1. Identify the research questions addressed by qualitative research.

2. Describe key approaches to qualitative research.

3. Explain the shared features of qualitative research designs.

4. Explain how qualitative research designs are implemented for producing evidence.

1. Evaluating interventions. Previously (see Ch. 7), we discussed how randomized controlled trials (RCTs) are used to evaluate the safety and efficacy of interventions. In addition to objective evidence, we should also look at the treatment/intervention experience, including the benefits obtained, from the participants’ perspectives.

2. Understanding cultural differences between health workers and clients. In countries such as the US, Australia, Canada or the UK we live in multicultural societies. There is persuasive evidence that the way people experience their bodies, or events such as childbirth, pain or illness, depends to a large extent on their cultural backgrounds. When health practitioners misconceive their clients’ view concerning their illness or injury, the outcome may be erroneous diagnoses and useless interventions. A particularly important area of qualitative field research is to clarify personal meanings of clients and therapists with regard to health care problems, in an attempt to improve communications and enhance treatment outcomes.

3. Evaluating the effects of health care environments. Health care institutions, such as general and mental hospitals, can be seen as ‘subcultures’ having strong influences on the lives of both staff and clients. Persons with chronic illnesses and disabilities requiring long-term care might come to view themselves and their life situations from an ‘institutionalized’ perspective. The development of critical theories in these areas is particularly relevant for understanding the influences of health care environments. Research findings in this area have been applied to devise strategies to empower people such as those with intellectual disabilities to live and participate in the community.

4. Relating to people with neurological or psychiatric problems. People diagnosed as suffering from problems such as schizophrenia, intellectual disability or brain disorders may, to some extent, experience themselves and the world in ways different from people living without a mental illness. How such persons experience aspects of their world is by no means obvious, as these clients may demonstrate severe information-processing impairments such as delusions, hallucinations or memory problems, which may make it extremely difficult to establish empathetic relationships. However, in order to ensure that persons with such severe impairments or disabilities are treated appropriately and with understanding, health professionals must learn to see things from their perspectives. Qualitative field research has provided evidence which has helped to clarify the personal perspectives of people with severe disabilities.

• What is it like to have a speech disorder? In what ways does it disrupt the person’s life, from their point of view?

• How do caregivers interact with terminally ill patients? How do health professionals experience the death of a patient?

• How do health professionals break the news of unfavourable diagnoses, such as heart disease, to their patients? How are such situations seen from the perspectives of the health professional or the patients?

1. Phenomenology. Phenomenology, which is both a system of philosophy and an approach to social science, emphasizes the direct study of personal experience and the understanding of the nature of human consciousness. Research in this area involves ‘bracketing’ or putting aside the usual preconceptions and prejudices that influence everyday perception so that we can uncover the pure constituents of conscious experience. Within this framework, conscious experience is seen as the basis for personal meaning as we reflect on our experiences in the context of our goals and purposes. An important concept adopted from phenomenology is the notion of ‘multiple realities’: that is, different people may experience the world in quite diverse ways. This suggests that, in order to understand the meanings of a person’s actions, we must become adept, through empathy, at seeing things from their point of view.

2. Symbolic interactionism. Symbolic interactionists emphasize that a social situation has meaning only in the way people define and interpret what is happening. That is, people do not react to ‘objective’ aspects of their environments, but rather their actions are guided by their personal interpretations of the situation. It follows that different people, on the basis of their past experiences and their particular social positions, may come to interpret a specific situation in quite divergent ways, and act in conflicting fashions. The central issue is how symbols, in particular those of language, express meaning and enable communication and understanding between people.

3. Ethnomethodology. Ethnomethodologists study the processes associated with the way in which people perceive, describe and explain the world. Ethnomethodologists argue that the meanings of specific actions and events are not necessarily obvious, but are in fact rather ambiguous and problematic. People select and apply specific rules and principles in order to define and give meaning to situations in which they find themselves and in order to justify their actions in a given situation. Ethnomethodologists assert that we take an enormous amount of cultural context, such as norms and rules, for granted in our everyday communications and social interactions, and we tend to ‘bracket’ this as obvious or common sense. It must be remembered, however, that when the cultural backgrounds of individuals diverge, the understanding of personal meaning becomes less obvious or common sense.

4. Grounded theory. This approach was developed by American sociologists, Glaser and Strauss in the 1960s. Strauss & Corbin (1990, p 23) define a grounded theory as one which is ‘… discovered, developed and provisionally verified through systematic data collection and analysis of data pertaining to that phenomenon’. The core idea is to begin the research process without holding an explicit theory or hypothesis which is to be tested through the data. Rather, the theory emerges gradually as more data are collected. This method enables health researchers to develop an understanding of how participants actually experience health and illness, rather than ‘filtering’ these experiences through preconceived theoretical ideas. There are currently several versions of grounded theory applicable to qualitative health research.