Summary from
QHR book Chapters
➔ Chapters to read from green and Thorogood book: 1,2,3,5,7,10,11,13
➔ Main points of Chapter 1:
- QHR has roots in social sciences and humanities, and aims to answer the “what”,
“how” or “why” questions about social aspects of health.
- Qualitative researchers aim to understand phenomena rather than measure
phenomena.
- In bigger health research programs, qualitative approaches contribute to generating
hypotheses, by adding depth to understanding.
- The data they produce and analyze are in the form of words and NOT numbers.
- Principles of qualitative methodology include: naturalism, reflexivity, a focus on
meaning and understanding.
- Reflexivity: a focus on the meaning and flexible research strategies.
- QHR aims to understand activities as health behaviors and health provision.
Summary from Chapter 1:
Intro info:
- Qualitative approaches to health have their roots in social sciences such as sociology,
social anthropology, psychology, history and geography
- What these social sciences have in common is that they focus on what people do, why
and why is the context of social relationships.
- Challenges for health policy and practice are being more rooted in the “social”, that is
why health care practitioners have turned to social enquiry to enhance understanding of
health and health behavior.
- Qualitative research has helped in that they are directed more about understanding a
phenomena rather than measuring it.
Topics that can be addressed using qualitative research:
- Topics related to individuals roles, identities and views. Ex: What do people understand
about a “healthy diet”?
- Topics related to social groups: Ex: How do the meanings of body size differ across
ethnic groups?
, - Topics related to the ways in which society is structured: Ex: How did Obesity emerge as
a social problem?
Possible aims of Qualitative research:
- Finding out what patients think of a service
- Evaluating a policy change
- Exploring how ideas of medicine have changed over time.
Health research: health research has 2 strands of work:
- Studies OF health: Critical” from various social sciences perspectives. Addresses
questions such as: What are health and illness? Studies of health aim to explore
concepts and categories that are implicit (NOT expressed) in the health agenda.
- Studies FOR Health: “Applied”contributions of social sciences are defined primarily by
the health agenda. Studies for health have the existing health agenda as their starting
point.
(The distinctions between studies OF health and studies FOR health also provides a
useful way of thinking about the aims of the study) (such as: expand on knowledge or
provide evidence?)
- Definitions of health research: any study addressing understandings of human health,
health behaviors and practices, or health services, whatever the disciplinary starting point.
Qualitative data:
- First way of Characterizing qualitative research is by describing the kind of data it
generates.
- Data in the form of words.
- There are no clear divisions between “quantitative” and “qualitative” data as all research
involves some quantification and all research involves some words.
- In qualitative data, simple frequency counts of themes are used in interview data.
Qualitative methods and designs:
- Second way of characterizing qualitative research is by the methods used to generate
those data. There are some methods that are specifically associated with qualitative
research. There are also some designs that are specifically associated with qualitative
research such as ethnographic case studies.
Aims of the study:
- A third distinction between qualitative and quantitative research relates to the overall
aims of the study.
- Qualitative research seeks to understand phenomena, NOT to quantify them.
- Qualitative RQ tends to be about the “what”,”how” or “why” of a phenomena, rather
than questions about “how many”.
, - Many qualitative studies have “understand” or “explore” as an aim.
- The fundamental aim of qualitative studies is that of understanding “what is going on”.
- Qualitative research is characterized by its fundamental aims of understanding
phenomena.
- Qualitative research addresses questions about the nature of the phenomena.
- Qualitative approaches are the most productive when they begin by seeking to understand
practices, or behaviors from the perspective of those being studied.
- Qualitative research attempts to understand the world from the perspective of the
participant, not the researcher. Ex: public health and health promotion, are often
concerned with changing behavior.
Hierarchy of Evidence:
- Within an “evidence-based approach”, given that the primary questions are about the
effectiveness of treatments, the research approaches that are most prized are those that are
the strongest for providing evidence of effectiveness.
- There is a “hierarchy of evidence”, where RCT “randomized control trial”is at the
TOP, as the most credible evidence on whether particular interventions “work” or not.
Case studies are at the bottom of the hierarchy, along with “descriptive studies” or
opinion.
- Qualitative studies count only for very little in this hierarchy of evidence.
Orientations of Qualitative research:
1. Naturalism:
- “Naturalism”: refers to a preference for studying phenomena in their “natural” or
everyday environments.
- It is needed because researchers have found that human behavior is altered as a result of
taking part in the study, rather than because of any of the specific interventions being
tested.
- “Naturalistic” approach is when they attempt to generate in-depth knowledge about
setting over time, in order to understand how and why people behave as they do.
- The aim of the researcher is to become part of the setting for long enough to understand
what is going on, and to provide detailed description. The researcher is more interested in
everyday or “real life” contexts than in ideal situations.
- Naturalistic research includes theoretical analysis of accounts of the social worlds.
- “Naturalism” is ofcourse an idealistic notion, as there is in practice no “clean”research
field. Any act of observations will impact the field, however “invisible” the researcher
becomes.
, 2. Reflexivity:
- The researchers should subject their own research practice to the same critical analysis
that they deploy when studying their topic.
- First, reflexivity involves reflecting critically on the research itself. Reflecting on why
some questions are legitimate and why they attract funding.
- The reflexive researcher considers the broader political and social context of their
research.
- The Second, level of reflexivity needed in qualitative research is more personal, and
involves the consideration of the role of the researcher him or herself in generating and
analyzing their data. Who you are as a researcher will shape the kind of data generated.
3. Flexible research strategies:
- Qualitative studies have a flexible research strategy, which can be adapted as early data
are produced and analyzed. Flexible in that we can change things during the process
such as literature and the research questions as we work on the research.
- For example: Early data analysis may suggest a more refined research question that will
influence later sampling, and may send you back to look for more literature.
- The degree of flexibility required depends on the demands of the study and the
perspective of the researcher.
Qualitative methodologies used in health agenda/or as part of mixed-method program:
1. Qualitative studies can be used in exploratory work. Given that a primary aim of
qualitative research is to explore phenomena, qualitative studies can therefore be used
when little is known about a topic.
2. Qualitative works can follow quantitative research, with the aim of adding “Depth”
to findings from quantitative studies. Qualitative research has a very important role in
understanding the “meaning” of quantitative record, in terms of uncovering the processes
by which the statistics that are used routinely in public health are produced. Qualitative
work can identify the social, organizational and historical factors that shape how these are
both produced and used.
3. Qualitative and quantitative approaches are used together, with the aim of
addressing different aspects of the same research question. These 2 can be used
together with the aim of extending our understanding of a phenomena. The rationale for
mixing qualitative and quantitative components may be to generate different kinds of
data, or to address “gaps” where one method cannot produce data.
