Using the Framework Method for the Analysis of Qualitative Dyadic Data in Health Research

There are an increasing number of qualitative studies which focus on the dyad (couples, families, caregivers–patients, health care professionals–patients). However, there is limited literature regarding qualitative methodology for dyadic analysis when members of the couple have been interviewed separately. The aim of this article is to share the knowledge we gained from undertaking a novel approach to dyadic analysis. We used an adapted version of the Framework method on data gathered in a study exploring the impact of prostate cancer on younger men and their partners. In this article, we examine and reflect on the challenges of this type of analysis and describe how we analyzed the interview data from a dyadic point of view, to share what we learned in the process.


Example Section of the Table of Themes for a Dyad with Reference to Gender Norms.
In instances where participants made reference to gender norms (see example), this was highlighted in another colour. This was considered further post-analyses and comparisons were made against other couples who also made reference to gender norms.

Example Section of the Table of Themes for a Dyad with Reference to being Younger and its Impact.
Reference to being a younger person and the impact of age on their experience of PCa was also highlighted. This was to keep focused on addressing the research question and objectives.
A table for 'OTHER' codes where the placement within the summary tables was not clear was created for each dyadic table, and returned too after all analysis was completed. It then became clear that some of the codes placed under OTHER could be collapsed into other codes under different themes, or in some cases a collection of these codes were created into a new theme.

Example Section of the Table of Themes for a Dyad which Highlights Overlapping Codes.
Some codes overlapped with others, therefore an acknowledgement of this was coded in red under the overlapping code (see screenshot). Dyadic summaries (last column in table) (stage 5) incorporated any overlapping codes to provide more context and depth to that part of the experience or impact. It is acknowledged that it is often not possible to separate experiences into simplified categories, as they are likely to overlap and interconnect in many ways, therefore overlaps in summaries exist so as to not lose the understanding of complexities that exist in experiences in general.

Example of Excel Framework Matrix for Theme Relating to 'Work & Finances'.
Dyadic summaries were placed into framework matrices relevant to the themes. The frameworks were created using Excel, with tabs created to reflect the different themes.
The initial framework matrices were: Relationships, Adjustment processes, Psychoemotional impact, Healthcare service, Support & Information, Improvement suggestions,

The Development of the Framework Called 'Family and Friends'
Dyadic code/summaries were placed under the appropriate subtheme in the specific framework.
Initially, there was code called 'implications on children' located under the framework: family and friends. As the analysis developed and further dyadic analyses was carried out, it seemed that the impact on the role of being a parent with cancer and on their children was a theme in itself, as there was detailed information on different aspects of this particular impact.

Theme and Subtheme Development for Matrix: Parenthood and Family Functioning
In response to this, a further framework termed: Parenthood and Family Functioning was created to highlight this being a separate framework. Subthemes Conversations about PCa, impact on children, challenges of being a parent affected by PCa, Hereditary implications, desire for children in the future and support were subthemes created under this theme.

Example of how Framework Matrix was Developed to Refine Subthemes and Subcodes within this Theme
After further analysis and discussions with co-investigators, the codes were developed further to highlight the key aspects of this particular theme.

Conversations about PCa, Parental perceptions of impact on children, parental reactions/responses
to PCa and levels of support were the codes redeveloped. See above for how the subthemes were derived.

Example Section of Coding Framework for 'Parenthood & Family Functioning'.
Themes were refined further by looking over each dyadic summary. Creating subcodes aided the development of themes (stage 6). This is part of the coding framework. Having this coding framework allowed for the analytical framework to be tested on other dyads (table of themes consisting of dyadic codes/summaries) and therefore development of further codes as required (stage 7).
Comments were made and checked with co-investigators against the framework matrices before finalising codes. Descriptions were created for each code, and with further analyses, descriptions were developed to reflect the extent to which the couple experiences were portrayed.

Development of Coding Framework to Create Conceptual Themes
The initial themes in the coding framework aided in the development of three overarching themes, one relating to the impact of PCa and treatment on couples' lives, a second theme relating adjustment processes and a third about experiences of treatment and healthcare services. With the research question in mind, the first overarching theme was further developed to become "Evolving Couple Identity" including core themes that were unique/magnified to/in the experiences of younger couples affected by PCa (relationships, parenthood and family functioning, work and finances, social connections). The same process facilitated the development of core themes relating to the second overarching theme 'couple engagement strategies and behaviours' and third overarching theme 'treatment and healthcare issues.' Themes and subthemes within these overarching themes were then further developed for writing as an article (Collaço et al 2020). The writing process highlighted where codes within these subthemes could be further collapsed. This, therefore, influenced changes to the structure, theme names and content of the themes presented for the article. Theoretical frameworks of adjustment and identifying overlaps and contrasts in dyadic narratives guided the analysis and interpretation further (stage 8).