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Rapid Responses: Rapid Responses published:
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Understanding articles demands an open mind
- Daniel Munday (23 June 2000)
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Qualitative research in health care
- Jacqueline Low (26 June 2000)
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Qualitative research, science and quality
- Kath Checkland (12 July 2000)
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Daniel Munday, SpR Palliative Medicine Myton Hamlet Hospice, Warwick
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I read with great interest Ibister's response to Mays and Pope's article (Mays N and Pope C. Qualitative research in Health Care: assessing quality in qualitative research BMJ 2000; 320:50-2 (1 Jauary) )and wondered whether he referred to the article which I had read and found to be very helpful and stimulating.
Having reread the original article I have to question whether Ibisters problem is more to do with his own assumptions as "such a lowly student as a surgeon". I do agree that it is sometimes difficult to follow articles on subjects of which we are unfamiliar, but suggest that in the case of this article, there was in fact little jargon and the terms used were adequately explained, in some cases explicitly and in others by the context of the article. I suggest with a little diligence and open mindedness the subject discussed should have been clear to any medically trained person with an open mind. All research has its limitations. The "gold standard" of the randomised controlled trial is limited in its application, because in its striving to compare like with like its relavence to the real world of wide individual variations cannot be assumed. The problem with qualitative research is it takes into account such wide variations in individuals that it cannot provide statistically "proven" results. Having been trained in the ivory towers of a British medical school by "surgeon-educators" (and others in the possession of "the truth") and then being plunged into the confusing world of uncertainty as a GP, (where much of what I had been taught seemed of questionable relavance), I am belatedly coming to realise the importance of qualitative research. I am thankful to the BMJ for publishing articles such as that of Mays and Pope, to help complete what my tutors failed to teach me, please give us more. |
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Jacqueline Low, lecturer De Montfort University
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I would like to point out that two of the terms Dr. Isbister cites in his letter as "strangely unscientific" and "difficult to read" are in fact terms that any undergraduate student in the sciences or social sciences should be familiar with. The terms I am referring to are 'epistemological' and 'inductive inquiries.' Neither of these phrases can be said to be esoteric jargon peculiar to qualitative methodology, rather they are relevant to all forms of research methods. I am concerned that someone who wishes to critisize a particular methodological orientation does not know that epistemology refers to the interface between theory and methods and that inductive inquiries are one side of the two-sided coin representing inductive and deductive research methods. |
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Kath Checkland, GP principal Marple Cottage Surgery, Stockport
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Ibister's critique of qualitative research methods (BMJ 320:1729) illustrates many of the problems faced by qualitative researchers in gaining funding for or recognition of their work. His unquestioning assumption that research seeks "facts" shows his lack of understanding of the nature of scientific inquiry. As any Popperian knows, we can never prove something to be true, we can only prove that something is not true. A reading of the literature relating to the philosophy of science would indicate that even those pursuing the "hardest", most objective sciences such as physics or checmistry recognise that our knowledge of the world can only ever be imperfect and provisional. This is especially the case when unpredictable human beings are involved in the experiment. It may seem esoteric, but consideration of what it is possible to know about the world (epistemology, to use what Ibister dismisses as "jargon") is vital if we are to be able to transfer the insights gained from quantitative, "objective" investigations into the real world. Ibister states that "Quality in qualitative research is a mystery to many health service researchers." I'm sure this is true, but it is not a valid reason for dismissing it. Qualitative methods have come very late to health research, but this doesn't mean that such methods are intellectually less rigorous than more traditional forms of research. In other fields - education, sociology, psychology - there is a long tradition of this type of research. Quality is taken very seriously, with whole textbooks available on the subject (e.g. Kirk, J. and Miller, M. 1986. Reliability and validity in qualitative research. Newbury Pk., Sage). To dismiss such work as a "mystery" without having knowledge of it is intellectually indefensible. For an excellent and well-researched summary of the nature, history and claims to validity of qualitative research and its potential uses in the health field, I recommend the review by Murphy et. al. "Qualitative research methods in health technology assessment: a review of the literature." This is published by the NHS R&D HTA programme, and is available from their website : www.hta.nhsweb.nhs.uk. Overall, Ibister demonstrates the mindset of a true "naive realist": someone to whom the world is out there, full of truths waiting to be discovered. Any suggestion that this might not be so is dismissed as against commonsense. This attitude has much in common with religious fundamentalism. As someone trained as a natural scientist, working (as a GP) in an environment in which scientific insights, although important, can seem remote from messy human experience, I have found the exploration of an alternative "Weltanshauung" [in italics] (now there's some jargon!) via a Masters degree in social research profoundly liberating. |
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