Research Methods for Clinical and Health Psychology

David F Marks, Lucy Yardley, David F Marks, Lucy Yardley

• Publisher: SAGE Publications Ltd
• Year: 2003
• Print ISBN: 9780761971917, 9780761971900
• eBook ISBN: 9781446232323
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

`If you are teaching postgraduate research methods courses, including those aimed at a mixture of psychologists and other health professionals, this book is worth considering as a core text?

- John Hegarty, THES

This textbook offers an excellent introduction to the variety of research methods used within the fields of clinical and health psychology. The book provides a detailed, yet concise, explanation of both qualitative and quantitative approaches and draws upon case-study examples to illustrate how these can be used in a variety of health-care settings, with special relevance to clinical disorders, disease prevention and health promotion.

Key features of the book include:

- A clear and concise narrative

- Real-life case studies and examples drawn from clinical practice.

- Revision questions in each chapter

- Boxes, diagrams and tables to highlight key points

- Chapter outlines, summaries and a glossary of useful terms to help students and researchers with independent study and learning.

Research Methods for Clinical and Health Psychology fulfils the demand for a textbook explaining how qualitative and quantitative methods can be used explicitly in a health psychology context. It will be invaluable reading for clinical and health psychology students, trainees and practitioners, as well as those in nursing, medical and other healthcare departments taking an advanced psychology option.

1	INTRODUCTION TO RESEARCH METHODS IN CLINICAL AND HEALTH PSYCHOLOGY
	Lucy Yardley and David F. Marks

AIMS OF THIS CHAPTER

(i)	To consider what readers can expect to gain from this book.
(ii)	To discuss the aims and purposes of research, in relation to different theories of how knowledge can be obtained.
(iii)	To introduce the context of research in health and clinical psychology.
(iv)	To discuss procedures for establishing the validity of research.

WHAT CAN YOU GAIN FROM THIS BOOK?

One genuine frog is worth a bucketful of toads. Anon

What’s that? Frogs and toads, indeed! What have they got to do with a book on research methods? Well, read on – by the end of this chapter you will see.

This book is an introduction to methods for carrying out research in clinical and health psychology. It introduces the kinds of study designs and methods that are in common usage across the health sciences and which are of particular relevance to psychologists and social scientists. We aim to give readers sufficient understanding of the nature of psychological inquiry in these fields to be able to understand how and why a variety of different research approaches and methods can be used, and to ask sensible and searching questions about the best ways of doing things before, during and after a research project. This broad overview of the process of carrying out research will enable you to critically appraise published research, to evaluate the potential and limitations of a variety of qualitative and quantitative research methods, and to identify those that you may wish to use for particular research purposes.

Of course, it is not possible to provide exhaustive details of all the specific methods in a single textbook, and so we have provided references and recommendations for further reading that will help you to become more expert in any particular method that you may wish to use. We encourage the reader to apply the methods described here creatively to the particular unique setting in which she or he is planning a project. Obviously it is also impossible to list a complete set of features that will apply to all settings, times and places. Policies, circumstances and contexts vary enormously across settings and across time, and readers will need to adapt the research methods to each new situation.

This chapter provides the context for the following chapters on specific aspects of research, by examining some fundamental questions regarding the aims and validity of research in general, and considering the context of research in clinical and health psychology.

WHAT SHOULD BE THE AIMS AND METHODS OF RESEARCH?

Although this question might at first seem almost superfluous, it is actually the starting-point for some fundamental and long-lasting debates about ontology (what there is to be known, that is, what ‘reality’ is) and epistemology (how knowledge can be obtained). A range of positions has been taken in this debate, ranging from realism and positivism at one end of the spectrum to constructivism and idealism at the other.

The realism/constructivism debate

The modern realist perspective can be traced back to the philosophy of Descartes, who proposed that we have direct knowledge of subjective, mental reality (‘I think, therefore I am’), but must derive our knowledge of objective, physical reality through observation (see Yardley, 1999). Subjectivity is viewed as pure, rational thought, internal to the individual, and separate from the body. The rational mind is viewed as the vehicle with which we can seek to understand and control a mechanical, physical world (which includes our own bodies). Consequently, the task for research is to attempt to obtain accurate information about objective physical reality. This can be achieved by maximising the precision of our observations through quantification, and ensuring that error and bias are eliminated from our observations – for example, by isolating the variables we are studying in order to be able to identify cause–effect relationships more clearly. Subjective distortions of reality may also be introduced by us as researchers and, in psychology, by human ‘subjects’ or ‘participants’, and these potential sources of bias must be minimised also.

In the classic positivist hypothetico-deductive method, observations can then be used to empirically test our mental models of the generalisable causal laws that govern reality, using objective methods of analysis such as statistics to ensure that these analyses are not influenced by subjective expectations or values. Having ascertained the causal laws that govern the physical world we can intervene to achieve desired objectives. This approach to research provided an extremely useful initial foundation for modern science and medicine, and proved so successful that it was also adopted by the emerging discipline of psychology. Consequently, for most psychologists this is the most familiar approach to obtaining knowledge through research.

Despite the practical utility of the scientific method, post-modern critics of the realist perspective have suggested that eliminating subjectivity from our knowledge of the world is actually impossible to achieve (Gergen, 1985; House & McDonald, 1998). The constructivist argument is that since we can only gain knowledge through the human medium of our minds and bodies, all our knowledge of both ‘self’ and ‘body/world’ is inevitably mediated, constrained and thus constructed by our thoughts and activities. Moreover, constructivists do not view the construction of meaning as a private, subjective matter, but as an essentially social process, since our habitual ways of thinking and acting are fundamentally shaped by social interaction, language and culture. From this perspective, differences in perceptions and interpretations of ‘reality’ are not error, since different ways of living and thinking create different experiences of the world and different systems of meaning. This does not mean that the ‘objective reality’ of science is incorrect – in the context of the activities of predicting and controlling physical phenomena (including physical health) it is the most valid and useful way we currently have of understanding the world. However, it is not the only valid and useful way of understanding the world. For example, religion, politics, art and personal experience all offer different but equally valid perspectives.

At this point, a common realist response is to invoke the ‘death and furniture’ argument – to bang the table to prove it is objectively real not socially constructed, and to object that events such as death have a physical reality that cannot be construed in any other way (Edwards, Ashmore & Potter, 1995). However, death is actually a good example of an event that psychologists must consider from multiple points of view if they are to acknowledge and understand the psychological experience of health and illness. Without doubt, the physical dimension of death is best explained in scientific terms – although it should be noted that as our knowledge and practice of medical science has changed, so has the definition and indeed the physical reality of death; people whose heart had stopped would have been incontrovertibly ‘dead’ two centuries ago, but now death can be postponed until brain activity ceases (and two centuries into the future who knows at what point death will be considered to be irreversible?). Consequently, for the practical purpose of preventing death the medical scientific definition of reality is undeniably the most relevant. However, death cannot ultimately be prevented by science – and the non-scientific views of reality and interpretations of death may be much more relevant to understanding and shaping the experience for the living, dying and bereaved. These include all the religious, cultural, philosophical and personal beliefs that can help us to accept and find positive meaning in the inevitability of dying, and offer a way of integrating it into our lives.

Since constructivists believe that human culture and activities profoundly shape our experience and knowledge of ‘reality’, the aim of constructivist research is to understand the different meanings by which people in different contexts make sense of the world and of their lives, and the social processes whereby these meanings are created. Consequently, rather than isolating variables from their context and regarding human interpretations as ‘bias’ which obscures objective reality, constructivists deliberately seek to investigate how context and interpretation (including those of the researcher) influence our experience and understanding of the world. This can be achieved by collecting contextualised data, often in real-world settings and in the natural language of participants, and encouraging reflection on the social and subjective processes influencing the interpretations that are constructed. The aim is not to identify universally applicable laws but to develop insights which are meaningful and useful to particular groups of people, such as patients, participants in a study, or people in similar situations, health care workers, and/or other researchers.

Despite the passion with which researchers sometimes argue for one or other pole of the realism/constructivism divide, the ontology on which each position is founded can never actually be proven correct or incorrect, but must remain a matter of faith; since we cannot extricate our knowledge from our subjective perceptions and thought processes we will never know with complete certainty whether there is an ‘objective’ reality out there or not (Potter, 1996). Moreover, as the next section explains, the divergence in ontology and epistemology between realists and constructivists need not become a barrier to maximising and integrating the insights and benefits that can be derived from different approaches to research.

Beyond the realism/constructivism divide

In practice, few researchers are extreme realists or extreme constructivists, and there are many intermediate positions that can be adopted (see Guba & Lincoln, 1998). For example, the post-positivist view is that although an objective reality exists, and we should seek to understand it, we can never gain perfect knowledge of it. While this view is entirely compatible with the scientific method, rather than seeking to establish the ‘truth’ through experimentation, the aim of post-positivist research is to test, falsify and thereby improve our imperfect models of reality, using a variety of methods. Similarly, many researchers are happy to concede that indeed there may be an independent external reality which constrains and shapes people’s lives, but that it remains vitally important for researchers to take into account and investigate the way in which human experience (including the process and outcome of research) is also shaped by subjective interpretation and social interaction.

Moreover, although the different aims and assumptions of realist and constructivist researchers clearly tend to steer them towards different methodologies, there is no rigid mapping between ontology/epistemology and method. A qualitative grounded theory analysis of interviews with patients might be undertaken by a realist who wanted to uncover their rationale for accepting or rejecting a particular treatment, or by a constructivist who wanted to explore how the treatment was perceived and depicted by the patients. In each case the method used and data obtained would be similar, but the focus of the analysis and the interpretation would be slightly different; the realist would be interested in patients’ statements as a reflection of the underlying beliefs which caused them to behave in a particular way, whereas the constructivist might be interested in the accounts as an illustration of the range of socio-cultural meanings whereby patients made sense of the treatment in relation to their wider values and identities.

If the choice of method is based on the purpose of the research, rather than on epistemological assumptions about how to obtain valid knowledge, then it becomes possible to combine different methods in order to gain diverse forms of knowledge that can provide complementary insights (House, 1994). The insights gained using different approaches will not necessarily be congruent or converging; rather, the insights from one perspective can be used to challenge, modify or elaborate the understandings reached with a different approach. Eisner (2003) has pointed out that every perspective and every method reveals some things and conceals others; consequently the question the researcher should ask is not which method is ‘best’ in any absolute sense, but rather ‘what can we learn from each perspective?’ This attitude to research is consistent with the pragmatist view (Hickman & Alexander, 1998; Tashakkori & Teddie, 1998), that common sense, scientific and moral judgements are all purposive, constructive activities which share the same fundamental test of validity as any other form of human inquiry: ‘What happens if …?’ From the pragmatist perspective all human inquiry involves the interpretation, intentions and values which constructivists regard as paramount – but must also necessarily be grounded in the empirical, embodied experience which realists regard as fundamental.

With respect to our basic understanding of the experience of health and illness, qualitative methods are generally most suitable for inquiring into subjective meanings and their socio-cultural context, as these are not causes or mechanisms which can be scientifically proven, but malleable, negotiable interpretations which people offer themselves and others to make sense of their feelings and actions. In this respect, qualitative data could be considered analogous to a video diary, which provides rich, personal information about what it is like for a certain person to be in a certain place. Data derived from quantitative methods is more like a map; it provides precise and economical information that is essential in order to discover the location and distance of a place relative to other places. Maps do not convey the information needed to know what a place is like, and so we need video diaries to understand subjective experience (for example, the personal and socio-cultural meanings and implications of ‘stress’). However, we also need maps in order to locate precisely experiences relative to other similar experiences (for example, to determine whether a person’s stress is greater than at a different time-point, or than that of other people), and to link them with other dimensions of experience (for example, to determine whether stress causes or is caused by changes in physiological functioning). Similarly, different methods can serve different but complementary purposes with respect to applied research in health care. Case studies can provide a sound foundation for informing health-related practice (Fishman, 1999), but planners and policy-makers may require quantitative data on prevalence and cost-effectiveness in order to be persuaded and to persuade others of the utility of planned health care provision, and to manage such provision effectively on a large scale.

Integrating the results of research which has employed such different perspectives and methods requires an appreciation that it is perfectly possible for realist analyses of quantitative data and constructivist analyses of qualitative data to yield different but equally impor...

Table of contents

• Cover Page
• Dedication
• Title
• Copyright
• Contents
• List of contributors
• Preface and acknowledgements
• 1 Introduction to research methods in clinical and health psychology
• 2 Getting started: the practicalities of doing research
• 3 Qualitative data collection: interviews and focus groups
• 4 Content and thematic analysis
• 5 Qualitative analysis of experience: grounded theory and case studies
• 6 Qualitative analysis of talk and text: discourse and narrative analysis
• 7 Observation and action research
• 8 Questionnaires and surveys
• 9 Analysis of questionnaire and survey data
• 10 Intervention studies: design and analysis
• 11 Synthesising evidence: systematic reviews, meta-analysis and preference analysis
• Glossary
• Bibliography
• Index