Application of Guided Self-Determination Method and Photovoice in Qualitative Longitudinal Research for Enhanced Sensemaking in Chronic Kidney Disease with Multimorbidity

Qualitative longitudinal research (QLR) elevates the dynamic dimensions of time, process, continuity and change and is particularly well placed for understanding how people’s lives unfold over their health journeys. This study illustrates how the application of a novel multimodal method for exploring patient life stories and complex health journeys enables enhanced sensemaking of their perspectives. The QLR was a two-year study spent collecting data over a one-year period with each participant, exploring experiences of people living with Chronic Kidney Disease (CKD) and multimorbidity and eliciting their preferences, needs, values and possible change over time. The method was based on Guided Self-Determination (GSD) theory using reflection and conversation sheets combined with photovoice for visual representation of lived experiences and semi-structured interviews. Unique layering of multimodal data and iterative analysis inspired by Thematic Trajectory Analysis, enabled creation of trajectory case profiles. Four case profiles are presented to provide illustration of new knowledge generated by the expression of lived experiences of patients, by patients and the researcher, through the QLR methods. Temporal change is evident in all cases in various forms through experiences expressed visually, in text and in conversation as either, (a) values challenged by reality, (b) adaptation, (c) navigation and uncertainty or (d) reflection and pr oblem-solving. In one case, study participation and use of the GSD tool had an unintended intervention effect. Researcher and participant reflexivity was promoted through the GSD and photovoice methods. The novel QLR methodology allowed complex trajectory case profiles to be framed in a new way to illuminate depth of person-specific insights about processes of change over time when navigating uncertainty in CKD and multimorbidity. This work further contributes new dimensions of sense-making in QLR through the layering of GSD and photovoice alongside interviews.