2 In Chapter 1, we discussed the conceptual foundations of health research methods. It was suggested that contemporary health research follows a pragmatic paradigm which includes both quantitative and qualitative methods. In terms of the quantitative approach, health problems are conceptualized as impairments and dysfunctions in an organism. The aim for researchers is to accurately describe these problems and to identify their causes and consequences. Armed with accurate, evidence-based knowledge, practitioners can act to prevent illness or to repair or mitigate the associated damage and dysfunction. This type of approach may be considered to think of patients as if they are broken-down mechanisms in need of repair. However, ignoring personal values and experiences will undermine the efficacy and ethics of health services. This is why qualitative research is also essential in the clinical context; this method provides the evidence that enables us to understand our patients as human beings. Qualitative research gives a voice to research participants, allowing us to gain valuable insights into how health problems are viewed and experienced. In this chapter, we will examine these two methods in greater detail. The aims of this chapter are to: 1. Outline different conceptual approaches to qualitative research. 2. Compare and contrast specific dimensions of qualitative and quantitative approaches to research. 3. Emphasize the importance of using evidence from both qualitative and quantitative research. 4. Discuss basic strategies used for ensuring the validity of qualitative research. 5. Examine the scope and limitations of qualitative research in the health sciences. As discussed in Chapter 1, knowledge is acquired and applied from a particular perspective. It follows that there are a number of different ways of looking at and researching health problems. To illustrate qualitative and quantitative perspectives, let us look at an example outside health research. Imagine that you are given a piece of paper. Say that it is a bank note and it has ≤100 printed on it. You can look at this object from a number of perspectives (qualitative and quantitative) depending on who you are and how you are positioned in relation to this object: • If you are a person from a remote tribe with no exposure to the use of bank notes, you might see it as a decorative object and value it as a curio. (Qualitative.) • If you are a person having financial difficulties, ≤100 would be seen as a means of improving your quality of life; for instance, allowing you to buy food or cover outstanding bills. (Qualitative and quantitative.) • If you are an accountant, you would focus on the number printed on the bill for making fiscal calculations. (Quantitative.) • If you are a counterfeiter (we hope not!), you would be intensely interested in the physical properties of the object, such as its length, width, colour, texture: details required for successful forgery. (Quantitative.) Money is very much a social construct. It is ‘real’ enough; having it or not having it can influence all aspects of life, including the level of health services a person can access. At the same time, money is an abstraction; it can take virtually any physical form (e.g. coins, notes, or even a set of numbers representing your bank balance). Its reality is constructed through the actions of a number of institutions (e.g. banks, State treasuries, etc.), which determines its value for buying goods and services. Likewise, health researchers can look at a problem from different perspectives depending on the questions they are asking and the nature of the information they wish to acquire. In this section, we will identify and discuss the fundamental differences between quantitative and qualitative methods (see Table 2.1). One key difference is that these two methods have different historical and disciplinary backgrounds. Quantitative methods are based on the traditions of the natural sciences (physics, biology, etc.), whereas qualitative methods emerged from disciplines such as philosophy, anthropology and other social sciences (see Ch. 10). Table 2.1 Contrast between quantitative and qualitative methods Adapted from McGartland & Polgar (1994). Copyright (1994) The Australian Psychological Society Ltd. Reproduced by permission.
Quantitative and qualitative methods
Introduction
The social construction of reality
Contrasting qualitative and quantitative methods
Quantitative
Qualitative
Perception of subject matter
Reductionistic: identification and operational definition of specific variables
Holistic: persons in the context of their social environments
Positioning of researcher
Objective: detached observation and precise measurement of variables
Subjective: close personal interaction with participants
Database
Quantitative: interrelationships among specific variables
Qualitative: descriptions of actions and related personal meanings in context
Theories
Normative: general propositions explaining causal relationships among variables
Interpretive: providing insights into the nature and social contexts of personal meanings
Theory testing
Controlled: empirically supporting or falsifying hypotheses deduced from theories
Consensual: matching researcher’s interpretations with those of participants and other observers
Applications
Prediction and control of health-related factors in applied settings
Interacting with persons in a consensual, value-consonant fashion in health care settings
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