Triangulation in Qualitative

Research: Evaluation of Completeness

and Confirmation Purposes
Bonnie J. Breitmayer, Lioness Ayres, Kathleen A. Knafl

The term triangulation has been applie6 ;o research strategies intended to

serve two distinctpurposes, confirmation andcompleteness.Many researchers
who claim to have used a triangulated approach fail to provide evidence to
show that their approach contributed to either confirmation or completeness
of the data set. This paper reviews these distinct purposes and describes how
triangulation of qualitative and quantitative methods was built into a study to
achieve them. Analysis of data related to a single construct illustrates how
data generated by qualitative and quantitative methods can provide both
convergent validity and a broader understanding of ones subject matter.

[Keywords: research design; nursing methodology-research]

* * *

iterature in nursing science has increasingly advocated method. The objectives of this paper are to illustrate how

L combining qualitative and quantitative methods in a

single study, apractice often referred to as triangulation
(Goodwin & Goodwin, 1984; Hinds & Young, 1987;
Meyers & Hasse, 1989; Mitchell, 1986). To date, most
of the literature on triangulation has emphasized the potential
merits of a triangulated research design. There has been little
explicit discussion of the varying purposes that a triangulated
approach may serve. Furthermore, few authors have provided
suggestions for designing or for analyzing a triangulated study
to accomplish specific purposes.
After reviewing the literature on triangulation, Knafl and
Breitmayer (199 1) concluded that the term triangulation has
been applied to strategies meant to accomplish two quite
distinct purposes, confirmation and completeness. They further
concluded that in practice researchers tend to treat the combining
of qualitative and quantitative measures as an inherent good.
Often investigators refer to their use of multiple methods as
triangulation without explicitly stating the specific purpose or
purposes that triangulation was meant to accomplish. Lacking
an explicit delineation of purpose, investigators initially may
fail to choose the most appropriate measures and subsequently
fail to analyze the qualitative and quantitative components of
their study in a manner that capitalizes on the strengths of each
qualitative and quantitative measures were incorporated into
the design of one study to serve both confirmation and
completeness purposes and to provide an example of how the
data were analyzed to achieve these purposes.
Triangulation is a technical term used in navigation to
describe a technique whereby two known or visible points are
used to plot a third. Campbell (1956) was the first to apply the
term triangulation to research methodology. While studying
leadership characteristics of men who successfully commanded
ships in the United StatesNavy, Campbell adoptedthe expression
triangulation to characterize his use of multiple imperfect data
Bonnie 1. Breitmayer, RN, PhD, Rho, i s Associate Professor, Department
of Psychiatric Nursing, University of Illinois; Lioness Ayres, RN, MS,
Alpha Lambda, is a doctoral student at the University of Illinois; Kathleen
A. Knafl, PhD, Alpha Lambda, i s Professor and Associate Dean for
Research, Collegeof Nursing, Universityof Illinois. The research reported
here was supported by grants from the Deans Fund at the University of
Illinois at Chicago College of Nursing and from the National Center for
Nursing Research (NR01-594). The authors acknowledge the helpful
comments of members of the Department of Psychiatric Nursing on an
earlier draft of this paper. Correspondenceto Professor Breitmayer, 1056
College of Nursing, University of Illinois at Chicago, 845 South Damen
Avenue, Chicago, IL 60612.
Accented for oublication lulv 17. 1992.

Volume 25, Number 3, Fall 1993 237

Triangulation in Qualitative Research: Evaluation of Completeness and Confirmation Purposes

collection methods, such as direct observation and questionnaire, analyzing data generated by techniques traditionally associated
to measure a single construct, leadership effectiveness. The with separate research paradigms (Hasse & Meyers, 1988;
term triangulation is now widely used in this metaphorical sense Mitchell, 1986). Mitchell (1 986), noting that most literature on
to refer to the use of multiple measures to converge on a single, triangulation offers ideas about conceptualization and design
discrete construct. Used in this way, the purpose of triangulation but not about analysis, has suggested that more sharing of
is confirmation. When using triangulation for the purpose of approaches to data analysis may help to generate solutions to
confirmation, the investigator must select data collection these issues.
instruments or techniques whose strengths and weaknesses are
both known and counterbalancing with regard to threats to Design of a Triangulated Study
validity.
Denzin (1970) extended Campbells metaphorical use of the The overall aim of the DMCI study was to conceptualize
term to encompass the incorporation of multiple sources of data, family response to a school-aged childs chronic illness. Data
multiple theories, and multiple investigators within a study in were collected from multiple family members, including mother,
order to overcome the intrinsic bias that comes from single- father, ill child, and, if available, a school-age sibling. The
method, single-observer, single-theory studies. While Denzin primary objective of the DMCI study was to identify family
extended the triangulation metaphor beyond a measurement management styles. Family management style is conceptualized
focus to the level of design, he, like Campbell, advocated the as the configuration formed by individual family members
use of triangulation to confirm ones results and conclusions. definitions of their situation as well as their specific strategies
In recent years, investigators have identified some quite for carrying out necessary treatments and for incorporating the
different purposes served by combining methodological demands of illness into their lives. Both definition of the
strategies while retaining the word triangulation to designate situation and management strategies must be understood within
their approach. Fielding and Fielding (1986), for example,
linked the expression triangulation to the goal of completeness. Table 1: DataCollectionTechniquesby Domainof Interest
They maintained that qualitative researchers seldom use in a Study of Family R w n s e to a ChildsChronic
triangulation to achieve convergent validity. Rather, qualitative Illness
researchers combine multiple methods, data sources, theories,
andor investigators in order to reveal the varied dimensions of DOMAIN OF INTEREST
an area of interest; each measure, source, or investigator
contributes another piece to the puzzle. Jick (1 983) agreed that Family Management Style Impact
triangulation may be used to achieve coverage of various Definition of Management Sociocultural
aspects of a phenomenon of interest, and added that using Situation Behaviors Context
qualitativeand quantitativemethods together may also illuminate
DATA SOURCE
elements of the context of a phenomenon, thereby achieving a
more complete understanding. When triangulation is used for Semi-Structured
the purpose of completeness it reveals multiple dimensions of Interviews:
an area of interest and can capture a contextual portrayal of the
Parent
unit or units under study. The metaphorical use of the expression
triangulation breaks down when the term is applied to a situation ill Child
in which completeness, not confirmation, is the goal.
Sibling
The principle purpose for using a triangulated approach in the
ongoing study, How Families Define and Manage a Child s Structured
Chronic Illness (Knafl, Breitmayer, Gallo, & Zoeller, 1987; Intstruments:
1990), was to achieve a more complete understanding of family
Parent FFFS FFFS
response to a childs chronic illness. However, the investigators
anticipated that selected aspects of various data collection POMS
techniques also could serve a confirmatory function for one
another. In the remainder of this paper we describe how ill Child CATIS CBCL
qualitative and quantitative instruments were incorporated in SPPC
FSI
the design of the study (hereafter abbreviated DMCI). We
complete the illustration of triangulation by describing our Sibling CBCL
approach to the analysis of data generated by qualitative and SPPC
_.. -
quantitative methods. Using a single construct, parental mood, CATIS = Child Attitude Toward illness Scale (Austin & Hubem/, 1987)
as an example, we describe, first, the analysis camed out to CBCL =Child Behavior Checklist (Achenbach & Edelbrock, 1983)
achieve completeness and, second, the analysis carried out to FFFS = Feetham Family Functioning Survey (Feetham, 1988)
achieve confirmation. Advocates of combining qualitative and FSI = Functional Status Instrument (Stein & Jessop, 1982)
quantitative measures in a single study have acknowledged the POMS = Profile of Mood States (McNair, Lorr, & Droppleman, 1981)
existence of a number of issues that must be confronted when SPPC = Self-Perception Profile for Children (Harter, 1985)

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 ~ Triangulation in Qualitative Research: Evaluation of Completeness and Confirmation Purposes
the familys own sociocultural context (see Knafl & Deatrick
[ 19901 for a more detailed discussion of the concept of family
management style).
Table 1 presents by domain of interest the qualitative and
quantitative instruments used in the DMCI study. Definition of
the situation, a term usually associated with the symbolic
interactionist framework, refers to the subjective meaning that
a particular situation has to the person (Burr, Leigh, Day, &
Constantine, 1979, p. 64). Consistent with the symbolic
interactionist underpinnings of the study, the investigators
selected open ended interviewing as the principal technique for
generating data to provide the basis for conceptualizing family
management styles. Interview guides that contained open-
ended questions designed to elicit detailed accounts of family
members definitions of the illness, management strategies and
perceptions of their support system were developed specifically
for the study. Separate interview guides were developed for
parents, child with chronic illness and sibling.
Although the principal technique for generating data on
family management style was open-ended interviewing,
structured instruments were used in addition to assess two
components of family management style. The purpose of the
instruments was to elicit information that would converge with
and confirm information from related interview questions.
First, the Child Attitude Toward Illness Scale (CATIS; Austin
& Huberty, 1987) was added to assess the chronically ill childs
definition of his or her illness. Previous qualitative researchers
have relied almost exclusivelyon adults as the primary informants
about childrens experiences. Recently, however, many have
argued persuasively that children themselves can be a valuable
source of information about their own thoughts and feelings
(Faux, Walsh, & Deatrick, 1988).Nonetheless, questions remain
about the quality of data provided by children, and research
suggests that the reliability of information provided by six to
nine year-olds is rather low (Edelbrock, Costello, Dulcan,
Kalas, & Conover, 1985; Holaday, Turner-Henson, & Swan,
1991).To the extent that data obtained by open-ended interview
and by the CATIS are mutually confirming, the credibility of
the DMCI studys conclusions about childrens definitions of
their chronic illnesses will be strengthened.
Similarly, the Feetham Family Functioning Survey (FFFS;
Feetham & Roberts, 1983) was used in conjunction with
interviewing to assess the parents perceptions of the
sociocultural context. The FFFS includes questions that address
the respondents satisfaction with intrafamilial functioning as
well as with the relationship between the family and broader
social units (Roberts & Feetham, 1982).The FFFS and interview
questions are expected to provide mutually confirming
information. That is, one would expect that persons who express
high dissatisfaction by a high FFFS score will also express
specific dissatisfactions with their families and/or external
systems in the interview. At the same time, the strengths and
weaknesses ofthese two data collection instruments are different
and to some extent counterbalancing. The FFFS provides for a
systematic assessment of satisfaction in specified dimensions
of family life previously theoretically and empirically linked to
family functioning (Roberts & Feetham, 1982), whereas the
Volume 25, Number 3, Fall 1993
interview allows respondents to identify perceived sources of
stress or support that may be unique to families who have a child
with a chronic illness.
The primary objective of the study was to conceptualize how
families define their situation and manage the childs illness.
However, the phenomenon of family response to chronic illness
extends beyond definition and management. Previous research
indicates that families with a chronically ill member experience
a higher incidence of emotional and behavioral problems and
greater dissatisfaction with family hnctioning than families in
which all members are healthy (Breslau, Staruch, & Mortimer,
1982; Daniels, Moos, Billings, & Miller, 1987; Hauenstein,
1990; Wallander, Varni, Babani, Banis, & Wilcox, 1989).
Consequently, to achieve a more complete understanding of
family response to chronic illness, the study design incorporated
measures of the impact of illness, which was conceptualized as
psychosocial adjustment. The analysis of the impact of illness
will focus on identifying relations between the measures of
psychosocial adjustment and the various components of family
management style because the investigators believe that the
family context potentially exacerbates or ameliorates
psychosocial distress.
Standardizedinstrumentswere chosen as the primary measures
of impact because scores on these instruments can be compared
with scores attained by normative samples (Breitmayer, Knafl,
Gallo, & Zoeller, 1992). However, questions about the impact
of illness were included in the interview guides as well. Family
members responses to these questions were expected to yield
data that confirm information provided by the standardized
instruments.
In summary, the research design incorporated triangulation
of qualitative and quantitative methods to serve both
completeness and confirmation purposes. Triangulation was
used within a domain to conJirm information, thereby increasing
credibility. It was used across domains to achieve a more
complete understanding of the broad area of family response to
illness by both revealing varied aspects of family response and
providing explanatory insights into relations among these varied
aspects.
Analysis of a Triangulated Study
In an effort to develop a system for analyzing the contribution
of qualitative and quantitative measures in the DMCI study, the
investigators focused on the construct of parental mood as
measured by the Profile of Mood States (POMS; McNair et al.,
1981) and addressed in the open ended interviews. The system
developed for analyzing the contribution of different data
collection methods to understanding parental mood state serves
as a model for the more comprehensive analysis in the larger
study of the way and extent to which different methods serve a
confirming or completeness function.
The POMS is a factor analytically derived inventory which
measures six identifiable mood states: tension-anxiety,
depression-dejection, anger-hostility, fatigue-activity,
confusion-bewilderment and vigor. A Total Mood Disturbance
score may be derived by summing the six individual scale
239
Triangulation in Qualitative Research: Evaluation of Completeness and Confirmation Purposes

scores. The strengths and weaknesses of the POMS and the semi-
structured interview are counterbalancing. For example, the
POMS, unlike the interview, provides an objective index on
which the mood of individual participants can be compared with
one another and with other populations. In the interests of
objectivity, however, respondents are directed to answer each
item in terms of his or her mood in the past week. Consequently,
the POMS is a measure of mood state, which may be influenced
by unusual circumstances. In contrast, the format of the semi-
structured interview encouraged interviewers to elicit details
about the duration of affective responses to the childs illness.
Furthermore, several interview questions address the availability
of and satisfaction with various support systems and thus are
expected to yield potentially explanatory insights into variations
in mood state as measured by the POMS. Used together, then,
the POMS and the interview questions provide a more complete
understanding ofparents affective responses to achilds chronic
illness than either instrument used alone. At the same time, these
two dissimilar data collection strategies are expected to yield
mutually confirming information, thus increasing confidence in
the credibility of the study findings.
Analysis for Completeness
In this analysis of the completeness function of triangulation,
the objective was to identify in the interview data potential
explanations for variations in mood state, as measured by the
POMS. To this end, each parents transcribed responses to
selected interview questions were examined in relation to the
parents POMS score. In choosing interview questions, the
interviewers were guided by theory and previous research. For
example, studies reviewed by Hauenstein (1990) indicate that
although a significant proportion of parents who care for a child
with a chronic illness report emotional distress, parental distress
is not an inevitable consequence of childhood chronic illness.
Because mothers of chronically ill children tend to have less
diverse social networks than mothers ofhealthy children (Kazak,
Reber, & Carter, 1988), it seems likely that the family unit will
play a prominent role in either buffering or exacerbating
parental distress. Accordingly, when choosing interview
questions whose answers might provide potential explanations
for variations in parental mood state, the investigators included
questions that focused on the respondents perception of the
family environment.
Once questions were chosen, matrix techniques (Marsh,
1990; Miles & Huberman, 1984) were employed to display each
parents answer to the selected questions in relation to his or her
POMS score. Matrix display facilitates comparison of data
across subjects and thus aids in the identification of relationships
among constructs.
To illustrate the analytic procedure, Table 2 depicts responses
of six parents to a single interview question, which concerned
whether the respondent perceived his or her childs illness as
having pulled the family together or having pulled it apart. The
six parents, all of whom had a child with diabetes, were chosen
on the basis of their total Mood Disturbance score. One mother
and one father were randomly selected from among parents who
had a high Total Mood Disturbance Score. A high score was
defined as one that was at least a standard deviation above the
total sample mean. One mother and one father were selected
because they had a low Total Mood Disturbance Score,
defined as one standard deviation below the sample mean.
Finally, a mother and a father, each of whom had an average
Mood Disturbance score, were selected. Data from parents
whose POMS scores were at the midpoint and extreme ends of
the distribution were chosen for this illustration because of the
likelihood that they would provide the clearest examples of how
qualitative data may provide explanations for variations in
mood state.
The responses displayed in Table 2 suggest that high mood
disturbance, as measured by the POMS, may be explained in
part by a perceived lack of family support in managing the
illness. The response of the high mood disturbance mother

Table 2: Triangulation of Quantitative (Profile of Mood States) and Qualitative Data for the Purpose of Completeness

Respondent Response to Question about the Effect of the Childs illness on Family Relationships

High Mood Disturbance Mother Idont know. I suppose in a way it kind of pulled us apart because its so stressful and everything and I
feel like he should not say so much! (Described her husbands persistent questioning of daughters
adherence to her diabetic regimen)

High Mood Disturbance Father Iwould say in this family anything tragic pulls us together.

Average Mood Disturbance Mother Its probably brought us closer together ...maybe because shes a teen-ager. Dealing with it has brought
me and her closer. When asked directly about the effect of the illness on her relationship with her
husband, she said, We havent changed.

Average Mood Disturbance Father Probably pulled us closer. Not that we were far apart, but it hasnt caused any riffs in the family that
would pull us apart. Were pretty close in the way we think. I almost know what my,wife is thinking if
she brings something up.

Low Mood Disturbance Mother Probably pulled us closer because you are so much more aware and youre with them so much more!

Low Mood Disturbance Father I think if anything it brought our family closer together. Now we do things as a family unit. Before,
everyone went their separate ways.

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Table 3: Triangulation of Quantitative (Profile of Mood States) and Qualitative Data for the Purpose of Confirmation
POMS Classification Answer to question about CeSpoRdent's
view of the word "acceptance"
H
i
J&
mother "I don't know. I guess you never really accept it."
father "There's nothing we can do about it. lt would mess
up your life too much to not just say he's diabetic
and this is the way we have to go about things
now.''
mother "Well, to me you don't have a choice. You have to
accept it. It's there and you either deal with it or
father you're in trouble."
"You can temper it a little one way or the other, but
you gotta accept it-it's never going to go away."
low
__.
mother "You've resigned yourself to the fact that it's not
going to go away ...soyou have to make the most
or it. We've accepted it from the beginning."
father "Everybody with a chronic illness has to accept it,
and I think we pretty well accept it. It's a fact of
life."
provides a particularly clear example. This mother judged that
the illness tended to distance family members and discussed in
this response as well as elsewhere in the interview disagreements
between herself and her husband over their daughter's adherence
to the diabetic regimen. Although the high disturbance father
responded that the illness brought the family together, he
attributed that effect very generally to the unifying power of
"any tragic event." In contrast,both the average mood disturbance
and the low mood disturbance mothers and fathers provided in
their responses to this question and elsewhere in the interview
examples of how the illness led family members to solve
problems together and to share feelings and activities. The
pattern of responses made by these six parents suggests that any
explanation for variations in distress among parents of
chronically ill children must incorporate an understanding of
the functional alterations that the family unit undergoes in
response to childhood chronic illness.
Analysis for Confirmation
Whereas the analysis of the completeness function of
triangulation focused on identifying explanatory relations
between POMS scoresand the socioculturalcontext,the objective
in the analysis of the confirmation function of triangulation was
to demonstrate similarity or convergence of two different
measures of a single construct, parental mood. The investigators
first identified interview questions likely to elicit responses that
would describe or characterize parents' mood states. Before
viewing the data, they discussed as a group how parents with
high medium and low scores on the POMS might be expected
to differ in their answers to specific interview questions. Matrix
Volume 25, Number 3, Fall 1993
Triangulation in Qualitative Research: Evaluation of Completenessand Confirmation Purposes
Answer to question about how respondent
maintains a positive outlook
"Ijust keep telling myself as long as she eats the way
she does and takes her insulin and checks her blood,
she'll be normal" (in fact, her daughter did not follow
the regimen).
"I try to always think in my head that they're going to
figure it out soon, but I have the feeling they're not. I
don't think they're any closer than they were 20 years
ago."
"Ijust take each day as it comes."
"It's just the way I was brought up." (to think positively)
"We eat a much better diet and it's not like we're losing
anything that we need to sustain a normal health life."
'I (If we feel down) we just talk it out. Discuss it amongst
ourselves."
display was again employed to facilitate the inspection of data.
Table 3 depicts the answers of the six parents with high, average
and low mood disturbance to two questions. The first question
concerned the respondent's interpretation of the meaning of the
word "acceptance" in relation to chronic illness, and the second
inquired about strategies he or she used to maintain a positive
outlook.
Responses to the word acceptance are examined first. The
investigators hypothesized that parents with high mood
disturbance scores, as compared to those with average or low
scores, would describe more difficulty in accepting the illness.
This hypothesis is supported by data displayed in Table 3. The
high mood disturbance mother doubted that she would ever
really accept the illness, whereas the average mother conveyed
her belief in the need to accept the illness in order to deal with
it, and the low mood disturbance mother even reported active
attempts to "make the most of' the illness.
The six parents' strategies for maintaining a positive outlook
are displayed in the right column of Table 3. As hypothesized,
the responses of the high mood disturbance mother and the high
mood disturbance father differ markedly from the responses
provided by the average and low mood disturbance parents and
indicate that they are relatively unsuccessfid in maintaining a
positive outlook. The high mood disturbance mother reported
thinking that if her daughter follows her diabetic regimen she
will lead a relatively normal life. However, this strategy was of
doubtful effectiveness because a major theme in this mother's
interview was her concern that her daughter did not follow her
diet, did not properly record her blood sugars, and had developed
disturbances in visual acuity and symptoms of peripheral
24 1
Triangulation in Qualitative Research: Evaluation of Completeness and Confirmation Purposes
neuropathy. The high mood disturbance father qualified his
strategy for feeling positive-looking forward to a cure-with
a comment indicating that he believed that no progress toward
a cure was being made. Thus, his strategy, like that of the high
mood disturbance mother, was ineffective as judged by other
comments in the interview. In contrast, the mothers and fathers
with low or average Mood Disturbance Scores reported using
coping strategies that apparently worked for them. Three parents
used cognitive coping strategies, such as focusing on a positive
aspect of the treatment, without adding qualifying remarks that
suggested that the strategy was ineffective. One parent, the low
mood disturbance father, reported relying on social support to
feel positive. The examples in Table 3 offer preliminary
evidence that data provided by structured instruments and open-
ended interviewing are mutually confirming. Of course, the
final analysis of mutual confirmation of data yielded by the
POMS and by open ended interview will not be limited to an
examination of parents responses to these two questions, but
will take advantage of the entire transcribed interview.
Table 4 provides an additional example of how data obtained
with qualitative and quantitative instruments were used for
purposes of mutual confirmation. Recall that the analysis of the
responses of the high, average and low mood disturbance
parents to the interview question about whether the illness
tended to pull their family together or apart suggested an
association between parental mood state and the respondents
perception of the quality of family functioning. The availability
of data obtained with the Feetham Family Functioning Survey
(FFFS) provided an opportunity to seek confirmation of this
association. The FFFS yields a discrepant score, which indexes
the difference between expected and achieved satisfaction in a
total of 21 areas (thus higher scores indicate greater
dissatisfaction). The discrepant scores (expressed as standard
scores) of high, average and low mood disturbance mothers and
Table 4: FeethamFamilyFunctioningSurvey Scoresof High,
Average and l o w Mood Disturbance Parents and
their Spouses
FFFS Discrepant Score
POMS
Classification of
MothedFather
Mother Husband Father
High + 1.190 + ,548 +.880
Average - ,244 - ,695 - ,778
Low - ,602 - 1.016 -1.524
Note:Scores are expressed as standard scores. The reference groups are all
mothers and all fathers in the DMCI sample.
242
fathers are depicted in Table 4. The FFFS score of the spouse
of each o f these six parents is presented as well.
As can be seen in the table, each mothers FFFS score is
predictably related to her classification on the POMS. The high
mood disturbance mother experienced the most dissatisfaction
with family functioning and the low mood disturbance mother
the least. A similar pattern obtained in the case of high,
average, and low mood disturbance fathers. The FFFS scores
thus tend to confirm the association identified between parental
mood state and the quality of family support. Moreover, the
FFFS scores of the target parents spouses reveal the same
pattern; the greater the target parents mood disturbance and
dissatisfactionwith family functioning,the greater the husbands
or wifes dissatisfaction with family functioning. Thus, the
spouses FFFS score-which was obtained independently of
that of the target parent-further confirms the association
between mood disturbance and family life that was identified
in the analysis of interview material.
Conclusion
The goal oftriangulation in any study is to increase confidence
in the trustworthiness of the researchers data and its
interpretation. In the context of trustworthiness, triangulation
is most often thought of as a method for demonstrating
convergent validity. However, identifying convergences in
qualitative and quantitative data is not always a straightforward
process (Jick, 1983; Patton, 1990). Triangulation for
convergencerelies on differentmeasuresof the same construct,
but structured instruments and interviews by their nature
seldom measure precisely the same construct. For example, the
POMS measures the relatively discrete construct mood state,
whereas the interview questions in the DMCI study were
designed to capture patterns or processes. In the analysis
illustrated in Table 3, convergence was sought between each
respondents mood state, as measured by the POMS, and his or
her answer to an interview question about strategies for
maintaining a positive outlook. Counter to expectations, the
high mood disturbance mother readily identified such a coping
strategy, namely assuring herself that her daughter will be
normal as long as she follows her diabetes regimen. Only when
the investigators interpreted her answer within the context of
her entire interview, in which she discussed many examples of
her daughters failure to adhere to her regimen, did convergence
become apparent.
The advantages of triangulation are not limited simply to
Wife their use as a check on the credibility of data. The challenge of
qualitative data analysis is to make sense of massive amounts
+ ,832 ofdata (Patton, 1990).Used together, qualitativeand quantitative
- ,542 data increase opportunities for alternative interpretive schemes.
For example, the data displayed in Table 3 point to differences
- ,841 in the coping style of average and low mood disturbance
mothers. Specifically, the average mother accepts the illness
because she must, and she maintains a positive attitude by
taking one day at a time, whereas the low mood disturbance
mother makes the most ofthe illness and even finds advantages
in the familys healthier diet. Of course conclusions about the
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 -- Triangulation in Qualitative Research: Evaluation of Completeness and Confirmation Purposes
importance of this difference must await a more holistic analysis
of data from the entire sample. Nonetheless, in sensitizing the
investigators to subtle, but potentially important, variations in
how mothers define their childs chronic illness, triangulation
has guided the discrimination of family management styles.
In a related vein, Lather (1 986) reminds us that it is essential
that the research design seek counterpatterns as well as
convergences in the data. Structured instruments, for example
the Child Behavior Checklist (CBCL) and the POMS, have been
built into the design for the purpose of examining potentially
significant outcomes of various family management styles, the
identification of which is the principal aim of the DMCI study.
A construct is defined implicitly by a network of associations
in which it occurs (Cronbach & Meehl, 1955).The investigators
believe that a familys style ofdefining and managing childhood
chronic illness mediates family members risk for adverse
psychosocial outcomes. Therefore, significant relations between
the various family management styles and scores on measures
of adjustment will support the construct validity, or
meaningfulness, of the styles identified. Equally important,
however, failure to identify such relations will lead the
investigators to reexamine the qualitative data for alternative
patterns of defining and managing and even to reconsider
whether the construct of family management style is a useful
one.
In a recent call for greater rigor in qualitative research, Lather
(1986) counseled that our best shot is to construct research
designs that push us toward becoming vigorously self-aware
(p. 66). When investigators design triangulated studies so that
data obtained by qualitative and quantitative methods are
purposefully linked from the outset, they take an important step
in that direction. @Q
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243
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