due to geographical limitations and acknowledging possible limitations.
Murray (2004) and Murray and Harrison (2004) used both face-to-face and email
interviews. Reynolds and Prior (2003) analysed both interview transcripts and written
narratives, and express some concern that in the former, participants may have been
doing some presentational work to convey their replies in a manner thought desirable.
However, this can be addressed within the IPA analysis and it is unclear why participants
might not also engage in the use of similar self-presentational devices (if indeed
these were used) in the case of written narratives. Alexander and Clare (2004) invited
respondents who lived outside the geographical boundaries of the study to submit written
narratives. Whilst not including these in their final account, the authors reflections
(p. 74) on these are described as helping to shape the final analysis presented.
Of those papers employing interviews, the vast majority followed a semi-structured
format, employing some sort of interview schedule. Interview questions are generally
described as open-ended and interview style as non-directive. All papers express a desire
to use the interview schedule to facilitate the participants ability to tell their own story in
90 J. M. Brocki & A. J. Wearden
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their own words, a central premise of IPA (Smith et al., 1997) but few describe the process
of designing the interview schedule and few give examples of prompt questions used to
facilitate disclosure. Indeed, little guidance is given as to the extent to which the interviewer
should interpret what is being said as the interview proceeds, and the extent to which these
interpretations should be shared with the interviewee. Smith and Osborn (2003) suggest the
use of minimal probes (e.g. how did you feel about that?) (p. 63) and note that the effect
of the interview on the respondent should be monitored, with the respondent ideally
being allowed a strong role in how the interview proceeds (p. 63). Authors tend to
describe questions posed as open-ended allowing for the introduction of new topics and
some (e.g. Collins & Nicolson, 2002; Carradice, Shankland, & Beail, 2002) provide a
summary at the end of the interview session to ensure participants views were fully under-
stood and offering the opportunity to add any additional points. However, without details of
interview construction or a copy of the interview or focus group discussion guide in the
appendices (rarely did the articles reviewed here provided this or detail where such a
copy could be obtained and not all remaining articles even provided examples of questions
posed) it is difficult for the reader to judge the quality of the interview and the impact this
might have had on the data subsequently obtained. The questions posed must be crucial to
the replies obtained. Authors might justify this omission on the basis that the interview
schedule was used only as a framework. Most papers (but not all) list the topic areas covered
in the interview but if themes subsequently elicited are greatly similar to the topic areas
investigated then researchers are in effect structuring the analysis before the process of
data collection begins. Swift, Ashcroft, Tadd, Campbell and Dieppe (2002) readily
acknowledge that the structure and focus of their interview provided a framework for
subsequent analysis. Given the stated recognition in IPA of the researchers interpretative
role in analysis (e.g. Smith, 1996), it would seem apt for such an acknowledgement to be
made generally of the researchers involvement (including the role of preconceptions, beliefs
and aims) prior to the analysis stage of the research proceedings. Where details of interview
construction were given, details provided tended to be fairly brief. Interviews were often
designed on the basis of theory or existing writings (Michie, Hendy, Smith, & Adshead,
2004 based their interview questions on theoretical constructs identified in previous
research; Swift et al., 2002, used Aristotles theory of virtue and vice to construct a guide
for interviews; Flowers, Marriott, & Hart, 2000b used both previous exploratory qualitative
work and empirical quantitative work; Turner & Coyle, 2000, based their questionnaire on
findings from similar fields of research and current literature; Turner et al., 2002, used
established interview schedules to help generate specific questions). In a different approach,
Robson (2002) used completely unstructured interviews and purposely made no detailed
literature review of the research topic until after analysis of the data was complete. There
is no reason why either approach is incompatible with the use of IPA but given IPAs
recognition of the dynamic role of the researcher, the approach to data collection should
perhaps be discussed in more detail in qualitative research and be subject to more rigorous
examination. The role of the interviewer in generating the account is not always made
entirely clear: is the interviewer intended to be passive and to do their work primarily at
the interpretative stage or might the interviewer influence the account given through
active listening, prompting and encouraging further disclosure on selected topics? Smith
and Osborn (2003) suggest that, in movement away from the schedule, the researcher
must decide how much movement is acceptable, whilst being aware that novel avenues
may be the most valuable to, and enlightening of the investigation. There is a role for the
interpretative facet of IPA in data generation as well as data analysis. Realistically, it may
be that the pragmatics of publication and the existence of word limits demand that
The use of IPA in health psychology 91
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descriptions of methodology be curtailed in preference to diluting the analysis section.
It may be that researchers writing up qualitative research, in an effort to prove their
credibility, are obliged to do so in terms of generalised traditional criteria which may not
be appropriate.
A related issue to the matter of interview design is the possible use of IPA within a
pre-existing theoretical framework, which again may impact upon information provided
by participants. Green, Payne and Barnitt (2004) used the self-regulation model
(e.g. Leventhal et al., 1984) as a framework for analysis and acknowledge that this
might arguably have imposed constraints on the analysis (p. 336). However, Green
et al. (2004) suggest that the outstanding themes (most notably in their analysis of
uncertainty) still emerged and the ways in which they related to different elements of the
model then described. Swift et al. (2002) used Aristotles theory of virtue and vice as a
guide for both interview construction and analysis but generally, if studies discuss theory,
they do so subsequent to the process of data collection Turner and Coyle (2000) use
identity process theory as a framework for understanding participants accounts; Smith
(1999) links the findings in his study to a theory of the relational self; Carradice et al.
(2002) compare a model derived from their data with the stress process model; Senior,
Smith, Michie and Marteau (2002) discuss experiences described by their participants in
terms of the causal attributions made and consider this process in terms of models of illness
perception. Schoenberg and Shiloh (2002) refer to the theoretical approach-avoidance
conflict model used to analyse their data as the researchers own conceptions (p. 124).
Smith and Osborn (2003) state that in IPA research there is no attempt to test a pre-
determined hypothesis of the researcher; rather the aim is to explore, flexibly and in
detail, an area of concern (p. 53). IPAs suitability for application to novel research
questions means that work within pre-existing theoretical frameworks might not always
be appropriate or possible. However, it is not the case that such usage is prohibited
by the desire of IPA advocates to maintain flexibility and avoid coming to the analysis
with preconceived ideas. In fact, it seems unlikely that researchers could embark upon
a project without having at least some awareness of the current literature and issues
surrounding the area.
Issues surrounding reflexivity affect all qualitative approaches to research, not just IPA.
IPA does in fact often go further than many other approaches in addressing these issues.
A focus on researcher characteristics may not necessarily benefit readers interpretations
of an analysis and might perhaps even represent a misleading diversion. However, it
would perhaps represent best practice for researchers to present appropriate reflections
on their role in the dynamic process of analysis where this might be argued to have had a
significant impact on the final narrative account presented and in the course of the research
itself. Whilst this issue affects other approaches to qualitative research, IPA explicitly
recognises the interpretative facet of the approach in its theoretical grounding and it can
be argued that researchers who choose to utilise this method are thus under a certain
obligation to address this issue.
Alternative methods of data collection
Four of the papers reviewed used focus groups as a means of eliciting data, all using a
schedule to structure group discussions. Dunne and Quayle (2001) argue that this data
collection technique is ideally suited to research investigating issues of concern to an
accessible, circumscribed and homogenous population (p. 680). Smith (2004) expresses
some caution about the use of focus groups, arguing that IPA is committed to the detailed
92 J. M. Brocki & A. J. Wearden
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exploration of personal experience (p. 50). Flowers, Duncan and Knussen (2003),
Flowers, Knussen and Duncan (2001) and Flowers, Duncan and Frankis (2000a) used
focus group data in conjunction with interview data and note that there are potential
differences in the data yielded. However, Dunne and Quayle (2001) are convinced
(p. 682) that their participants gave essentially the same accounts as they would have
done if interviewed individually. They argue that there is little difference in the demand
characteristics of the two settings but provide little evidence for this claim. Perhaps this
may be dependent upon the topic of discussion for a more neutral topic such as service
provision this may indeed be the case, but the discussion of more personal matters such
as sexual health issues may elicit very different data in the two settings. Dunne and
Quayle (2001) provided the opportunity for members of the group to add any additional
views at the conclusion of the discussion and assert that participants would have taken
the opportunity to question the validity of the project as a whole had that seemed necessary
(p. 682). Whilst in keeping with the interpretative facet of the IPA approach these reflec-
tions are, nonetheless, purely speculative. Flowers et al. (2000a), Flowers et al. (2001) and
Flowers et al. (2003) present analysis of their focus group and interview data in
combination. They acknowledge that this mixing of data is potentially problematic but
maintain that with their specific research populations and the particular dynamics of the
groups a synergistic effect (p. 669) was produced, adding to the analysis presented
(Flowers et al., 2001).
Dunne and Quayle (2001) reflect on the possible impact of group dynamics in focus
groups and argue that the processes through which such groups are assembled and run
(i.e. homogeneity of population from which participants drawn; intimate knowledge of
and concern with research topic; use of moderation in the discussion), address the potential
problem of group dynamics taking precedence over discussion topic. In all the three papers
discussed here, participants were recruited from existing support groups and were already
known to each other. Dunne and Quayle (2001) argue that this is likely to reduce the
dominance of interpersonal factors but provide no evidence from the literature to support
this. In fact, Leask, Hawe and Chapman (2001) found that in focus groups consisting of
pre-existing groups, pressures of group conformity were accentuated and argue that the
level of homogeneity in natural groups reduces diversity of results with pre-established
group norms and leadership patterns increasing the potential for conformity. However,
Leask et al. (2001) accept that natural groups may be preferable when exploring sensitive
topics and when studying narrow target populations. In Dunne and Quayles (2001)
study, group participants were women with iatrogenic Hepatitis C and the authors suggest
that group members were likely to be more concerned with topic-related issues than with
group dynamics per se. One of the authors acted as co-moderator for the group and part
of her assigned task was to monitor the group for any evidence that interpersonal dynamics
were influencing the topic focus of the group. According to Dunne and Quayle (2001), no
significant impact was observed but the authors do not provide the criteria used to ascertain
this and it is unclear as to how the moderator would know how, or if, interpersonal
dynamics were affecting topic focus in any way.
Larkin and Griffiths (2002) used IPA to analyse observational notes. Whilst recognising
the selective and interpretative nature of note-taking, the authors argue that this problem
can be equated to problems surrounding levels of transcription (p. 308). They point out
that, in qualitative research, data is always a selective account of the event itself
(p. 308) (which may also be the case for some forms of quantitative research e.g. partici-
pants responding to questionnaires will form their own interpretations of the questions
posed) and suggest that the analysis they present is reasonably plausible, well grounded
The use of IPA in health psychology 93
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in the data and essentially an insiders perspective (p. 309) (Larkin & Griffiths, 2002).
They do, however, acknowledge that it may not be possible to offer interpretations with the
same depth or confidence as one might when working with a different qualitative research
method.
In conjunction with interview data, Smith (1999) used diaries as the main data source for
his case studies of women undergoing the transition to motherhood. Open instructions were
given to participants and weekly entries made. The diaries were collected by the researcher
at regular intervals to allow comparability of participants reconstructive accounts and
diaries were completed conscientiously (p. 411) (Smith, 1999). Smith (1999) notes
that the use of longitudinal case-studies allowed detailed study of the processes of
preparatory significance (p. 421) in pregnancy. Diaries seem to provide an excellent
alternative to providing a narrative account for analysis.
Email was chosen as the mode of communication in Turner and Coyles (2000) study,
primarily due to geographical limitations, although the authors argue that its immediacy
(in comparison to traditional postal methods) facilitated dialogue and follow-up and suggest
that the richness of the data obtained argues for its use as an intermediary between postal
questionnaires and interviews. Murray and Harrison (2004) and Murray (2004) both used
email interviews, allowing prolonged contact between researcher and participants (p. 965).
Murray (2004) suggests that the interview data obtained via email was more frank . . . more
focused . . . more reflectively dense (p. 965) than that obtained face-to-face and suggests
this might be a result of the additional time afforded to online respondents to consider
their replies prior to responding. Murray (2004) also analysed communications made
over a two-year period on an online discussion group in his analysis of the embodiment
of artificial limbs in conjunction with interview data. He argues that the analysis of
naturally occurring communication (p. 965) is advantageous in this context. However,
although IPA is flexible enough to allow for the use of differing data collection methods,
it would be useful for authors to acknowledge how these differences might affect the data
obtained and the possible advantages and disadvantages of mixing methods. In the case
of both focus groups and analysis of online discussion forums, it might, for example,
conceivably not be possible to obtain an account of participants experiences in the same
depth as a one-to-one interview focused on discussion of the topic might. Of the studies
reviewed here, such acknowledgements and reflections are not consistently reported.
How many participants were included and what was the sampling strategy?
In the studies using interviews reviewed here, participant numbers vary from one (Robson,
2002) to thirty (Collins & Nicolson, 2002 although the authors present an interpretative
account of just one interview, necessitated, they argue, by their desire to represent an
IPA approach). The largest number of transcripts included in an analysis was a total of
forty-eight (Clare, 2002, 2003, interviewed twelve patients and their spouses separately,
on two occasions). Smith and Osborn (2003) note that sample size depends on a
number of factors and that there is no right sample size (p. 54). As an idiographic
method, small sample sizes are the norm in IPA as the analysis of large data sets may
result in the loss of potentially subtle inflections of meaning (p. 626) (Collins &
Nicolson, 2002) and a consensus towards the use of smaller sample sizes seems to be
emerging (Smith, 2004; Reid et al., 2005).
Turner et al. (2002) used twelve participants in their study as they felt that at this point
data saturation (defined in this instance as no new themes emerging) had been achieved.
However, saturation is a problematic concept in this context. Smith et al. (1999) comment
94 J. M. Brocki & A. J. Wearden
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on the cyclical or iterative nature of analysis, in which passages are analysed repeatedly in
the light of insights obtained from other sources. This is a process which could theoretically
continue ad infinitum. In qualitative research, it is always possible that the next interview
might be the one to produce confounding evidence and it is therefore important that
researchers acknowledge limits to the representational nature of their data. According to
Elliott, Fischer and Rennie (1999), qualitative research should strive to achieve under-
standing represented in a way that achieves coherence and integration while preserving
nuances (pp. 222223) and perhaps it is when the researcher feels that their analysis has
achieved these goals whilst telling a suitably persuasive story that the analysis may be
considered sufficiently complete.
IPA sampling tends to be purposive and broadly homogenous as a small sample size can
provide a sufficient perspective given adequate contextualisation (Smith & Osborn, 2003).
In this respect, IPA differs from other methodologies, such as grounded theory, as in IPA
the aim is to select participants in order to illuminate a particular research question, and
to develop a full and interesting interpretation of the data. Grounded theory, on the
other hand, uses theoretical sampling, which aims to keep collecting data in the light of
the analysis that has already taken place, until no new themes are emerging. Thus, while
grounded theory seeks to establish claims for the broader population, IPA studies tend
to be more concerned with examining divergence and convergence in smaller samples.
Holt and Slade (2003) argue that the validity of qualitative research should be assessed in
terms of the applicability of the illustrated themes to similar situations. However, most
papers employing IPA do not aim to achieve a representative sample in terms of either
population or probability. Touroni and Coyle (2002) note that the parameters of their
target population (lesbian parents) are in fact not known. Smith, Michie, Stephenson
and Quarrell (2002) interviewed fairly comparable cases in the hope that this would
facilitate the analysis of patterns of similarity and difference within the group. Touroni
and Coyle (2002) argue that qualitative research seeks to produce in-depth analyses of a
small groups accounts rather than representative samples. Conclusions drawn are thus
specific to that particular group and generalisations should be approached with caution
(Flowers, Smith, Sheeran, & Beail, 1997). Smith (1999) argues that from an idiographic
perspective, it is important to find levels of analysis which enable us to see patterns
across case studies while still recognising the particularities of the individual lives
from which those patterns emerge (p. 424). He asserts that, in his study of womens experi-
ence of pregnancy, a web of patterning across three womens lives is described and suggests
therefore that the theory of a relational self developed from this data corpus has applicability
to some women in this transitional period (pregnancy), meaning that the theory is of value
(Smith, 1999). Smith (1999) argues that such research should be judged first and foremost
on how illuminating it is of the particular cases studied and that the micro-level theorising
should be richly informative of those particular individuals and may well be fairly modest in
its claims to generalisation (p. 413). Duncan, Hart, Scoular and Bigrigg (2001) explicitly
state that they make no claims as to the generalisability of their results but suggest rather
that the data obtained might be useful in providing some insights. Hunt and Smith
(2004) hope that their research into the experience of carers of stroke patients might
have clinical implications for such families. Chapman (2002) interviewed people living
with genetic conditions and suggests that, given the importance of this populations invol-
vement in wider bioethical debates (p. 195), the use of qualitative methodology picks up
these salient beliefs . . . very well . . . (with the data) then available for dissemination to wider
audiences (p. 205). Touroni and Coyle (2002) argue that qualitative research advances
knowledge through a series of detailed, small-scale studies and Turner et al. (2002) also
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suggest that such methodologies achieve a specific and deep knowledge. Carradice et al.
(2002) describe a theoretical model formulated from the combined data of individual par-
ticipants. They note that their analysis showed heterogeneity in the individual models with
individuals having a more limited understanding than that suggested by the group model
(p. 25) (Carradice et al., 2002). Flowers et al. (2000b) and Flowers, Smith, Sheeran and
Beail (1998) also point out that not every participant in their studies articulated the
themes identified, with some participants presenting a plurality of themes and some describ-
ing contradictory themes. According to Smith and Osborn (2003), IPA is not opposed to
making general claims for larger populations, but is committed to analysis of small numbers
of cases which may subsequently lead on to generalisations.
Some researchers do argue for the generalisability of their study results. Golsworthy
and Coyle (2001) adopted a theoretical sampling strategy in an attempt to recruit a hetero-
geneous sample and capture a diversity of perspectives and argue that this analytic
method is more concerned with capturing experimental and conceptual diversity than
with quantification (p. 186). MacLeod, Craufurd and Booth (2002) used a maximum vari-
ety sampling technique (the patients interviewed were being seen for a variety of reasons
and the extent to which the conditions they had were controllable, varied) and note that
this sampling technique is particularly useful in exploring abstract concepts. Swift and
Wilson (2001) used a heterogeneous participant group which they deemed suitable for
their exploratory study. Carradice et al. (2002) believe that the generalisability of findings
in qualitative research is important and go so far as to argue that when considering a qual-
itative study, the research should be evaluated by applicability of the concepts to other
situations and to others involved in the phenomenon (p. 25). Salmon (2003) points out
that although qualitative researchers may disown generalisability, they may be less clear
about what should replace it. Whilst an IPA analysis may not strive for generalisability,
neither should it merely be the retelling of respondents accounts. The inductive nature
of IPA allows authors to discuss their analysis in the light of varied existing psychological
theories, models or approaches. For example, Flowers et al. (1997) use their analysis of
sexual decision making in gay men to highlight the inadequacies in psychological theories
relating to sexual health and sexual health promotion.
What are the methodological criteria for carrying out analysis?
All papers reviewed here explicitly state that they are utilising IPA, except Walker, Holloway
and Sofaer (1999) who, although referring to Smiths (1996) paper, describe their method
of analysis as inductive interpretations using a phenomenological framework and Jarrett,
Payne, Turner and Hillier (1999) who describe their analysis as an approach based on
IPA (p. 139). The extent to which authors describe the analysis process varies from paper
to paper with many referencing Smith et al.s (1999) detailed account of the
analytic process. Theoretical preconceptions brought by researchers to the data analysis
process are recognised by IPA (although this is not always done explicitly in the
papers reviewed here) and the process is not merely one of practical categorisation of
data. Analysis requires close interaction between analyst and text: the analyst seeks
to comprehend the presented account whilst concurrently making use of his or her own
interpretative resources (p. 223) (Smith et al., 1999). Smith (2004) argues that the quality
of the final analysis is determined by the personal analytic work done at each stage of the
procedure (p. 40).
Whilst the provision of guidelines to analyses serves to foster the accessibility of IPA,
such guidelines are intended for adaptation and development rather than stagnating
96 J. M. Brocki & A. J. Wearden
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the development of the approach (Smith, 2004). Not all researchers proceeded with
their data analysis in the same way and Smith et al. (1999) explicitly state that it is not
appropriate to provide a prescriptive methodology for IPA. In comparison to other
methodologies, whilst there is a basic process to IPA (moving from the descriptive to the
interpretative), the method does not seek to claim objectivity through the use of a detailed,
formulaic procedure. Senior et al. (2002) first categorised each transcript into broad
themes, working back from these into more specific themes. Different researchers use the
initial familiarisation stage in different ways. Collins and Nicolson (2002) used this stage
of the analysis to make notes about anything in the transcript related to previous literature
and theoretical models of the research topic. Swift et al. (2002) also used the theory upon
which their interview was based as a starting point. However, Smith (1999) at this stage
preferred to concentrate on themes and connections available within the text, rather
than attempting to find instances that would fit a particular pre-existing theoretical
viewpoint (p. 411). Turner et al. (2002) also used a process of open-coding (a technique
from grounded theory detailed by Strauss & Corbin, 1990) to prevent interpretations
based on associations in the literature and their analysis is thus mainly organised around
themes which emerge from the transcripts rather than pre-determined constructs (p. 289).
Evaluating the analysis
Jarman, Smith and Walsh (1997) recommend that IPA researchers should take particular
care in their production of lists of themes to ensure that each theme is actually represented
in the transcripts. Themes are not selected only on the basis of prevalence. Other factors
including the articulacy and immediacy with which passages exemplify themes (perhaps
the eloquence with which one participant summarises the point may best sum up what
many others sought to say in more words and less precisely) and the manner in which
the theme assists in the explanation of other aspects of the account are also important
considerations (Smith et al., 1999). For example, if it were found that self-identity were
to emerge as an important theme (for instance, see Smiths (2004) example of chronic
back pain), then this might assist in explanations of another aspect of the account, perhaps
relationships with others. Care should be taken to minimise researcher bias in the process of
selecting themes for analysis (Smith et al., 1999). For example, Collins and Nicolson
(2002) report a final rereading of the original transcripts to ensure that interpretations
were grounded in participants accounts. Smith and Osborns (2003) guidelines recom-
mend that care is taken to distinguish between the participants original account and the
analysts interpretations. The centrality of researcher subjectivity in this kind of work
means that traditional research evaluation criteria such as representative samples and
appropriate statistical analyses are irrelevant (Touroni and Coyle, 2002; Yardley, 2000).
In all but one of the papers reviewed here, verbatim extracts from transcripts provide
a grounding in examples (p. 222, Elliott et al., 1999) which, acting as alternative
criterion, allow the reader to make his or her own assessment of the interpretations
made. Extracts may be selected as exemplars of a theme with those presented representing
the most articulate expression (pp. 668669) of that theme (Flowers et al., 1999, 2000a,
2000b and 2001). Although recognising that the use of verbatim extracts is central to IPA
(p. 608), Wilson, Christie and Woodhouse (2004) do not provide quotations in an effort to
save space, although they do state that these may be obtained through correspondence with
the authors if wished. Given the centrality of such quotes as a form of evaluation in quali-
tative research (e.g. Elliott et al., 1999), their absence in a published paper seems wanting.
The use of IPA in health psychology 97
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As a qualitative research method, IPA is inevitably subjective as no two analysts working
with the same data are likely to come up with an exact replication of the others analysis.
Although this fact is recognised and welcomed by advocates, for others this may raise
questions of validity and reliability (Golsworthy and Coyle, 2001). Some papers had
analyses checked and interpretations validated by other academics or professionals, either
involved in the research (e.g. Duncan et al., 2001; Smith et al., 2002, Alexander &
Clare, 2004) or independently (e.g. Walker et al., 1999; Turner & Coyle, 2000; Robson,
2002; Clare, 2002). Transcripts may be analysed by a number of researchers
independently before a joint thematic framework is agreed (e.g. Michie et al., 2003).
Some researchers asked participants for feedback on preliminary interpretations (Smith,
1999; Turner & Coyle, 2000; Alexander & Clare, 2004), whilst Touroni and Coyle
(2002) discussed their analysis with members of their target population who did not
meet study eligibility criteria. Yardley (2000) argues that reliability may be an inappropriate
criteria against which to measure qualitative research if the purpose of the research is to
offer just one of many possible interpretations. The papers reviewed here often acknowledge
the themes examined to be a subset of the total themes extracted, focusing on the data
from a particular viewpoint (e.g. Smith, 1999). This is in keeping with IPAs recognition
of the researchers interactive and dynamic role. For those who question the objectivity
of knowledge, the use of inter-rater reliability (p. 218) measures merely produces an
interpretation agreed by two people rather than functioning as a check of objectivity
(Yardley, 2000). The aim of validity checks in this context is to not prescribe to the singular
true account (p. 69), but to ensure the credibility of the final account (Osborn &
Smith, 1998).
Interpretative role of the researcher
The interpretative role of the researcher in terms of data analysis is not always referred to in
much detail by authors with some making no mention of it at all. In such cases, given the
explicit recognition of the interpretative role of the researcher in IPA, the fact that the
researchers have chosen to utilise this method of data analysis must involve a tacit
acceptance of this role, even if it is not mentioned outright. Some authors acknowledge
the role of the researcher in data analysis but provide no further details whilst others reflect
more on their role in research and analysis. Flowers et al. (1998) describe the analysts
attempt to acknowledge and suspend any existing knowledge of the field and personal
experiences within it . . . in an attempt to see the world as it is experienced by the respon-
dent (p. 412). Smith (1999) notes that the analysis process is not entirely inductive. In his
study of the transition to motherhood, he was struck by participants many references to
their significant others and consulted literature in this area thus a symbiotic relationship
also exists between the comparing of individual cases and the writing of Mead who the
investigator was reading at the time (p. 412). Smiths aim was to propose a theoretical
model which, while influenced by a metatheoretical position has been derived from and
is grounded in, rather than predates and constrains, a body of data (p. 412) (Smith,
1999). In Collins and Nicolsons (2002) study, the researcher made summary notes imme-
diately after each interview and kept self-reflective notes throughout the research project.
Clare (2002) provides details of pre-existing assumptions held by the researcher prior to
analysis. Touroni and Coyle (2002) and Reynolds and Prior (2003) express a hope that
their different respective interpretative positions might mean that they were sensitive to dif-
ferent aspects of the data and along with Osborne and Coyle (2003) and Golsworthy and
Coyle (2001) provide details of factors they believe may have shaped their interpretative
98 J. M. Brocki & A. J. Wearden
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frameworks. Golsworthy and Coyle (2001) note that these will inevitably have influenced
what was attended to in the interviews and fostered a tendency to prioritise certain
themes over others, possibly also affecting the extent to which a critical approach was
taken to certain concepts. However, it is argued that due to the awareness of these possibi-
lities, conscious attempts were made to bracket preconceptions and concerted efforts
were made to ensure that interpretations were grounded in the data (Golsworthy &
Coyle, 2001). Carradice et al. (2002) note that characteristics of the main researcher
may have introduced bias but also potentially have avoided other biases. However, they
argue that credibility was ensured by the adoption of measures such as having the analysis
scrutinised by others.
Smith (2004) addresses the question of how one is to establish what is a good enough
interpretation (p. 46) and identifies several different levels of interpretation (e.g. social
comparison, temporal, metaphorical). IPA accounts should be both sufficiently interpreted
and contextualised. Smith (2004) argues that IPA moves beyond the text to a more
interpretative and psychological level (p. 44) but contrasts a grounded IPA reading
with (in the example he uses) an imported psychoanalytic one (p. 45). In IPA, the
analysis is based on a careful reading of the participants account. In analysing a particular
passage, the analyst may refer back to what the participant has said in other parts of the
interview. However, whilst the analysis should be informed by a general psychological
interest (p. 45), Smith (2004) suggests that the IPA analyst should not be invoking
a specific pre-existing formal theoretical position (p. 45). Whilst an IPA account may
draw on particular theory, Smith (2004) suggests that this should be clearly distinguishable
from interpretation in the analysis.
Whilst the interpretative facet of IPA has been articulated to varying degrees in published
work, it is a key feature of the approach and one worthy of more consideration by authors.
Salmon (2003) notes that results of psychological research reflect the researcher as much as
the researched (p. 26) but this remains tacitly rather than openly acknowledged in many
cases. A clear acknowledgement of authors particular perspectives (perhaps including
research interests, theoretical groundings and why they sought to undertake this particular
piece of research) might assist in this.
Reflections on the analysis process
Some researchers reflected on the usefulness and appropriateness of utilising IPA with their
data set. Turner and Coyle (2000) consider it to have been appropriate to use IPA as a
means of analysis for their study because of its potential for providing interesting insights
into the subjective perceptual processes involved in their topic of research. Dunne and
Quayle (2001) describe the IPA approach as true to their study aims, to the experiences
of participants and to the richness of participants accounts. Kay and Kingston (2002)
argue that their choice of a qualitative research method reflected their desire to explore
in depth the reasons behind peoples thoughts, beliefs and behaviours regarding their
research topic. IPA was deemed an appropriate method of analysis as the authors consider
it particularly suitable where one is interested in complexity or process or where an issue
is personal (p. 171) and able to contribute to understanding an area of interest through
a deeper, more personal, individualised analysis (Kay & Kingston, 2002). Smith et al.
(2002) also support the notion of qualitative research methodology being especially
useful when the research is concerned with either a novel domain or where the issues are
complex or dilemmatic (pp. 132133). According to Turner et al. (2002), serendipitous
findings are a major advantage of utilising a qualitative approach to research, particularly
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in exploratory areas. Smith et al. (2002) suggest that their research illustrates the particular
value of IPA in examining difficult health care decisions.
Collins and Nicolson (2002) argue that in undertaking in-depth interpretative engage-
ment with the respondents text there was a sense that data were also becoming diluted
by the disaggregation and unitisation of the data (p. 627) necessitated in following the
analytic procedure detailed by Smith et al. (1999). On the other hand, Smith et al.
(1999) argue that, at the writing up stage, there is the opportunity for the unique nature
of each participants experience (to) re-emerge (p. 235). Collins and Nicolson (2002)
question whether IPA in its search for connections, similarities or divergences across
cases misses a potentially richer seam of data, that of a contextualised, unfolding and
sequential account within a single interview (p. 627). They also question whether, or to
what extent, such analysis is different from a rigorous thematic analysis. However,
Warwick et al. (2004) analysed their data (interviews with women with chronic pelvic
pain) using both thematic analysis and IPA and argue that the latter proved the more
informative in terms of clinical implications (p. 132). Collins and Nicolson (2002) describe
IPA as a useful approach to guide the analysis of data but suggest that more attention be
paid to the sequential nature of an individual account. However, Smith et al. (2002)
argue that, in their analysis presentation, a particular feature is an idiographic
presentation, illuminating complex thinking processes of individuals faced with a decision
not only whether to accept genetic testing offered to them but also highlighting patterns
across their accounts. Smith (2004) suggests that the use of IPA with smaller samples
and single case studies is an important area for development . . . the very detail of the
individual brings us closer to significant aspects of a shared humanity (pp. 4243).
Willig (2001) notes that IPA has been frequently contrasted with grounded theory, with
some struggling to see any meaningful distinction between the two. Willig (2001) argues
that, in addition to IPAs theoretical grounding, IPA differs from grounded theory in its
particular suitability for understanding personal experiences as opposed to social processes.
It is also suggested that IPAs status as a new and developing approach allows researchers
more room for creativity and freedom (p. 69), avoiding the debates and controversies
associated with grounded theory (Willig, 2001).
Conclusions
Reid et al. (2005) suggest that the future of IPA research looks bright (p. 23). Smith
(2004) suggests a number of ways in which IPA research might develop, including
microtextual analysis, different possibilities in terms of participant groups and data
collection, the consideration of emergent core constructs in IPA and the relationship
between IPA and other phenomenological approaches. A final possibility suggested by
Smith (2004) is increasing analysis of the single-case study. Smith (2004) argues that
the idiographic commitment to the case (p. 51) is central to IPA and it has been
suggested that study of the case has special relevance in health psychology (Radley &
Chamberlain, 2001). An increased focus on the individual case might address concerns
relating to preservation of the richness of individual accounts (Collins & Nicolson, 2002)
and is in line with increased efforts within the National Health Service to make greater
efforts to acknowledge the voices of service-users. IPA is entirely congruent with the
increase in patient-centred research.
Qualitative research generally might be criticised on the grounds that it is kept somewhat
mysterious. Guidelines are offered to the researcher who is then informed that they cannot
do good qualitative research simply by following guidelines. Thus, the judgement about
100 J. M. Brocki & A. J. Wearden
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what is a good qualitative analysis remains rather subjective and ineffable. In contrast to
many other qualitative methodologies, IPA is highly accessible. IPA theorists have tended
to use easily comprehendible language and straightforward guidelines, rather than using
language to obscure meaning in the way that other qualitative methodologies might be
criticised for. However, authors do not always explicitly recognise either the theoretical
preconceptions they bring to the data or their own role in interpretation and this is a
vital facet of IPA and one which ensures its accessibility and clarity.
Whilst Smith (2004) deals to some extent with the matter of levels of interpretation,
it may not be clear which of these is most important and fundamental and authors
reflections on this would be advantageous. More reflection on the different available
levels of interpretation may make it more obvious to readers if an analysis offered might
be considered somewhat weak, making a lack of interpretation more obvious. It seems
probable that different levels of interpretation (e.g. social comparison, temporal,
metaphorical) may be of differing importance to researchers with different areas of interest
investigating varying topics. The fact that IPA is a flexible and inductive approach, able
to engage with both new areas without a theoretical pretext and existing theoretical
frameworks is, of course, one of its strengths (Reid et al., 2005).
The present article has attempted to provide an overview of the work carried out to date
in the field of health psychology utilising IPA. Given the growing value assigned to qualita-
tive methodologies in health research, the proliferation of research utilising IPA in this area
looks set to continue. For example, since completing the review in November 2004, a
further six IPA papers have been published in Psychology and Health alone in 2005
(Bramley & Eatough, 2005; Free, Ogden, & Lea, 2005; Howes, Benton, & Edwards,
2005; Jarman, Walsh, & De Lacey, 2005; Lavie & Willig, 2005; Moskowitz & Wrubel,
2005). IPA has proven to be particularly suitable in health psychology research and
particularly at illuminating processes operating within models as opposed to the traditional
focus on outcome measures. However, there is some variability in the way that papers
published deal with the interpretative facet of the approach. Whilst the inclusion of
verbatim extracts in the analysis certainly helps the reader to trace the analytic process,
perhaps including more acknowledgement of analysts preconceptions and beliefs and
reflexivity might increase transparency and even enhance the accounts rhetorical power.
Acknowledgements
The first author was supported by an ESRC PhD studentship (R42200134160).
The authors would like to thank Jonathan A. Smith and three anonymous reviewers for
their constructive comments on earlier drafts of this article.
References
*Alexander, N., & Clare, L. (2004). You still feel different: The experience and meaning of womens self-injury in
the context of a lesbian or bisexual identity. Journal of Community and Applied Social Psychology, 14, 7084.
*Baillie, C., Smith, J. A., Hewison, J., & Mason, G. (2000). Ultrasound screening for chromosomal abnormality:
Womens reactions to false positive results. British Journal of Health Psychology, 5, 377394.
Bramley, N., & Eatough, V. (2005). The experience of living with Parkinsons disease: An interpretative
phenomenological analysis case study. Psychology and Health, 20, 223235.
*Carradice, A., Shankland, M. C., & Beail, N. (2002). A qualitative study of the theoretical models used by
UK mental health nurses to guide their assessments with family caregivers of people with dementia.
International Journal of Nursing Studies, 39, 1726.
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Chamberlain, K., Stephens, C., & Lyons, A. C. (1997). Encompassing experience: Meanings and methods
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*Chapman, E. (2002). The social and ethical implications of changing medical technologies: The views of people
living with genetic conditions. Journal of Health Psychology, 7, 195206.
Chapman, E., & Smith, J. A. (2002). Interpretative phenomenological analysis and the new genetics. Journal of
Health Psychology, 7, 125130.
*Clare, L. (2002). Well fight it as long as we can: Coping with the onset of Alzheimers disease. Aging and Mental
Health, 6, 139148.
*Clare, L. (2003). Managing threats to self: Awareness in early stage Alzheimers disease. Social Science and
Medicine, 57, 10171029.
*Collins, K., & Nicolson, P. (2002). The meaning of satisfaction for people with dermatological problems:
Reassessing approaches to qualitative health psychology research. Journal of Health Psychology, 7, 615629.
*Colton, A., & Pistrang, N. (2004). Adolescents experiences of inpatient treatment for anorexia nervosa. European
Eating Disorders Review, 12, 307316.
*Duncan, B., Hart, G, Scoular, A., & Bigrigg, A. (2001). Qualitative analysis of psychosocial impact of Chlamydia
trachomatis: Implications for screening. British Medical Journal, 322, 195199.
*Dunne, E. A., & Quayle, E. (2001). The impact of iatrogenically acquired Hepatitis C infection on the well-being
and relationships of a group of Irish women. Journal of Health Psychology, 6, 679692.
Elliott, R., Fischer, C. T., & Rennie, D. L. (1999). Evolving guidelines for the publication of qualitative research
studies in psychology and related fields. British Journal of Clinical Psychology, 38, 215229.
*Flowers, P., Duncan, B., & Frankis, J. (2000a). Community, responsibility and culpability: HIV risk-management
amongst Scottish gay men. Journal of Community and Applied Social Psychology, 10, 285300.
*Flowers, P., Duncan, B., & Knussen, C. (2003). Re-appraising HIV testing: An exploration of the psychosocial
costs and benefits associated with learning ones HIV status in a purposive sample of Scottish gay men. British
Journal of Health Psychology, 8, 179194.
*Flowers, P., Hart, G., & Marriott, C. (1999). Constructing sexual health: Gay men and risk in the context of
a public sex environment. Journal of Health Psychology, 4, 483495.
*Flowers, P., Knussen, C., & Duncan, B. (2001). Re-appraising HIV testing among Scottish gay men: The impact
of new HIV treatments. Journal of Health Psychology, 6, 665678.
*Flowers, P., Marriott, C., & Hart, G. (2000b). The bars, the bogs and the bushes: The impact of locale on sexual
cultures. Culture, Health and Sexuality, 2, 6986.
*Flowers, P., Smith, J. A., Sheeran, P., & Beail, N. (1997). Health and romance: Understanding unprotected sex in
relationships between gay men. British Journal of Health Psychology, 2, 7386.
*Flowers, P., Smith, J. A., Sheeran, P., & Beail, N. (1998). Coming out and sexual debut: Understanding the
social context of HIV risk-related behaviour. Journal of Community and Applied Social Psychology, 8, 409421.
Free, C., Ogden, J., & Lee, R. (2005). Young womens contraception use as a contextual and dynamic behaviour: A
qualitative study. Psychology and Health, 20, 673690.
*Gannon, K., Glover, L., ONeill, M., & Emberton, M. (2004). Men and chronic illness: A qualitative study
of LUTS. Journal of Health Psychology, 9, 411420.
Giorgi, A., & Giorgi, B. (2003). Phenomenology. In J. A. Smith (Ed.), Qualitative psychology: A practical guide
to research methods. London: Sage.
*Golsworthy, R., & Coyle, A. (2001). Practitioners accounts of religious and spiritual dimensions in bereavement
therapy. Counselling Psychology Quarterly, 14, 183202.
*Green, A., Payne, S., & Barnitt, R. (2004). Illness representations among people with non-epileptic seizures
attending a neuropsychiatry clinic: A qualitative study based on the self-regulation model. Seizure, 13,
331339.
*Holt, R. E., & Slade, P. (2003). Living with an incomplete vagina and womb: An interpretative phenomenological
analysis of the experience of vaginal agenesis. Psychology, Health and Medicine, 8, 1933.
Howes, H., Benton, D., & Edwards, S. (2005). Womens experience of brain injury: An interpretative
phenomenological analysis. Psychology and Health, 20, 129142.
*Hunt, D., & Smith, J. A. (2004). The personal experience of carers of stroke survivors: An interpretative
phenomenological analysis. Disability and Rehabilitation, 26, 10001011.
*Jarman, M., Smith, J. A., & Walsh, S. (1997). The psychological battle for control: A qualitative study of
health-care professionals understandings of the treatment of anorexia nervosa. Journal of Community and
Applied Social Psychology, 7, 137152.
Jarman, M., Walsh, S., & DeLacey, G. (2005). Keeping safe, keeping connected: A qualitative study of
HIV-positive womens experiences of partner relationships. Psychology and Health, 20, 533553.
*Jarrett, N., Payne, S., Turner, P., & Hillier, R. (1999). Someone to talk to and pain control: What people
expect from a specialist palliative care team. Palliative Medicine, 13, 139144.
*Johnson, S., Burrows, A., & Williamson, I. (2004). Does my bump look big in this? The meaning of bodily
changes for first time mothers-to-be. Journal of Health Psychology, 9, 361374.
*Kay, E., & Kingston, H. (2002). Feelings associated with being a carrier and characteristics of reproductive
decision-making in women known to be carriers of X-linked conditions. Journal of Health Psychology, 7,
169181.
102 J. M. Brocki & A. J. Wearden
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*Larkin, M., & Griffiths, M. D. (2002). Experiences of addiction and recovery: The case for subjective accounts.
Addiction Research and Theory, 10, 281311.
*Larkin, M., & Griffiths, M. D. (2004). Dangerous sports and recreational drug-use: Rationalising and
contextualizing risk. Journal of Community and Applied Social Psychology, 14, 215232.
Lavie, M., & Willig, C. (2005). I dont feel like melting butter: An interpretative phenomenological analysis
of the experience of inorgasmia. Psychology and Health, 20, 115128.
Leask, J., Hawe, P., & Chapman, S. (2001). Focus group composition: A comparison between natural and
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*MacLeod, R., Craufurd, D., & Booth, K. (2002). Patients perceptions of what makes genetic counselling effec-
tive: An interpretative phenomenological analysis. Journal of Health Psychology, 7, 145156.
*Michie, S., Smith, J. A., Senior, V., & Marteau, T. (2003). Understanding why negative genetic test results
sometimes fail to reassure. American Journal of Medical Genetics, 119A, 340347.
*Michie, S., Hendy, J., Smith, J. A., & Adshead, F. (2004). Evidence into practice: A theory based study of achiev-
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*Murray, C. D. (2004). An interpretative phenomenological analysis of the embodiment of artificial limbs.
Disability and Rehabilitation, 26, 307316.
*Murray, C. D., & Harrison, B. (2004). The meaning and experience of being a stroke survivor: An interpretative
phenomenological analysis. Disability and Rehabilitation, 26, 808816.
*Murray, C. D., & Turner, E. (2004). Health, risk and sunbed use: A qualitative study. Health, Risk and Society, 6,
6780.
Munley, P. H., Anderson, M. Z., Briggs, D., Devries, M. R., Forshee, W. J., & Whisner, E. A. (2002).
Methodological diversity of research published in selected psychological journals in 1999. Psychological
Reports, 91, 411420.
*Osborn, M., & Smith, J. A. (1998). The personal experience of chronic benign lower back pain: An interpretative
phenomenological analysis. British Journal of Health Psychology, 3, 6583.
*Osborne, J., & Coyle, A. (2002). Can parental responses to adult children with schizophrenia be conceptualized
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logical review. The Psychologist, 18, 2023.
*Reynolds, F., & Prior, S. (2003). A lifestyle coat-hanger: A phenomenological study of the meanings of artwork
for women coping with chronic illness and disability. Disability and Rehabilitation, 25, 785794.
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undergoing termination of pregnancy for foetal abnormality. Journal of Health Psychology, 7, 183193.
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*Schoenberg, M., & Shiloh, S. (2002). Hospitalized patients views on in-ward counseling. Patient Education and
Counseling, 48, 123129.
*Senior, V., Smith, J. A., Michie, S., & Marteau, T. M. (2002). Making sense of risk: An interpretative
phenomenological analysis of vulnerability to heart disease. Journal of Health Psychology, 7, 157168.
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*Smith, J. A., Michie, S., Stephenson, M., & Quarrell, O. (2002). Risk perception and decision making in
candidates for genetic testing in Huntingdons disease: An interpretative phenomenological analysis.
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The use of IPA in health psychology 103
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*Swift, T. L., Ashcroft, R. E., Tadd, W., Campbell, A. S., & Dieppe, P. A. (2002). Living well through chronic
illness: The relevance of virtue theory to patients with chronic osteoarthritis. Arthritis and Rheumatism, 47,
474478.
*Thompson, A. R., Kent, G., & Smith, J. A. (2002). Living with vitiligo: Dealing with difference. British Journal
of Health Psychology, 7, 213225.
*Touroni, E., & Coyle, A. (2002). Decision-making in planned lesbian parenting: An interpretative phenomeno-
logical analysis. Journal of Community and Applied Social Psychology, 12, 194209.
*Turner, A. J., & Coyle, A. (2000). What does it mean to be a donor offspring? The identity experiences of adults
conceived by donor insemination and the implications for counselling and therapy. Human Reproduction,
15, 20412051.
*Turner, A., Barlow, J., & Ilbery, B. (2002). Play hurt, live hurt: Living with and managing osteoarthritis from
the perspective of ex-professional footballers. Journal of Health Psychology, 7, 285301.
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the perspectives of those seeking help from pain clinics. Pain, 80, 621628.
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helpful from whom? Psychology and Health, 19, 117134.
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structured survey. BJU International, 94, 607612.
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*Studies used in the review. These studies are summarised in Appendix 1.
Appendix 1
Summary of studies considered in the review.
Authors Topic
How many participants, how
recruited and how data gathered
1. Alexander and
Clare (2004)
Womens self-injury in the context
of a lesbian or bisexual identity.
Interviewees were 16 women identified
as lesbian or bisexual who had
engaged in self-injurious behaviour on
more than one occasion. Participants
recruited through advertisement in a
variety of settings.
2. Baillie et al. (2000) Looking at the subjective experience
of women in response to false
positive results at ultrasound
screening for foetal abnormality.
Interviewees were 24 women referred
to hospital after false positive
ultrasound results.
3. Carradice et al. (2002) Investigation of theoretical model
used by nurses to guide assessments
of family carers of people
with dementia.
Interviewees were 8 female G grade
nurses working in a Community
Mental Health Team for Older
People.
4. Chapman (2002) Subjective levels of health and quality
of life for individuals with early
(cystic fibrosis) and late
(Huntingdons disease) onset genetic
conditions.
Interviewees were 12 adults with
cystic fibrosis and 12 adults with
Huntingdons disease in the family
recruited from 2 specialist regional
centres.
5. Clare (2002) Identification of coping strategies
used by people with early-stage
Alzheimers disease.
Interviewees were 12 people with
early-stage Alzheimers (9 men,
3 women) recruited from a memory
clinic and their spouses.
6. Clare (2003) Exploration of awareness in early-stage
Alzheimers disease.
Interviewees were 12 people diagnosed
with early-stage Alzheimers
recruited from a hospital memory
clinic and their spouses.
(Continued )
104 J. M. Brocki & A. J. Wearden
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Authors Topic
How many participants,
how recruited and how data gathered
7. Collins and
Nicolson (2002)
Exploration of the meaning of
satisfaction health-care for
people with dermatological
problems.
Interviewees were 30 dermatology patients
(12 men, 18 women) referred from
8 GP surgeries and 1 teaching hospital in
Sheffield. Participants were part of a
larger randomised controlled trial of
telemedicine.
8. Colton and Pistrang
(2004)
Adolescents experience of inpatient
treatment for anorexia nervosa.
Interviewees were 19 females aged between
12 and 17 years recruited from two
inpatient eating disorder units and with
a primary diagnosis of anorexia nervosa.
9. Duncan et al. (2001) Investigation of psychosocial impact
of a diagnosis of Chlamydia for
women.
Interviewees were 17 women attending
a genitourinary medicine clinic or
family planning clinic in Glasgow
with a current or recent diagnosis
of Chlamydia.
10. Dunne and Quayle
(2001)
Impact of iatrogenic Hepatitis C
on well-being of patients.
5 focus groups run with 32 women with
iatrogenically acquired Hepatitis C
(range of 3 to 9 participants per
group with an average of 6
participants per group) recruited
through a national support group.
11. Flowers et al. (1997) Exploration of gay mens thoughts
about unprotected anal sex
and relationships, with the aim
of considering this in terms of
current theoretical models.
Interviewees were 20 working class gay
men from a small South Yorkshire
town with participants initially recruited
through involvement with the gay
community and subsequent participants
recruited through these initial contacts.
12. Flowers et al. (1998) Exploration of HIV risk-related
behaviour in the context of
entry into the gay community.
Interviewees were 20 working-class gay
men from Barnsley with participants
initially recruited through involvement
with the gay community and
subsequent participants recruited
through these initial contacts.
13. Flowers et al. (1999) Gay mens sexual decision making
in the context of public parks.
Interviewees were 20 gay men from
Glasgow, Scotland recruited in gay
bars, through membership of existing
gay groups and through previous
contacts.
14. Flowers et al. (2000a) Exploration of understandings of
community amongst Scottish
gay men.
Interviews with 18 gay men and 4
focus groups [representing distinct
locations in Scotland] run with 19
gay men (average of 5 participants
per group) with varied HIV testing
histories and HIV status. Participants
were recruited through gay bars,
sexual health service providers and
community support groups.
15. Flowers et al. (2000b) Role of locale and location in
understanding gay mens
sexual behaviours.
Interviewees were 20 gay men from
Glasgow, Scotland recruited in gay
bars, through membership of existing
gay groups, through previous contacts
and through a recruitment poster.
16. Flowers et al. (2001) Gay mens understandings of HIV
testing within the context of new
treatments for HIV.
Interviews with 18 gay men and 4
focus groups [representing distinct
locations in Scotland] run with 19
gay men (average of 5 participants
per group). Participants were recruited
through gay bars, sexual health service
providers and community support groups.
(Continued )
The use of IPA in health psychology 105
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Authors Topic
How many participants,
how recruited and how data gathered
17. Flowers et al. (2003) Exploration of psychosocial
consequences of learning HIV
status in a purposive sample of
Scottish gay men.
Interviews with 18 gay men and 4
focus groups [representing distinct
locations in Scotland] run with 19
gay men (average of 5 participants
per group). Participants were recruited
through gay bars, sexual health service
providers and community support
groups.
18. Gannon et al. (2004) Mens experience of chronic
lower urinary tract symptoms.
Interviewees were 16 men recruited from
outpatient urology clinic of a London
teaching hospital, with lower urinary
tract symptoms.
19. Golsworthy and
Coyle (2001)
Exploration of the religious and
spiritual dimensions in
bereavement therapy.
Interviewees were 12 therapists involved
in practice for a minimum of 1 year
where bereavement constituted a
major part of therapeutic work and
recruited through six hospices and
bereavement services in south England.
20. Green et al. (2004) Investigation of illness
representations of people
with non-epileptic seizures.
Interviewees were 9 participants with
a diagnosis of non-epilleptic seizures
recruited on an opportunistic basis
from neuropsychiatry outpatient clinics.
21. Holt and Slade (2003) Exploration of experience of
living with vaginal agenesis.
Interviewees were 7 women with vaginal
agenesis (congenital absence of vagina)
recruited from 2 gynaecological clinics.
22. Hunt and Smith (2004) Experiences of the carers of
stroke survivors.
Interviewees were 4 relatives of stroke
survivors on a rehabilitation ward.
23. Jarman et al. (1997) Healthcare professionals
understandings and experiences
of treating anorexia nervosa.
Interviewees were 5 members of a
multidisciplinary child and adolescent
team who had recently treated
children with eating disorders.
24. Jarrett et al. (1999) Investigation of patients and
relatives expectations of
specialist palliative care services.
Interviewees were 18 patients at a
specialist palliative care unit and
11 relatives.
25. Johnson et al. (2004) Meaning of bodily changes for
first-time mothers-to-be.
Interviewees were 6 first-time
mothers-to-be recruited through email
advertisement at an institution of
higher education. All were interviewed
in the last trimester of pregnancy.
26. Kay and Kingston
(2002)
Feelings associated with being a
carrier of an X chromosome
linked genetic condition
associated with serious disability
and impact on reproductive
decisions.
Interviewees were 14 women identified
as carriers of an X chromosome
linked genetic condition associated
with serious disability recruited
from a Regional Clinical Genetic
Service in North West England.
27. Larkin and Griffiths
(2002)
Subjective experiences of addiction
and recovery in individuals
with addictive behaviour
problems.
Observational notes taken on 2 research
visits to an addictions recovery centre
and analysis focussed on these notes.
28. Larkin and Griffiths
(2004)
Dangerous sports and recreational
drug-use.
Interviewees were 5 bungee-jumpers
and 6 Ecstasy users.
29. MacLeod et al. (2002) Impact of genetic counselling
on counselees perceptions and
adjustment.
Interviewees were 17 adults from 12
families attending a UK Regional
Genetics Centre for the fist time.
(Continued )
106 J. M. Brocki & A. J. Wearden
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Authors Topic
How many participants,
how recruited and how data gathered
30. Michie, Smith, Senior
and Marteau (2003)
Investigation of perceptions of risk,
illness and tests amongst persons
who had received negative test
results following predictive
genetic testing.
Interviewees were 9 people (1 man,
8 women) who had received negative
results following predictive genetic
testing within the previous 12 months
at a London hospital.
31. Michie et al. (2004) Investigation of why general
practices achieve National
Service Framework milestones
to different extents.
Interviewees were 16 London General
Practioners 8 high and 8 low
implementers.
32. Murray (2004) The embodiment of artificial limbs. Participants were 35 prosthesis users 14
interviews conducted with participants
recruited from Mancunian NHS service
provider and 21 email interviews
conducted with participants recruited
via advertisement on online email
discussion. Documentary analysis also
made of an online discussion group.
33. Murray and
Harrison (2004)
The meaning and experience of
being a stroke survivor.
Interviews conducted with 10 stroke
survivors (5 face-to-face, recruited
via National Stroke Network and 5 by
email, recruited via online discussion
group for stroke survivors).
34. Murray and
Turner (2004)
An analysis of the use of sunbeds. Interviewees were 18 sunbed users
(9 male, 9 female) recruited via
information sheets left at 4 Merseyside
tanning salons.
35. Osborn and
Smith (1998)
Exploration of the subjective
experience of chronic low
back pain.
Interviewees were 9 women patients
attending a hospital out-patient
back clinic.
36. Osborne and
Coyle (2002)
Exploration of parental responses
to adult children with
schizophrenia.
Interviewees were 4 parents of adult
persons diagnosed with schizophrenia,
recruited through National
Schizophrenia Fellowship.
37. Reynolds and
Prior (2003)
Exploration of meanings and
functions of art for chronically
ill women.
Interviews and lengthy written answers
to interview questions were analysed.
Participants were 35 women with
disabling chronic illness recruited
by advertisement. 30 interviews were
conducted, 5 written narratives
were submitted.
38. Robson (2002) Examination of aspects of grief
from a male perspective
following late termination
of pregnancy due to foetal
abnormality.
Interviewee was one man whose partner
underwent termination of pregnancy
for foetal abnormality at 34 weeks
(19 months prior to interview)
recruited through tertiary referral
centres in Northern England.
39. Schoenberg
and Shiloh (2002)
Exploration of views of patients
hospitalised in an orthopaedic
rehabilitation clinic on in-ward
psychological help.
Interviewees were 10 patients (6 men,
4 women) hospitalised in a Tel Aviv
orthopaedic rehabilitation ward.
40. Senior et al. (2002) Investigation of perceptions of
familial hypercholesterolaemia
and its genetic basis in patients
diagnosed with familial
hypercholesterolaemia.
Interviewees were 7 patients
diagnosed with familial
hypercholesterolaemia and were
receiving treatment at a hospital clinic.
41. Smith (1996) Exploration of perceptions
of renal dialysis.
Interviewee was one woman being
treated for end-stage renal disease
with haemodialysis.
(Continued )
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Authors Topic
How many participants,
how recruited and how data gathered
42. Smith (1999) Exploration of transition to
motherhood, with a theoretical
model of the relational self
emerging from the data.
3 women interviewed on four occasions
(at 3, 6 and 9 months of pregnancy
and 5 months after birth) and diaries
kept between visits. Both interviews
and diaries used in analysis.
43. Smith et al. (2002) Examination of risk perception
and representation and
decision-making processes in
candidates for genetic testing
for Huntingdons disease.
Interviewees were 5 women offered
genetic testing for Huntingdons
disease at a UK regional genetics
centre. All had a 50% prior risk of
inheriting the condition.
44. Swift and
Wilson (2001)
An exploration of misconceptions
about brain injury, as perceived
by those with experience of
brain injury.
22 interviewees took part in 19
interviews and were recruited through
a charitable organisation for head
injury. Interviewees were 2 persons
who had suffered traumatic brain
injury, 1 person who had suffered
non-traumatic brain injury,
5 caregivers (2 spouses, 3 parents)
and 14 rehabilitation professionals.
45. Swift et al. (2002) Assessment of the relevance of
Aristotles virtue theory to
patients with chronic
osteoarthritis.
Interviewees were 5 female patients with
chronic osteoarthritis recruited
through a specialist rheumatology
service.
46. Thompson et al. (2002) Examination of experience of
living with vitiligo.
Interviewees were 7 women with the
skin condition vitligo recruited from
dermatology clinic.
47. Touroni and
Coyle (2002)
Decision-making processes
in lesbian parenting.
Interviewees were 9 lesbian couples
who had had children within current
relationships, recruited through
advertisements in lesbian and gay
press and through lesbian parenting
support groups and social networks.
48. Turner and
Coyle (2000)
Experiences of adults conceived
by donor insemination.
Semi-structured questionnaires
completed by email and post by 16
adults conceived through donor
insemination recruited through donor
conception support networks in the
UK, the USA, Canada and Australia.
49. Turner et al. (2002) Experience of living with
osteoarthritis from the perspective
of ex-professional footballers.
Interviewees were 12 exprofessional
footballers with osteoarthritis
recruited through the Former
Players Association.
50. Walker et al. (1999) The experience of chronic back pain. Interviewees were 20 back pain
patients recruited from 2 pain clinics.
51. Warwick et al. (2004) Social support for women with
chronic pelvic pain.
Interviewees were 8 women recruited
from hospital settings with chronic
pelvic pain.
52. Wilson et al. (2004) Investigation of factors determining
quality of life as perceived by
adolescents with bladder
exstrophy.
Interviewees were 16 adolescent
(aged 16 to 21 years) patients born
with bladder exstrophy recruited
from a hospital adolescent unit
database.
108 J. M. Brocki & A. J. Wearden
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