2. Key concepts in research
Key points
• Research is a lot easier to appreciate through an understanding of some of the concepts covered in this chapter.
• Quantitative and qualitative approaches to research relate to the different research designs, and are based on philosophical beliefs about the nature of empirical evidence, that is, evidence collected in the real world through the senses. Quantitative research is based on the belief that the truth of a situation exists in an objective state outside the personal views or perceptions of the individual. It emphasises accuracy, and produces numerical data. Qualitative researchers believe that the truth of a situation is produced by our subjective experience, and that we need to look at things from an individual’s point of view. Midwifery is concerned with issues that draw on both beliefs.
• Research questions can relate to three levels of exploration. Level-one questions relate to describing one variable, usually about which little is known, or that has rarely been the subject of research. Level-two questions look for relationships between variables but where little theory exists. Level-three questions relate to questions where theory exists and the aim is to test hypotheses based on the theory.
• Variables are the elements in which the researcher is interested. In level-three questions, there will be a dependent variable that is the outcome or effect, and one or more independent variables that are presumed to influence or cause the dependent variable.
• Concept definitions relate to how the researcher defines the topic in which they are interested. This can be thought of as a dictionary definition or alternative word for the topic of interest.
• Operational definitions refer to the way in which a concept is measured. It reduces the vagueness of such words as comfort, pain, and benefit by producing a clear specification of how the researcher will make them visible in a specific study.
• Theoretical and conceptual frameworks provide the context and meaning for the ideas and concepts contained in a study.
• Reliability, validity, bias and rigour relate first to the extent to which the tool of data collection is accurate and consistent between different measurements, or different researchers. Validity relates to whether the method does measure what the researcher intends it to measure. Bias is the extent to which the findings are distorted either by the choice of subjects or the method of measurement. Rigour is the extent to which the researcher has attempted to conduct the study to ensure accuracy and high-quality research.
This chapter will examine some of the important concepts used by researchers and simplify the language by helping you to understand its meaning. The language of research can appear to be composed of ‘jargon’, that is, unhelpful and meaningless words. This can form a barrier to understanding research, as people resent the use of words they do not understand, particularly if they feel they are just being used for effect. However, in reality, the words are a shorthand for complex ideas, and once the most commonly used words are understood, research can take on a completely different level of understanding. The chapter will also cover some of the important issues that researchers face when demonstrating that their research is accurate and carried out to a high standard. These are called ‘methodological issues’. An important starting point is to recognise that research takes many different forms; in this book we will focus specifically on research examining midwifery issues, carried out on the whole by midwives.
In Chapter 1 research was defined as the systematic collection of information using carefully designed and controlled methods that answer a specific question objectively and as accurately as possible. This definition can look similar to audit and so lead to some confusion between these two sources of information. The basic difference between the two, however, is that the key role of research is to extend knowledge and understanding of a particular topic or issue through the systematic collection of information that leads to generalisations about the topic examined. Research conclusions are usually placed within a context of existing knowledge. That is, they are usually compared to previous research that has examined the same topic in order to confirm existing knowledge or help to clarify or extend it. The purpose is always to enrich our understanding of the topic so that we can better use, or control its features.
Audit, on the other hand, is usually interested in the performance level of a part of a service, and a comparison of results against an agreed standard (or previous audit results) that may allow action to be taken. Watson and Keady (2008) suggest that we can think of audit as management activity concerned with measuring the extent to which agreed standards for clinical practice or procedures are being met or are reaching a sufficient level. Gerrish and Lacey (2010) agree, saying it is a process of measuring care against predetermined standards. This is very different from the way research is designed to increasing our overall understanding of a topic and which can be applied generally, rather than the very specific location to which audit data can apply.
One problem in trying to define research is that it is similar to words such as ‘care’, ‘birth’, or ‘midwifery’; it is used as though it consisted of a single entity when, in fact, in can take many different alternative forms. This means that once we decide to study it, we have to learn something about the many forms it can take. At this stage it is useful to think of research as a process that will follow a number of principles or guidelines that will change depending on the type or category of research considered. In this book we will focus on midwifery research, that is, research that explores the problems and issues of direct concern to the midwife and that has implications for the work of the midwife more than any other discipline.
Quantitative and qualitative research
These two concepts are an ideal starting point for learning about research as they categorise very different approaches to thinking about the role of research and the beliefs or philosophies underpinning its production. This is important as it explains why some studies look very different from others. If we know why they differ we can make the best use of both types. Although Chapter 4 on quantitative and qualitative research explores the differences in more detail in, here we need outline ideas associated with them, and the implications these have for midwifery research and knowledge.
Historically, research has been synonymous with the word ‘scientific’, often associated with words like ‘objective’ or ‘accurate’, as these are two key characteristics that ‘good’ research is presumed to posses. Gerrish and Lacey (2010: 8) see a scientific approach to research as indicating ‘a rigorous approach to a systematic form of enquiry’. The philosophy or belief on which this approach is based is that the natural or ‘real’ world does not depend on an individual’s experience of it to exist and that it is open to study and quantification. In other words, it can be measured in some way independent of the person doing the measuring. This type of research can be characterised as ‘quantitative’ research as it attempts to quantify concepts, such as blood pressure, family size and even pain, in the form of a numeric value. These numbers can be summarised and allow the use of a range of statistical techniques to give the results greater usefulness and meaning (Chapter 13). The purpose of quantitative research is seen as the search for relationships between things in the world so that we can understand the way they act and relate together. The ultimate aim of this understanding is to be able to control the elements in our world that impact on human existence. Our understanding of gravity and how we are influenced by its ‘laws’ is a good example of this measurement and developing of relationships leading to theories about ‘how things are’. In midwifery, an example may be the search for a relationship between physical skin-to-skin contact with the baby at birth and parental feelings of emotional attachment so this pattern can be measured and demonstrated to be advantageous.
This scientific view is one ‘paradigm’ or total way of looking at things (world view) in research. It is the one embraced by medical research as the ‘right’ and ‘proper’ approach for a profession that is concerned with clinical outcomes. These words have been put in inverted commas to show that there may not be total agreement on this statement, and it is open to debate whether the belief applies in all circumstances. We must remember that this is only one approach to research and, without suggesting that it is not an indispensable approach in midwifery, that there are other, just as legitimate ways of conducting a study in addition to counting or measuring something that can also extend midwifery knowledge and practice.
Qualitative research (sometimes referred to as representing a naturalistic paradigm as it avoids controlling situations) is the second in the pair of concepts that go to make up the two largest research approaches in midwifery. This has a different view of the characteristics of knowledge and the best way of conducting research to discover, extend or confirm that knowledge. It is believed that the real world can only be understood through our personal experience of it, and everything depends on how we experience and interpret that experience. This explains why some people are afraid of spiders or going to the dentist. It is a product of how people experience them, or the associations they hold for the individual. It does not mean that spiders or dentists themselves are frightening. Naturalistic or qualitative researchers believe that if we are to understand a topic we need to look at it through the eyes of those who experience it and try to understand it from their point of view. This way of thinking creates a different understanding of reality and the type of research we need to capture it accurately. This kind of research produces qualitative data in the form of verbal or written statements and dialogue, or extensive descriptions of observed human activity and behaviour. It uses methods such as interviews or observations, and information taken from documents such as diaries or health records that capture perceptions, interpretations, experiences or understanding.
One of the guiding principles of qualitative research is that it tries to capture people’s thoughts and feelings in their own words. So, questionnaires with fixed-choice options would not be classed as qualitative research even though they may have tried to see things from the individual’s point of view, as the list of alternative answers has been developed by the researcher. This format does not allow individuals to express ideas and answers in their own words, only in those of the researchers who have designed the alternatives and selected what they think are relevant alternatives.
An important visual distinction between quantitative and qualitative research is the presentation of data. Quantitative research will use numerical or visual forms of data presentation such as tables, bar charts and histograms (more of these in Chapter 13 on statistics). This form of data presentation is not a main feature of qualitative research, although some studies may present a table showing details of the sample, such as age, number of children, etc. It is more usual for qualitative results to avoid numbers and simply present broad theme headings and discuss the type of comments made, often with examples of direct quotations or dialogue. As will be seen in Chapter 4, these two forms of research are so different they are almost two different entities. The importance of this is that we must avoid criticising qualitative research using the criteria of a quantitative approach.
Which of these two approaches is best suited to midwifery research? The answer is, the one that is most appropriate to the question posed. If the midwifery question is one of quantity, or frequency, particularly in regard to clinical outcomes, then a quantitative approach will be appropriate; if the question is one of perceptions, understanding and interpretations, then the best approach will be qualitative.
Levels of questions in research
There is no shortage of questions that need to be answered through midwifery research. From the research point of view, it is the question posed by the researcher that results in the aim of the research. The aim usually begins with the word ‘to’ as in:
… this study aims to examine how a certain group of midwives (the participants) conceptualise the phenomenon of the ‘good’ midwife and the ‘good’ leader.
Research questions will differ in their complexity and this will have implications for the way a study is designed. Wood and Ross-Kerr (2006) make a useful distinction between what they call the three levels of research question. These levels are influenced by how much is known about a particular subject, or how much theory exists in relation to it (Table 2.1). The advantage of this system is that it allows you to predict the way a study should be structured to answer a question at each of the levels.
| Level of question | Description | Type of research |
|---|---|---|
| Level 1 | Examines one variable (or a series of variables) but without looking for patterns between variables. Exploratory situation where little is known about the topic. | Quantitative descriptive, e.g. survey Qualitative study: all types are level 1. |
| Level 2 |
