Approaches to Concept Clarification: Issues for Consideration

Abstract

Defining concepts is universally recognised as good practice, whether this be in our academic, professional or personal lives. The need to understand exactly what someone is referring to is an essential part of communication. In healthcare, words and terms can have multiple meanings and assumed understandings. When doing research, it is particularly important to define concepts, in order to ensure understanding of the precise context in which they are used. With this clarity and shared understanding, researchers are able to effectively conduct the research, and subsequently, readers can appropriately interpret and make meaning of the research. Concept analysis is a popular method for achieving clarity in the definition of concepts. The Journal of Advanced Nursing frequently publishes concept analyses, many of which become quite highly cited. In this editorial, we want to consider the different options that exist for defining a concept.

A starting point is to acknowledge that some terms are unproblematic and do not need lengthy definition. Handwashing, for example, is a universally understood concept and its meaning could be simply clarified by an existing definition, such as that provided by the World Health Organization. Infection control, however, is far more complex and would require careful definition to ensure that the way the term is used is clear to all readers and used consistently throughout the work. A concept needs to have some complexity within it to require detailed clarification. For example: ‘theory-practice gap’ or ‘professional enjoyment’—which is more complex than either happiness or joy. Both of these concepts have an inherent ambiguity within them and hence require clarification.

Concept analysis is a method used frequently within nursing literature. There are several methods for doing so; many have their roots in the technique devised by Wilson in Thinking with Concepts (1963). Wilson's aim was to help students revise for general university entrance exams, and he encouraged the methodical analysis of words used in questions in order to produce instances or cases nearest ‘the heart of the concept’ when they were applied (Wilson 1963, 27). Most methods for concept analysis include several distinct stages similar to those first proposed by Wilson, making the process of concept analysis a detailed and lengthy one. For example, Walker and Avant's (1988) popular model for doing a concept analysis has eight stages: selection of concept, aim of analysis, identification of uses, determination of defining attributes, development of model cases, construct cases for further understanding, refine attributes by defining antecedents and consequences, and define empirical referents.

There is some concern that the popularity of concept analysis methods is more connected to their ubiquity, rather than to their somewhat contested epistemological position. A recent review suggested a need for further clarity about the methods involved (Rodgers, Jacelon, and Knafl 2018). In addition, concept analysis suggests an allure of certainty in outcome (Duncan, Cloutier, and Bailey 2007); this realist ontological perspective might be in opposition to scholarship in nursing, which is usually broadly relativist or hermeneutic in outlook. Therefore, if the outcome of a concept analysis is certainty of definition, there is the risk that the outcome appears contrived. Nevertheless, the attraction for nurses, especially those getting to grips with complex ideas and devising research questions, is that concept analysis offers this prescriptive method, akin to a recipe, which can produce a reliable output. It also fulfils another intention, which is promoting the science of nursing by the development and understanding of concepts of importance to practice. In being guided by these concept analysis frameworks, nurse researchers engage in a thorough examination of concepts, which look beyond their conventional definitions or taken for granted meanings. The exercise of concept analysis promotes a conscious attitude towards ideas and meanings, outside a sometimes otherwise narrow focus (or one used unquestioningly). As nursing knowledge is derived from multiple disciplines and human experiences, this exercise, which encourages analytical thinking beyond one's own field, can be seen to be very valuable for some. The downsides are that the process is a lengthy one; doing a concept analysis as a part of doctoral study for example is a significant task, and it is important to consider whether the concept requiring clarification is complex enough to warrant this attention and that there is the time and resources to do so.

An alternative approach to defining concepts is a focussed mapping review and synthesis (FMRS) which was developed in 2019 by Bradbury-Jones (Bradbury-Jones et al. 2019). The FMRS is a systematic way of recognising patterns and trends in published literature. This can include, but is not limited to, identifying patterns in the way concepts are used in contemporary publications. Although not as in depth as a full concept analysis, a focussed mapping review and synthesis will enable the current and frequent uses of a particular concept to be explored; the assumption being that current use of a term is a workable reference point from which a definition of a concept can be taken.

A FMRS is generally a concise academic endeavour. The researcher sets the boundaries for the review with regard to journal type of interest and the range of dates from which to search for the publications. For example, a researcher might choose just one or two academic journals and a short date range, or they might undertake a larger FMRS and include more journals and a wider timeframe. This can depend on the amount of time available, and the scope of papers needed for the clarification of the concept. In order to map the concept, the researcher simply searches for the concept within the journals and timeframe decided. The search for the concept is likely to be restricted to the title, as the researcher is interested in publications where the concept is the key focus of the publication. Essential to a successful FMRS is clarity about what the researcher is looking for in the papers identified. This depends on the aim of the FMRS. When clarity of use of a concept is required, it is important that the papers identified provide a definition of the way the concept is used. The researcher can then extract and compare the definitions of the concept, as used by the authors of each paper and then identify the most commonly used definition or highlight one of the definitions as the preferred one. In this way, researchers acknowledge different definitions but identify one—probably the most common one—to be applied in their project. This differs from a concept analysis, where forming a definition is the final part of the process, as described above.

It should be noted that the approach taken in a FMRS is not restricted to obtaining an understanding of how particular terms are currently used; there are many different ways the method can be employed. For example, McCallum et al. (2019) used the approach to explore how different authors recruited vulnerable participants to a study. This example illustrates the flexibility of the approach; however, the use of a FMRS to help provide a definition of terms used in research and scholarly writing provides an alternative to a full concept analysis and might be the method of choice for some researchers.

The final approach to clarifying concepts which we address in this editorial is lighter touch and might be considered by those studying for masters or doctoral awards. This involves the peer definition of concepts and asking colleagues what their understanding of the concept is, that is, where and how it is used. This is a developing method that we have used with other people's perspectives on words and concepts that we ask doctoral students to seek, (i.e. they ask colleagues or fellow students) as opposed to definitions or explanations of concepts that other people cite. This approach is reflected in the work of Brueton et al. (2017) who used informal discussions with colleagues to understand more about the various terms (such as attrition and withdrawal) used to describe loss to follow-up in randomised controlled trials. The discussions were held with principal investigators and trial managers in different international healthcare settings. This led to a clearer understanding of the concept of loss to follow-up itself, and the authors were able to identify that the concept had different meanings to those involved in conducting clinical trials.

Clarifying and defining concepts in research is important. Methods for doing so need to be chosen after consideration of the complexity of the concept and the resources available. Until recently, a full concept analysis was the standard choice for those seeking to develop their concepts; few alternative options existed. However, a concept analysis is a large undertaking and as such needs to be considered in the timeline of the project if considered appropriate. It might be out of scope for many researchers, especially those undertaking masters or doctoral study. Although a concept analysis can be the method of choice for many researchers, we suggest alternatives to this method which might be appropriate for individual projects. The question to ask is whether completing a concept analysis will provide a ‘solution’ for the conceptual problem as was intended (Rodgers, Jacelon, and Knafl 2018), or whether an alternative approach is appropriate.