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TitleLiving with unpredictability in Multiple Sclerosis Hannah R Wilkinson BSc
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Living with unpredictability in Multiple Sclerosis

Hannah R Wilkinson BSc (Hons), MSc


A thesis submitted in partial fulfilment of the requirements of the University of

Lincoln for the degree of Doctorate in Clinical Psychology

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Portfolio Abstract

Background: Unpredictability is identified as a major factor in Multiple Sclerosis

reported to be a factor of uncertainty, which is indicated to have a biopsychosocial

impact on these individuals. However the impact of uncertainty is argued to

diminish over time. Whereas, the lived experience of unpredictability is reported to

be continual. Furthermore, unpredictability is argued to have a continual

psychological effect on individuals with MS. However, unpredictability is an aspect

that remains relatively unaddressed in the research. Qualitative research has been

highlighted to be fundamental in exploring the individual experience of illness,

providing rich detailed descriptions. In addition it has been instrumental in the

development of services to meet the needs of these individuals. The significance

of unpredictability in MS highlights the need for further exploration of lived

experience of this aspect of the illness to support healthcare professionals and the

development of services to meet the needs of these individuals.

Aim: This study aimed to address the limited research examining unpredictability

in MS, to develop a comprehensive understanding of how this aspect affects the

lives of individuals with MS.

Method: This study employed a qualitative design. Twelve participants were

sampling technique. All participants lived in England, had a diagnosis of MS, and

were able to provide consent to participate. Individual interviews were conducted

(7 face-to-face and 5 telephone interviews) using a semi-structured interview.

Interviews were transcribed verbatim and analysed by the researcher using a

thematic analysis (TA) approach.

Results: Three main themes were derived from the analysis: 1) Challenges to

meaning-making; 2) A wide picture of unpredictability; and 3) Surviving

unpredictability. Each of the themes generated between two or three sub-themes.

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This section expands on the journal article. It opens by considering the

epistemological underpinnings for the study and continues by providing a critical

examination and rationale for the methodology. The research procedure is

described, offering a critical reflection upon the method of analysis used (Thematic

Analysis [TA]). Finally this section provides the research

perspective for the present study.

Research Design

Ontology and epistemology. The framework for qualitative research relies

on the ontological and epistemological positions of the researcher (Braun & Clarke,

2013). Ontology is the study of being, or the nature of reality (Braun & Clarke,

2013) and epistemology is the theory of knowledge, how we know things or believe

them to be true (Barker, Pistrang, & Elliott, 2002). It is argued that it is important

for researchers to consider their position prior to starting research as this can direct

and determine the type of knowledge generated and the theoretical models and

methodological frameworks used (Braun & Clarke, 2013).

Ontology ranges along a continuum, from realism, where reality is entirely

independent of human ways of knowing about it, to relativism where reality

depends entirely on human interpretation. Realism assumes that a knowable world

(Braun &

Clarke, 2013) (Madill,

Jordan, & Shirley, 2000). What we know is assumed to mirror truthfully what there

is. In contrast, relativism argues that there are multiple constructed realities, what

(Braun & Clarke, 2013).

Between these two positions lies the critical realist position, which argues that there

located knowledge of the researcher (Madill et al., 2000). This position is argued

to underpin a number of different qualitative approaches, including TA (Braun &

Clarke, 2013).

Epistemology is concerned with the nature of knowledge, addressing the

question of what is possible to know. Ontology and epistemology are argued to be

similar in terms of their use of the realist-relativist continuum. Distinctions between

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epistemological positions are based upon whether reality is discovered or created

through the process of research. A realist epistemological stance assumes the

knowledge is based upon perceptions and thus no single absolute truth is possible

(Braun & Clarke, 2013). Within the continuum there are a number of variants

(Harper, 2012). A brief outline of positivism, constructionism and contextualism is

provided, as these are argued to be prominent in psychology (Braun & Clarke,


Positivism assumes a straightforward relationship between the world and

our perception of it. The truth can be discovered through the appropriate

application of scientific measures. Postpositivism is argued to be a less pure

version of the positivist stance (Braun & Clarke, 2013). From this position

researchers seek the truth, yet acknowledge that they are influenced by their

contexts and in turn influence the research. Therefore findings are facts of truth

but subject to theoretical influence (Guba & Lincoln, 2005). Researchers from this

position aim to achieve the truth through controlling or removing the subjective

influences on knowledge production as much as they are able to (Braun & Clarke,


Constructionism argues that what we know is not a true reflection of the

world. Our knowledge of the world and ourselves are constructed through

discourses and various systems. This position assumes that knowledge is a

product of how we come to understand it (Braun & Clarke, 2013).

Finally, contextualism is argued to be akin to critical realism, assuming

knowledge emerges from contexts reflecting the researchers position and findings

are provisional and situated in the context (Madill et al., 2000). Yet it seeks the

truth acknowledging that a truth may not be found through one single method but

a truth can be found in a certain context (Braun & Clarke, 2013).

Researcher’s epistemological position. The present study was

conducted from a contextual critical realist position. This position is committed to

an ontological realists stance where a differentiated, structured, layered and

independent of mind, reality exists; and a epistemological position of relativism

whereby beliefs are socially produced and potentially fallible, yet it argues that in

principle it is possible to provide justifiable grounds to have a preference of one

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Appendix P: Designing the study - Research Network Questionnaire

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Appendix Q: Procedure Flow Diagram

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