Successful Qualitative Health Research

A practical introduction

Emily C Hansen

• Publisher: Routledge
• Year: 2020
• eBook ISBN: 9781000246544
• Edition: 1
• Topic: Social Sciences
• Subtopic: Health Care Delivery
• Index: Social Sciences

A practical overview for health students and health professionals embarking on an applied research project using a qualitative approach. Successful Qualitative Health Research offers a thorough introduction to the field, written in a very clear and concise fashion. Emphasising the rigorous approach required in health research, it provides a step by step guide to designing a research project using qualitative methods, and to collecting, analysing and presenting different types of data.Hansen provides essential insights into the ideas and arguments underpinning different qualitative methods, and highlights the links between theory and practice. She also explains the importance of choosing the most appropriate form of data analysis. Each chapter features real life examples from experienced researchers from a wide range of health fields. These examples show how researchers have overcome common problems and offer inspiration and guidance. Applied qualitative research is increasingly being used to explore a range of issues in health, both on its own and as an adjunct to quantitative research. This book offers a clear, no-nonsense approach that will be invaluable to students and professionals in nursing, medicine, allied health and public health.'I strongly recommend this book to all those looking to undertake ethical and rigorous qualitative research in the field of health and health care.' - Dr Jon Adams, Director, Qualitative Research Laboratory, Faculty of Health, University of Newcastle 'From thinking about theory to writing for publication, this text covers a massive amount of ground in a fresh and dynamic way. It will enthuse the beginner and refresh the old hand...' - Associate Professor Jane Gunn, Research Director, Department of General Practice, University of Melbourne

one
QUALITATIVE RESEARCH: AN INTRODUCTION

Qualitative research is becoming increasingly respected and popular among health researchers (Thomas, J. et al. 2004). This is because qualitative research methods are well suited for investigating the meanings, interpretations, social and cultural norms and perceptions that impact on health-related behaviour, medical practice and health outcomes (Jordens & Little 2004; Sayre 2000). They also allow researchers to explore issues from the perspectives of the individuals directly involved; for example, the experiences of spousal carers of people with multiple sclerosis, and the disclosure strategies used by adults with cystic fibrosis (Cheung & Hocking 2004; Lowton 2004).

This chapter provides an introduction to research as an activity and to qualitative research in particular. It presents the differences between qualitative and quantitative research, discusses combining qualitative and quantitative research and explains the close relationship between qualitative research and academic theory. The chapter provides essential background material for the following chapters in this book.

Defining research

Many people seem unsure about what research actually is. Popular conceptions of research often imply that it is rather mysterious, esoteric and invariably difficult. While research certainly can be all of these things, it doesn’t have to be. In fact, it can be an enjoyable and satisfying activity with the potential to improve healthcare practice, planning and policy. Because it is much easier to do something successfully if you understand what it is you are trying to achieve, I decided to start this book with a brief discussion about the meaning of research.

There are many different types of research and, on the surface, these may vary considerably. For example, compare a scientist culturing cells in a laboratory, an epidemiologist collecting information about bone mineral density in pre-menopausal women, an anthropologist living in a South American village and a social worker running focus groups with young mothers to learn about their needs. All of these people are conducting research if their inquiry meets the following criteria. First, for an inquiry to be called research, it should involve a disciplined and systematic search for knowledge. A researcher uses systematic, clearly described procedures; they are aware of the strengths and weaknesses of these methods; they value empirical verification; and seek plausible alternative explanations for their findings (Smith & Glass 1987:11).

Second, for an inquiry to be research, it should be a public activity available for scrutiny by peers. This involves clearly describing how the new knowledge was achieved and disseminating research results. For the majority of health-related research, this scrutiny will also involve review of a research proposal or protocol by an ethics committee or institutional research review board before the research is conducted.

A third and closely related characteristic of research is that it is an activity that should not occur in isolation. Research is ‘original creative intellectual activity leading to the generation of new knowledge’ (Whitworth 1994:26). The work of individual researchers is viewed as part of a larger process of finding answers. Associated with this is an expectation that the outcomes of research (including knowledge gained about methods and approaches) should be in some way transferable to other researchers and make a contribution to wider stocks of knowledge; for example, producing new information, testing existing knowledge or finding new applications for existing knowledge (Pryke et al. 2003).

Types of research

There are a number of different types of research relevant to the readers of this book. The first of these is social research. Social research refers to any research that investigates human behaviours and social life (Berg 2004). All qualitative research is social research; however, not all social research is qualitative research. The methods used by social researchers are largely derived from a group of academic disciplines known collectively as the social sciences. These include sociology, anthropology, education, psychology, geography and political science.

Other types of research may be defined by the purpose of the inquiry – descriptive research, explanatory research and applied research. Descriptive and explanatory research are undertaken because the researcher wants to contribute to the stock of knowledge and has interest and expertise in a particular field. These types of research tend to be the domain of academic researchers, university students and the occasional individual or group motivated by an overwhelming passion or interest in a particular issue or problem. In contrast, applied research is ‘specifically designed to be problem solving and to have an outcome which is expected to be of immediate relevance’ (Macoun 2004:1; Royse et al. 2001:2). Applied research is conducted because the researchers want to gain knowledge in order to meet a need, solve a problem or achieve a commercial objective. A wide range of people in addition to academics and students carry out applied social research. These include professional and market researchers, healthcare practitioners, educators, policy makers and managers. Evaluation research conducted to determine the success of programs can be seen as a type of applied research (Royse et al. 2001:2).

Evaluation provides information about the processes and outcomes of health-related programs for use by those involved in planning, implementing and funding them (Smith & Glass 1987:30). ‘Social programs, and the policies that spawn and justify them, aim to improve the welfare of individuals, organisations and society. Hence, it is useful to assess how much any social program improves welfare, how it does so and how can it do so more effectively’ (Shadish et al. 1991:19). Evaluation research can be undertaken during a program to assess implementation and at the conclusion of a program to assess how well the program met specified objectives. For example, while descriptive and explanatory research might produce results that suggest a relationship between vaccination rates and the incidence of childhood disease, the ensuing vaccination program can be evaluated to assess issues such as cost effectiveness, uptake and sustainability (House 1980:121). As with other aspects of health-related research, evaluation practitioners are increasingly making use of qualitative methods and approaches (Owen 1999; Burgess 1991; Patton 1990).

Qualitative methods permit the evaluator to study selected issues in depth and detail. Approaching fieldwork without being constrained by predetermined categories of analysis contributes to the depth, openness and detail of qualitative inquiry. (Patton 1990:13)

Establishing whether the social research you plan to conduct is applied, descriptive or explanatory is your first step. It will impact on how the research is conducted, and expectations about research dissemination and outcomes.

Qualitative research

In qualitative research, behaviours, understandings, actions and experiences are not measured using statistical analysis as in quantitative research (Devers 1999; Sofaer 1999). Instead, detailed written descriptions and explanations of the phenomena under investigation are produced. Baum describes this difference by stating that: ‘quantitative research attempts to reduce and measure social phenomena while qualitative research aims to understand social processes’ (Baum 1992:1). Qualitative methods are those that collect data in the form of talk, words, observations, visual images and documents.

Qualitative research is the subject of a longstanding debate among social researchers. From one side of this argument, researchers and writers have claimed that ‘social life does not lend itself to any kind of scientific investigation’ (Blaikie 1993:2; Smith & Glass 1987:1). Researching how people experience their lives and the meanings and interpretations they give to these aspects is viewed as being fundamentally different from conducting research on natural phenomena or ‘things’. Researchers with this viewpoint reject the use of ‘scientific method’ when investigating the social world, choosing to use an alternative approach often described as constructivist/interpretivist (sometimes also called the inductive paradigm or naturalistic research). Underpinning this approach is the assumption that there is no single reality or truth. From this perspective, research is about discovery arising from active participation by the researcher. ‘Hypotheses and theories are generated but the aim of the research is not to prove them to be true or false’ (Hamberg et al. 1994:177). Instead, it is assumed that there are a range of possible perceptions of reality and these will change over time and according to social context. In other words, what we are able to know is contextual and situational.

However, proponents of the other side of the argument have insisted that ‘there is no aspect of the social world that is not amenable to the application of the scientific method, or at least some kind of scientific method’ (Blaikie 1993:3). From this viewpoint (sometimes described as positivist) it is argued that social research should be conducted similarly to other types of scientific research. Studies should be based around hypothesis-testing designs, using statistical analysis and evaluated using criteria such as objectivity, generalisability, validity and reliability (Smith & Glass 1987:6). Examples are experimental studies or randomised controlled studies using quantitative social research methods such as standardised questionnaires and structured observation.

Most researchers involved in social research fall somewhere between these two positions and tend to use both qualitative and quantitative research methods as they deem appropriate (Sale et al. 2002). However, any researcher using one approach alone or who uses both qualitative and quantitative approaches needs to understand that qualitative and quantitative research are derived from perspectives that assume different views of reality. The two approaches vary in terms of ontology (assumptions about the nature of social reality) and epistemology (assumptions made about how knowledge of reality can be achieved). Many writers argue that qualitative and quantitative research are so dissimilar in their underlying claims and assumptions that they can be seen as representing two different paradigms (Guba & Lincoln 1994:11; Sale et al. 2002; Blaikie 1993). Certainly it is difficult to explain qualitative research without discussing quantitative research as a point of comparison.

Differences between qualitative and quantitative research

Recognising and understanding the differences between qualitative and quantitative research allows a researcher to make informed decisions about the most appropriate approach for their work. It should also assist them to better understand the longstanding historical divide between qualitative and quantitative research (Kelle & Erzberger 2004; Ritchie 2001). The differences between the two approaches are discussed below in terms of underlying assumptions, research design, the research setting and the role of the researcher.

Underlying assumptions

Qualitative research aims to provide ‘detailed descriptions and analysis of the quality or substance of the human experience’ (Marvasti 2004:7). Qualitative researchers assume that in order to understand human actions and behaviours, we need to understand the meaning and interpretations that people give to their own actions, to the actions of others and to situations and events. Qualitative researchers tend to focus on providing detailed accounts, recognising and explaining social context and discussing ambiguities. A critical stance and explicit questioning of ‘taken-for-granted’ ways of doing things or assumptions is another common theme found in qualitative research. This includes questioning the assumptions underpinning research methods and theories.

Qualitative research encompasses a wide range of theoretical positions. The majority fall within a constructivist/interpretivist paradigm where ‘the physical aspects of the world are seen to have independent existence, how the world is perceived (reality) is a social construction’ (Martin 1994:7). Preferred methods for learning about the social world are those that emphasise ‘human interpretation, inductive reasoning, holistic understanding, qualitative data and contextualised explanation’ (Martin 1994:6).

In contrast, quantitative social research derives from a positivist paradigm based on an assumption that the social world can be investigated using scientific method and that there is an independent reality, the ‘truth’ of which can be found by ‘applying the proposition that measurable influences (independent variables) affect measurable outcomes (dependent variables) in a cause–effect manner’ (Grbich 1999:15–16). From this perspective it is assumed that ‘what is being studied is external to the observer, does not change over time and is not influenced by being observed’ (Denzin 1989:24). Reality, truth and facts are viewed as existing externally to the researcher. Quantitative research searches for ‘universal explanations for phenomena’ (Smith & Glass 1987:23). For example, scientific explanations, if correct, are assumed to apply equally well to all instances of the same problem. Explanation in quantitative research emphasises the quantification of outcomes, generalisability and prediction. This is quite different to the context-based nature of explanations from most qualitative research, where researchers often qualify their statements as applying only to the example under study. Quantitative research tends to have a far more unified theoretical basis than does qualitative research (Martin 1994:3).

Quantitative social research involving the use of statistical measurement is familiar to the majority of people working in the health field. Examples include experimental psychology, standardised health-related quality-of-life questionnaires and large surveys of attitudes and practices. The popularity and widespread use of this type of social research among health researchers reflects the scientific basis of Western medical knowledge and the type of training that most healthcare professionals receive (Martin 1994:3).

Research design

Qualitative research designs can be deductive or inductive. That is, they can aim to test a hypothesis or to develop one (Creswell 2003). However, there is a preference among qualitative researchers for inductive design. While research, by definition, entails the application of disciplined and systematic research methods and study designs, the largely inductive nature of qualitative research projects means that their design tends to alter as the study unfolds in response to changing circumstances and the data being collected (flexibility of design). This is a normal aspect of qualitative research (Denzin & Lincoln 1994).

In contrast, quantitative researchers use standardised and repeatable methodologies that ‘represent human experience in numerical categories’ (Marvasti 2004:7). These are usually experimental in design (and deductive because they test a pre-existing hypothesis). Experimental design and standardised repeatable methodologies are the cornerstone of quantitative research. Because of this the flexi...

Table of contents

• Cover
• Title Page
• Copyright Page
• Contents
• Preface
• Acknowledgments
• 1. Qualitative research: An introduction
• 2. Planning your research
• 3. Research design and rigour
• 4. Observation and participant observation
• 5. Interviewing
• 6. Focus groups
• 7. Analysing qualitative data
• 8. Writing qualitative research
• Glossary
• References
• Index