The importance of theories in health care
BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7164.1007 (Published 10 October 1998) Cite this as: BMJ 1998;317:1007
- Priscilla Alderson, reader in sociology (p.alderson@ioe.ac.uk)
- Social Science Research Unit, Institute of Education, University of London, London WC1H 0NS
Series editor: Priscilla Alderson
This is the first in a series of six articles on the importance of theories and valuesin health research
“Medical journals and research funders are mainly concerned with practical factual research, not with research that develops theories.” This widespread view includes several assumptions: that research and facts can be separated from theory; that considering theories is not necessarily practical or useful; and that thinking about theories means developing them.
But theories are at the heart of practice, planning, and research. All thinking involvges theories, and it is not necessary to read academic texts about theories before using them—any more than it is essential to read texts on reproductive medicine before having a baby. Because theories powerfully influence how evidence is collected, analysed, understood, and used, it is practical and scientific to examine them. Hypotheses are explicit, but when theories are implicit their power to clarify or to confuse, and to reveal or obscure new insights, can work unnoticed.
Summary points
Theories are integral to healthcare practice, promotion, and research
The choice of theory, although often unacknowledged, shapes the way practitioners and researchers collect and interpret evidence
Theories range from explicit hypotheses to working models and frameworks of thinking about reality
It is important, scientifically and practically, to recognise implicit theories: they powerfully influence understandings of health care
Positivism
A scientist gazing through a microscope symbolises positivist objective examination, the distance and difference between the observer and the observed, the effort to examine intensely the tiniest part isolated from its context, the use of reliable, visible “hard” data. In medicine, the emphasis on specific body parts, conditions, and treatments assumes that these are universally constant, replicable facts. Positivism aims to discover general laws about relations between phenomena, particularly cause and effect. Experiments are designed to measure and explain associations and …
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