The research method for this project is Quantative and quantative:

1.1. Quantative (objective): based on structured Cultural Context Questionnaires (CCQ) and the Measure Yourself Medical Outcome Profile (MYMOP) questionnaire.
1.2. Qualitative (field research): based on engagement, observation, self-reflection and experiential feedback from the field research process.

The tools of quantative research include questionnaires, interviews and response rates. The planning and piloting questionnaires is important in terms of eliciting the information which will be helpful for the study; the questionnaires may be specific and structured and cross reference to pre-coded questions; they may ask open-ended questions which may generate new or unexpected categories.

2.1. The Cultural Context Questionnaire will ask specific questions to help define the cultural and ethnic setting and orientation; it will include reference to the following:
* Social setting; cultural norms
* Treatment methods
* Health care values
The question design may include the following:
* open/closed questions - specific questions
* Forms and prompts - attitude (opinion) questions
* Single item questions - knowledge questions

2.2. In order to quantify attitude data we will use the Lickert (1932) scale which presents a series of opinion statements about an issue; the persons attitude is assessed by the extent to which s/he agrees or disagrees with each statement, these are numerically divided into a series of ordered responses:
                        1                            2                         3                            4                             5
              Strongly agree               agree                undecided               disagree               strongly disagree

For numerically categorising change in a health condition:
                  1                          2                       3                        4                          5                          6
               None                very mild                mild                moderate                severe               very severe
Categorical scales are preferred because of their ease of administration, analysis and interpretation (Jaeschke et al 1990).

2.3. Measure Yourself Medical Outcome Profile (MYMOP):
The MYMOP questionnaire is a self assessment profile which is primarily concerned with changes in symptoms and will be adapted to assess progress and change as well as being used to quantify outcomes in the narrative data and case studies. The advantages of this approach are that it is client centred, responsive to the client’s experience while remaining brief. The MYMOP will be the format used with the research contact groups at the pre-group assessment; mid-group and evaluation stages.

2.4. Translation and cultural equivalence:
Measurement instruments generally reflect cultural norms of the society in which they are developed and some items may not translate well. It is essential that we ensure congruity between words and their true meaning in the translated language. Sensitivity to culture and the selection of appropriate words is important. White & Elander (1992) stress the importance of cultural equivalence; congruent values and the careful use of colloquialisms.

The psychometric properties of the instruments should be reassessed in each culture/country in which it is to be used including item-scale correlations,, compressions of missing responses, scale correlation with existing standards or other similar instruments in relation to the subgroup within the population of interest (Reese & Joseph 1995).

Qualitative data is gathered during field research and will include participant observation and/or qualitative interviewing of members of a culture (ethnography) which is used to document experience and assess outcomes of an intervention/treatment (Abel et al 1993).

This data does not test a causal hypothesis although it may devise a qualified hypothesis about cause and effect relationships in relation to the phenomenon observed.
Methods used:
* Observation - unstructured observation (non-verbal)
* Participant observations - structured observations
* Narratives - verbal/conversational
* Theoretical analysis - Case studies
* Self-reflection - personal reflection and problems encountered
* Quotes and comments from patients and colleagues

3.1. Theoretical analysis:
Feldman (1995) described four techniques of analysis used by social scientists regarding the focus of observation:
3.1.1. Ethno methodological - understanding the processes by which people make sense of interactions rather than what sense is made.
3.1.2. Semiotics - understanding the means by which meaning is attached to language.
3.1.3. Dramaturgist - focus on the roles people are in and their strategies for producing desired effects; the technique is used for the study of institutions and organisational ritual.
3.1.4. Deconstructionist - the search for multiple meanings implicit in text, speeches, conversations or events.

3.2. Observation:
The importance of observation is its creative capacity to find themes which emerge during the course of the research project; for this to be useful however, the process of the analysis of observation data will need to be cross-reference: fully transcribed field notes of each observational period will be used to search for categories and themes and the overall research data will then be indexed in relation to these themes.

3.3. Narratives:
Narrative research is a record of the subjective experience of individuals or groups involved in the research which will form a picture of diverse and individual experiences of the use of art therapy. The qualitative format requires a full transcript which may be used as to illustrate a situation and used to support a theoretical interpretation, for example the structured and unstructured date used by Goffman (1961).

3.4. We will use the case study as a research method which focused on the circumstances, dynamics and complexity of a single case or small number of cases - used with other research methods to investigate fully complex situations and to validate the findings. This is valuable for the study of complex social settings and also used as a biographical research method i.e. unstructured interviews to obtain a narrative of a respondent’s life. The aim of the case study is to interpret the data in a rigorous manner rather then reporting selective perceptions to understand phenomenon in the case selected.

3.5. Reflexivity (self and personal reflection):
The researchers own subjective experience through self-reflection will provide a narrative based on experience using the self as subject and recording thought process and interpretation of events. How we describe and make sense of the events will be based on one’s own cultural and social background as well as personal experiences. Because the researchers own interpretation is central to ethnography it is important to be explicit about how one’s own beliefs and background influences what we see.

In order to carry out clinical research it is necessary to seek approval for the project from the relevant research ethics committee which will be either in the health or social care organisations in which the project is to be set.

In terms of confidentiality; all research material will be logged and filed for future referencing. All parties will need to sign a consent form which will enable the use of all material, transcripts, questionnaires and artefacts (images and pictures) to be used in research related presentations. This consent must be sought at the beginning of the research project and also during the final evaluation interview with each participant.

The narrative data will contain case examples and artefacts; images; pictures; models and stories which will be used in the inter-cultural evaluation of the project. Permission will need to be sought at the outset of the project to enable their use in professional forums, discussions and presentations and any subsequent publication of related materials.

Abel, T., Geyer, S., Gerhardt, U., Siegrist, J. and van den Heuvel, W. (ed) (1993): Medical Sociology: Research on Chronic Illness. Bonn: Informationszentrum Socialwisenschften.

Bowling, A (1997): ‘Research Methods in Health: Investigating Health and Health Services’ Open University Press: Buckingham: Philadelphia.

Feldman, M.S. (1995): ‘Strategies for Interpreting Qualitative Data’, Qualitative Research Methods Series 33. Thousand Oaks, CA: Sage Publications.

Goffman, E (1961): Asylums’ New York: Doubleday.

Jeaschke, R., Singer, J and Guyatt, G.H. (1990): ‘A Comparison of the Seven Point and Visual Analogue Scales’, Data from a randomised trial. Controlled Clinical Trails, 11; pp 43-51.

Lickert, R (1932): ‘A Technique for the Measurement of Attitudes’, Archives of Psychology, 22; pp 1-55.

Reese, P.R. and Joseph, A. (1995): ‘Quality Translations - No Substitute for Psychometric Evaluation’, Quality of Life Research, 4; pp. 573-4.

White, M. and Elander, G. (1992): ‘Translation of an Instrument’, The US-Nordic Family Dynamics Nursing Research Project. Scandinavian Journal of Caring Science: 6; pp 161-4.