Qualitative Research: Observational methods in health care settings

Clinicians used to observing individual patients, and epidemiologists trained to observe the course of disease, may be forgiven for misunderstanding the term observational method as used in qualitative research. In contrast to the clinician or epidemiologist, the qualitative researcher systematically watches people and events to find out about behaviours and interactions in natural settings. Observation, in this sense, epitomises the idea of the researcher as the research instrument. It involves “going into the field”—describing and analysing what has been seen. In health care settings this method has been insightful and illuminating, but it is not without pitfalls for the unprepared researcher.

The term “observational methods” seems to be a source of some confusion in medical research circles. Qualitative observational studies are very different from the category of observational studies (non-experimental research designs) used in epidemiology, nor are they like the clinical observation of a patient. Observational methods used in social science involve the systematic, detailed observation of behaviour and talk: watching and recording what people do and say. Goffman neatly captured this distinct research method with his recommendation that, in order to learn about a social group, one should “submit oneself in the company of the members to the daily round of petty contingencies to which they are subject.”1 Thus, observational methods can involve asking questions and analysing documents, but the primary focus on observation makes it distinct from a qualitative research interview (see the next paper in this series) or history taking during patient consultation. Another crucial point about qualitative observation is that it takes place in natural settings not experimental ones; hence, this type of work is often described as “naturalistic research.”