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Triangulation in research, with examples

Article  in  Evidence-Based Nursing · June 2019

DOI: 10.1136/ebnurs-2019-103145

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 Research made simple

Evid Based Nurs: first published as 10.1136/ebnurs-2019-103145 on 14 June 2019. Downloaded from http://ebn.bmj.com/ on October 21, 2019 at Queen's University Belfast. Protected by
Triangulation in research, with examples
Helen Noble,1 Roberta Heale2
10.1136/ebnurs-2019-103145 What is triangulation Phase I of the study focused on understanding the
Triangulation is a method used to increase the cred- context of the study and included interviews with ambu-
1 ibility and validity of research findings.1 Credibility lance service staff and the collection of demographics
School of Nursing and
refers to trustworthiness and how believable a study and local policies. The second phase involved observa-
Midwifery, Queens University
Belfast, Belfast, UK is; validity is concerned with the extent to which a tion of paramedics’ daily work in order to throw light on
2
School of Nursing, Laurentian study accurately reflects or evaluates the concept or decisions related to transporting patients. Focus groups
University, Sudbury, Ontario, ideas being investigated.2 Triangulation, by combining with paramedics, followed by focus groups with service
Canada theories, methods or observers in a research study, can users were then completed in order to share personal
help ensure that fundamental biases arising from the experiences of the decisions made by the ambulance
use of a single method or a single observer are over- service in practice. The final phase included workshops
Correspondence to: come. Triangulation is also an effort to help explore to feed back findings.
Dr Helen Noble, School of Data were coded and thematically analysed. The
and explain complex human behaviour using a variety
Nursing and Midwifery, Queen’s
of methods to offer a more balanced explanation to observations of paramedic shifts identified the complex-
University Belfast, Belfast BT7
readers.2 It is a procedure that enables validation of ities of the decision-making process related to the
1NN, UK; h​ elen.​noble@​qub.​
ac.​uk data and can be used in both quantitative and quali- context. The observations were supplemented by the
tative studies. interviews and focus groups. Each research method
Triangulation can enrich research as it offers a exposed one aspect of reality.5 This multimethod, multi-
variety of datasets to explain differing aspects of a disciplinary collaborative research was insightful. It
phenomenon of interest. It also helps refute where one permitted cross-validation, and facilitated exploration,
dataset invalidates a supposition generated by another. of issues that influenced the decision making of para-
It can assist the confirming of a hypothesis where one medics and concerns and experiences of service users.
set of findings confirms another set. Finally, triangu-
lation can help explain the results of a study.3 Central
Example 2
to triangulation is the notion that methods leading to
A study was undertaken to explore the quality of care
the same results give more confidence in the research

copyright.
for patients in a unique model of primary healthcare
findings.4
in Ontario, Canada: the Nurse Practitioner-Led Clinic
Four types of triangulation are proposed by Denzin
(NPLC)7. The focus was on the care of patients with
(p.301):5 (1) data triangulation, which includes matters
diabetes and at least one additional chronic condition,
such as periods of time, space and people; (2) investi-
with the assumption that this group of patients repre-
gator triangulation, which includes the use of several
sents those with the most complex clinical presenta-
researchers in a study; (3) theory triangulation, which
tions managed in family practice settings. A multiple
encourages several theoretical schemes to enable
case study design was chosen for this research because
interpretation of a phenomenon and (4) methodolog-
with this approach, analysis of a variety of data arising
ical triangulation, which promotes the use of several
from several NPLCs allowed for assumptions to be made
data collection methods such as interviews and obser-
about the model as a whole.7 Additionally, both quali-
vations.
tative and quantitative research methods were used in
the study. Mixing methods is a form of triangulation
Examples of studies using triangulation in research seen as mitigating the weaknesses found in
Below, we offer two examples of triangulation within single methods.8
research studies, providing a context for each study The first research method was a chart audit,
and a description of how triangulation was used and conducted on randomly selected charts of adult patients
successfully implemented to ensure an in-depth and in five NPLCs who had diabetes and at least one addi-
more unbiased set of findings. tional chronic condition. The variables included demo-
graphic items as well as clinical data related to the care
Example 1 of patients with diabetes. The data were analysed to
Johnson et al,s6 qualitative study aimed to identify determine the completeness of the care of diabetes for
system influences on decision making in a pre-hospital the subjects.9
setting with paramedics. Several data sets were included The second research method was interviews with
and comprised exploratory interviews with ambulance nurse practitioners (NPs) working at the five NPLCs to
service staff (n=16); document review observations of determine their perceptions of the quality of care deliv-
paramedic shifts (n=34); paramedic accounts (n=10) via ered in the NPLC model for patients with diabetes and
audio-recorded ‘digital diaries’; staff focus groups (n=3) other chronic conditions. Data from the interviews were
and service user focus groups (n=3) to explore a range analysed using the processes related to an integrative
of experiences and perceptions. The approach followed description design.10 The draft themes arising from the
Denzin’s5 multiple triangulation approach, which analysis were forwarded to the participants for their
encourages several methods to collect data and multiple feedback and were confirmed through a review of liter-
investigators with varied expertise. ature. Finally, a detailed document search was under-

Evid Based Nurs July 2019 | volume 22 | number 3 |   67

 Research made simple

Evid Based Nurs: first published as 10.1136/ebnurs-2019-103145 on 14 June 2019. Downloaded from http://ebn.bmj.com/ on October 21, 2019 at Queen's University Belfast. Protected by
taken, including but not limited to academic articles, © Author(s) (or their employer(s)) 2019. No commercial
media releases and articles, letters to editor, government re-use. See rights and permissions. Published by BMJ.
policy statements and publications released from the
NPLCs. These data were used to confirm and support the
findings of the chart review and NP interviews, repre- References
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perceptions of the impact of the nurse practitioner-led clinic

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Patient consent for publication  Not required.
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