Chapter Eight Qualitative research
The research strategies discussed in previous chapters can be called ‘quantitative’ in that the data obtained consist of measurements which can be statistically analysed. Quantitative research pro-vides a particular perspective on health and illness. However, there are alternatives. Qualitative or interpretive research involves the investigation of individuals and groups in their social settings. The investigator seeks to understand the thoughts, feelings and experiences of the research participants as people coping with their conditions and treatments in a given social setting. The use of evidence from qualitative studies has traditionally been a fundamental source of knowledge in the clinical and social sciences.
Qualitative research is disciplined enquiry examining the personal meanings of individuals’ experiences and actions in the context of their social environments. ‘Qualitative’ refers to the nature of the data or evidence collected. Qualitative data consist of detailed descriptions based on language or pictures recorded by the investigator. By ‘disciplined’ we mean that the enquiry is guided by explicit methodological principles for defining problems, collecting and analysing the evidence, and formulating and evaluating theories.
‘Personal meaning’ refers to the way in which individuals subjectively perceive and explain their experiences, actions and social environments. Qualitative research provides systematic evidence for gaining insights into other persons’ views of the world, ‘putting ourselves into someone else’s shoes’.
There are a variety of approaches to qualitative research and these take different positions concerning how data should be collected and analysed. There are also several diverse schools of thought that have contributed to the historical development of qualitative field research (see, for example, Denzin & Lincoln 1994, Liamputtong Rice & Ezzy 1999).
Although taking somewhat different views of personal meanings, the above three approaches have common themes and have all contributed to the development of qualitative field research. Table 8.1 shows key aspects of qualitative field research, in contrast to quantitative approaches.
Table 8.1 Contrast between quantitative and qualitative 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 subjects |
| 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 subjects 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 |
Adapted from McGartland & Polgar (1994). Copyright (1994) The Australian Psychological Society Ltd. Reproduced by permission
The fundamental aim of planning and designing qualitative field research is to position the investigator close to the participants, so as to gain access to and describe personal experiences, and to interpret their meanings in specific social settings. The following subsection develops in more detail the corresponding points presented in Table 8.1.
Qualitative research is preferably carried out in a natural setting and there is no attempt made by the investigator to control for extraneous influences. Furthermore, there are no operational definitions provided for the study variables, but rather the health-related experiences being studied are perceived and described as a whole, in their social contexts.
Strong preconceptions or fixed hypotheses are not advantageous for qualitative field research. This is a different situation from that in quantitative research, where there are precisely defined hypotheses or aims for guiding the research. Qualitative researchers do have general aims and theoretical notions pertaining to the phenomena being studied but these are tentative and are open to modification as the data collection proceeds.
Qualitative field research focuses on the in-depth understanding of specific individuals and groups, rather than studying the general characteristics of a large population of individuals across specific variables. It should be kept in mind, however, that some quantitative designs may address single cases rather than large study populations. For example, we have reviewed n = 1 designs. The difference is that n = 1 designs address specific variables representing aspects of the individual’s behaviour or clinical symptoms, rather than attempting to describe and understand individuals holistically in the context of their natural social settings. Such an approach is called ‘idiographic’ (describing a specific individual) as opposed to the ‘nomothetic’ (describing general phenomena) view of research in quantitative research.
Accurate and replicable measurements are valued in quantitative research. The fundamental positioning of the researcher is ‘objective’, that is, aiming to perceive and record events without any personal bias or distortion. Within this quantitative framework we assume an objective reality that can be disclosed through accurate reproducible measurement or observation. The situation in qualitative field research is far more complex, as the researcher is more a part of the phenomenon being investigated than the detached observer in quantitative research. To understand personal meanings and subjective experiences one has to become involved with the lives of the subjects being studied. That is, some degree of empathy must develop between the researcher and the subject. By empathy we mean the ability to ‘put ourselves in the other person’s shoes’ or to see things from their perspective(s). Reality is said to be constructed by the individual.
A particular reason for the advancement of quantitative research has been the development of valid and reliable measurement instruments. However, when standardized tests and measures are used to study a person, they become ‘enframed’ within the limitations of the instrument, and their possible unique self-expression may remain outside the scope of the enquiry. The qualitative researcher may find instruments intrusive, restricting the possibilities for understanding the ideas and emotions of the respondent.
There are advantages to a ‘human measuring instrument’ which is used in qualitative research. After all, we are more adaptable and multi-purpose than even very sophisticated machinery and we may be able to observe subtle behavioural changes and verbal and non-verbal cues in our participants. In addition, as the investigation progresses, the human ‘instrument’ becomes more aware of what is happening and as we tune in with each other’s points of view the data collection becomes more accurate.
The data obtained in quantitative research consist of sets of measurements of objective descriptions of physical and behavioural events. These are summarized and analysed in accordance with statistical principles outlined at an introductory level in Sections 4 and 5 of this book. The data in qualitative research are descriptive, a ‘thick’ or thorough description of what people said, their actions and activities, non-verbal behaviours and interactions with other people: ‘The reality of the place should be conveyed through representation of its mundane aspects in a straightforward manner’ (Lofland 1971, p. 4). An important aspect of field research is keeping thorough, up-to-date field notes. These should be recorded as closely as possible to the time of occurrence of the phenomena under study. The field notes should contain direct quotations from the participants and the settings in which the statements and actions were recorded. Where possible (where it is appropriate and not overly intrusive), the researcher may use audio and video recordings. This helps to record interviews, and improves accuracy in conveying what was said and done in a given setting, since it is possible to review the obtained information.
Although ‘objectivity’ does not mean remaining detached from the situation, it is essential in qualitative research that the reports of events should be truthful. The investigators should not allow ideological biases to distort or censor their observations, or deliberately lie to place their subjects in a good or bad light. This is a particularly important point as, given the close personal interaction with the subjects, one may be predisposed to report favourably.
By ‘database’, we mean the overall evidence that forms the basis for theory formation and specific applications for health care. In quantitative research, the database will consist of the statistically treated data which will enable us to see how specific variables are interrelated. In terms of qualitative field research, the database is essentially a narrative (or a story, if you like) that reports what has happened to people, what they did or said in specific situations. This narrative should be adequately detailed so as to illuminate for the reader the personal meanings that the health-related events had for the informants.
Theories represent our current state of knowledge about the state of the world. Theories are abstract, coherent explanatory systems which integrate a broad range of research findings. Theories may be constituted of premises stated in everyday language, with particular attention paid to the appropriate use of concepts and the logical development of the premises.
Theories based on quantitative evidence integrate patterns of findings concerning the interrelationships among variables. Such theories often contain ‘models’, which may be mathematical and/or systems representations of the patterns of findings. Models of anatomical and physiological processes, such as those of the circulatory or nervous systems, are good examples of successful quantitative models. Conversely, theories integrating evidence from qualitative research do not address facts about how objects are constituted and interact, but rather are the overall interpretations of personal meanings emerging in specific social settings.
Some commentators (Guba & Lincoln 1983) argued that data collection and theory formation should be intrinsically integrated rather than being different stages of the research process. In addition, it is suggested that personal meanings should be seen as unique and idiosyncratic, and thus no attempt should be made to integrate systematically such diverse personal positions. Theory, from an idiographic position, is seen essentially as the accurate presentation of the situation from a particular person’s perspective.
Other qualitative researchers approach theory formation by attempting to identify common ‘themes’ or categories of meanings emerging from the data. The important point here is that the theoretical categories are developed from evidence expressing personal meanings, rather than ‘facts’ derived from the statistical treatment of objective measurements concerning variables. In this way, theory is said to be ‘grounded’ in the narratives of particular individuals.
Some researchers stress the broad, culture-interpreting aspects of qualitative field research. The formation of critical theory explains how personal meanings and actions emerge and are influenced by the person’s social and cultural milieu. Critical theories identify the extent to which individuals’ self-perception and freedom for action may become distorted and limited by the operation of power and coercion within a culture (e.g. Grundy 1987, pp 15–19, 106–114). As a general illustration, critical theories of the lives and experiences of Western women in the 1960s were crucial to the development of feminist movements.
Theories based on quantitative evidence lead to clear-cut, empirically testable predictions or hypotheses logically deduced from the theories. Theories are supported or falsified by a body of evidence collected under controlled conditions. Testing qualitative theories is somewhat different, as no causal mechanisms are included in the theoretical framework. The simplest verification of qualitative interpretations is to go to the subjects themselves, in order to establish if the researcher’s interpretations make sense to them. The extent to which a consensus develops between researchers and their subjects is one of the important indications of the truth of qualitative theories.
The applications of quantitative evidence and theories are essentially technical, providing mechanisms in terms of which we can predict and control specific health-related variables. That is, we apply quantitative approaches for discovering the causes and progress of diseases and disabilities, for developing and validating assessment procedures and for evaluating the effectiveness of interventions.
In contrast, qualitative field research provides evidence and theories that enable us to understand our clients better as human beings. This research discloses how illnesses, disability and health care delivery affect people’s lives interpreted from their points of view. In the following subsection, we will examine some of the applications of qualitative field research for improving health care delivery.
When there are significant differences in the cultural backgrounds and experiences of persons, the understanding of personal meanings becomes problematic. For example, an anthropologist might need to spend decades immersed in, and systematically studying, a different culture to be in a position to interpret accurately the actions and traditions of the participants.
There are numerous areas of health research where involving the interpretation of personal meanings is essential to ensure effective practices. The following three examples illustrate areas where qualitative field research can make strong contributions for clarifying personal meanings.
The above are some obvious examples where qualitative research is appropriate for clarifying personal meanings, and enhancing understanding and communication in health care settings. However, personal meanings are relevant to all health care situations, not only in the obvious areas discussed above. The following exemplify questions which are appropriately approached through field research strategies:
When used jointly, quantitative research tools can be particularly powerful. One of the authors has conducted a study of how people evaluate primary health services (Thomas et al 1993). The first step in this process was to conduct focus group interviews with 20 groups of 8 participants specifically selected from a wide range of ethnic backgrounds, ages and sexes. The groups were conducted by a facilitator who presented questions concerned with knowledge and opinions of, and satisfaction with, health services. The discussions were recorded and transcribed.
One set of analyses of the transcripts involved consideration of everything that had been said about the health services with regard to satisfaction or dissatisfaction. This resulted in a range of separate categories or themes. These themes, therefore, were directly derived from the participants’ own words and interpretations of their experiences.
The themes were then framed in the form of questions that sought information from people about their satisfaction and dissatisfaction with health services. The questions were then incorporated into a questionnaire (see Ch. 9). When the questionnaire was piloted with a sample of 500 people who attended several doctors’ surgeries over a period of three weeks, it was found that none of the participants nominated new factors that affected their satisfaction and dissatisfaction. Thus, the procedure used in developing the questionnaire had very effectively captured how people decided whether they were satisfied or dissatisfied with their health services. This study is an example of where qualitative and quantitative research methodologies can combine powerfully. There are many productive ways for combining quantitative and qualitative approaches to health research. Interested readers are advised to consult Tashakkori & Teddlie (1998).
It should be noted that the unstructured and descriptive nature of the data collection process in field research often sits uneasily with those favouring ‘quantitative’ research strategies. The major problem with the unstructured data collection techniques is that observer bias may cloud or distort the data being collected. As previously discussed, there are well-known observer effects such as the Rosenthal effect and the Hawthorne effect. Structured data collection methods are most likely to control for these effects, although there are no guarantees that they will be eliminated.
Furthermore, the sampling processes involved in qualitative field research are complex. Most social phenomena are profoundly affected by their participants. ‘Real’ situations may not reflect these biases. An important issue in understanding qualitative research is the specific culture dependence of the findings; what is true in one social setting may not be true in another. Also cultures change with time. For example, the experiences of psychiatric patients who lived in large closed mental hospitals up to the 1970s might not be generalizable to mentally ill people who nowadays live in the community.
Therefore, as in other types of research, qualitative field studies also have to confront problems of external and internal validity. Guba & Lincoln (1983) recommended a variety of strategies to ensure the validity and reliability of field studies. These strategies included:
There are many other ways for ensuring the validity or rigour of qualitative research. These more advanced issues can be explored in books dedicated to qualitative research in health care (e.g. Liamputtong Rice & Ezzy 1999).
Therefore, despite controversies in the area, qualitative researchers pay considerable attention to methodological issues to ensure the adequacy (that is, validity and reliability) of their investigations. The situation is essentially no different from quantitative research, although qualitative researchers take somewhat different steps to ensure the accuracy and generalizability of their findings.
Qualitative research strategies include data collection which is aimed at understanding persons in their social environments. Rather than generating numerical data supporting or refuting clear-cut hypotheses, field research aims to produce accurate descriptions based on face-to-face knowledge of individuals and social groups in their natural settings. The role of the observer in this context is crucial and usually involves physical and social closeness between the subject and the observer. Data collection involves objective and accurate reporting of the activities and appearances of persons in their natural environments. As with other strategies of research, investigators must pay considerable attention to the external and internal validity of field research. We briefly looked at some ways in which field researchers can cross-check their descriptions in an attempt to ensure the validity of their reports and interpretations.
Different research designs may be used to generate evidence of the same processes, although from different perspectives. For instance, any complex clinical phenomenon, such as schizophrenia, may be studied using any of the research strategies outlined in Chapters 4–8 5 6 7 8. To understand the scope of the problems and the effectiveness of the appropriate treatments, it is desirable to use a variety of research strategies. Conversely, a comprehensive theory of a clinical problem should generate any number of hypotheses within the realm of the research strategies discussed in this book. We will look at the analysis of qualitative data in Chapter 21.
Explain the meaning of the following terms: