In Chapter 1, we discussed the importance of practitioners becoming critical and self aware. A reflective practitioner will be looking closely at his/her professional practice, asking ‘what is the best way of doing this?’ or ‘why do we do it this way?’. It may be that a practitioner acts on the basis of tradition or an intuitive ‘knowing in action’ which derives from experience (Schon 1983) but a reflective practitioner will wish to be informed about his decisions.

The shift from an occupation to a profession, which has taken place in nursing and multidisciplinary public health, is characterized by an increased focus on research as the foundation for professional knowledge and practice. There is considerable pressure for all health and social care practitioners to be aware of relevant research and to base their practice on research findings. Practitioners may be aware of this, yet be unable to pinpoint any specific relevant findings. This may be because practitioners are not aware of the relevant research journals, or are unable to access journals and conferences, or lack the opportunity, skills and time to keep up-to-date with research. The weight of new information, even though it may be more readily available through the internet, means practitioners may suffer from information overload and be unable to sift out what is useful and relevant. Practitioners may not use research because they lack the critical appraisal skills and confidence to assess the quality and relevance of published studies. Practitioners may also be sceptical of the value of research because it is difficult to institute any change in their practice or organization.

Few practitioners see research as an integral component of their practice. It is seen as ‘out there’, separate from the knowledge base that informs practice, which is often received wisdom passed on from practitioner to student. However, practitioners often have questions relating to their practice, which can be answered by appropriate research studies. Examples of practitioners’ questions include the Macmillan nurse who wants to know why women choose not to come for mammography screening, the health promotion specialist who wants to know whether a safety education programme for young children has made any difference to the accident rate, and the midwife who wants to find out the needs of prospective fathers from the antenatal services. If we see research as providing information to guide the planning and carrying out of interventions, then research ceases to be seen as a remote activity but becomes an extension of everyday work.

This chapter aims to help you reflect on what distinguishes research in public health and health promotion. It looks at the social context in which research for public health and health promotion takes place and the kind of information that informs practice. It is not a tool kit to make you a better researcher. Some excellent texts are recommended at the end of the chapter which can provide guided tours of research methods and the fine-tuning in using particular methods. Above all, being a researcher involves doing research and ‘getting your hands dirty’; it cannot be learnt from a book.

Research has achieved a much higher profile in health organizations in recent years. Policy, service provision and professional practice are expected to be based on evidence derived from rigorous research. For example, in 2009 NICE (National Institute for Health and Clinical Excellence) launched NHS Evidence, a web-based service disseminating research-based best practices (www.nice.org.uk). Professional judgement and the preferences of users and clients may also influence decision making but the cultural shift to evidence-based health care that is explored further in Chapter 3 represents a major challenge for practitioners. A large body of research for public health and health promotion derives from public health medicine and epidemiology. Epidemiology analyses patterns of disease and risk factors in populations, and seeks to identify and quantify the effect of different causal factors (genetic, lifestyle, environmental) on health.

Epidemiology is generally acknowledged as a core scientific method underpinning public health. For example, the Whitehall I study tracked a large cohort of 18,000 men employed in the Civil Service since 1967, and has been influential in establishing the link between social status and health (Marmot et al 1984). The Whitehall II study has followed up a cohort of 10,308 male and female civil servants since 1985. The Whitehall II study found no diminution in the links between social status and health (Marmot et al 1991), and is now examining inequalities in health in an ageing population (Adler et al., 2008 and Britton et al., 2008).

Positivism is associated with quantitative research methods – the gathering of ‘hard’ data which can be quantified in some way. Quantitative research attempts to measure aspects of a phenomenon and explain any differences in variables between groups or over time. Quantitative research tests a hypothesis, which is a suggested explanation of why differences occur. The experiment is the main method. In experimental studies, one aspect in two matched groups is varied to see if it makes any difference to the result. Any difference can then be attributed to that variable. Randomized controlled trials, in which participants are randomly allocated to a control or experimental group, are used to assess the effectiveness of interventions. In research involving people and their lives, it is impossible to control for all the factors which may influence outcomes. There may also be ethical concerns about withholding a potentially beneficial intervention from one group of participants; or conversely of carrying on with an intervention that appears to be harmful. There is further discussion about the role of randomized controlled trials and their contribution to the understanding of the effectiveness of interventions in Chapter 3.

Interpretivism is associated with qualitative research methods which focus on understanding the ways in which an issue is perceived by the people whom it affects. Thoughts, feelings and meanings are viewed as real phenomena which can be studied by the researcher. Using methods such as interviews, observation and case studies the researcher can come to understand the perspective of the participants. In contrast to the positivist tradition, there is no assumption about what are the important phenomena which are then measured. Interpretivism gathers ‘rich’ data and then derives plausible theories and explanations from analysing that data. This approach has also been called ‘grounded theory’ (Glaser and Strauss 1986) because the mode of analysis (deriving codes and categories from the data until ‘saturation point’ is reached and no new codes or categories emerge) leads to theory that is grounded in, and emerges from, real life experience.

If we use the example of research into sexual health we can see how different paradigms or schools of thought determine what is to be studied. Most research into the spread of HIV/AIDS has been concerned with discovering the incidence, prevalence, and distribution of HIV in the population over time. By comparing the proportion of infected people engaging in different risk activities, attempts are made to correlate the risk of infection with behaviour. This knowledge can be used in the targeting and design of health education messages. Epidemiologists can also evaluate the effectiveness of health promotion activities by charting rates of HIV infection against interventions.

Gary Dowsett, who designed research programmes for the WHO Global Programme on AIDS, commented on the need for more close-focus research which looks at contexts and social situations in which people make sexual decisions:

Quantitative and qualitative research derive from different epistemological perspectives or views about the nature of knowledge and so are often presented as diametrically opposed. Table 2.1 summarizes the two philosophically divergent positions.