Intended for healthcare professionals

Rapid response to:

Analysis

An open letter to The BMJ editors on qualitative research

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i563 (Published 10 February 2016) Cite this as: BMJ 2016;352:i563

Rapid Response:

Informing physicians requires more than publishing ‘translational’ quantitative results

In an open letter to The BMJ, Greenhalgh and colleagues call for greater inclusion of qualitative research articles, noting that the journal’s mission of enabling health professionals to make better decisions and improve health outcomes makes no reference to particular research methods [1]. In response to Greenhalgh and colleagues, Loder and colleagues defend The BMJ’s position on qualitative research on behalf of the journal [2]. Loder and colleagues state: “our aim is to publish studies with more definitive—not exploratory—research questions that are relevant to an international audience and that are most likely to change clinical practice and help doctors make better decisions”; they suggest that “qualitative studies are usually exploratory by their very nature and do not provide generalisable answers” [2].

In their response, The BMJ editors situate the journal as a medium for translational knowledge. They are right that often one cannot transport (or translate) the findings of a qualitative study to a different context - the results are context-dependent. I imagine that for the editors a good exemplar of a translational quantitative study is a well-done systematic review of randomized clinical trials comparing one treatment to another. However, the assumption that the exact results of randomized trials – even our best trials - are straightforwardly transportable to different contexts lacks strong justification [3].

Furthermore, while qualitative studies are typically exploratory by design (they typically do not test a prior hypothesis), that does not imply that they are less definitive than quantitative studies. They can provide strong evidence of great relevance to clinical practice. If ‘changing practice and helping doctors make better decisions’ is narrowly understood as providing effect sizes, absolute risks and likelihood ratios that can be transported to target populations and applied to patients, then by their design qualitative studies fall short. But if The BMJ’s mission is truly to inform physicians and improve the health of patients, it must embrace a wide concept of evidence, of what it means to inform practitioners, and of what kind of knowledge it takes to change practice for the better.

References
1. Greenhalgh T, Annandale E, Ashcroft R, et al. An open letter to The BMJ editors on qualitative research. BMJ 2016;352:i563.
2. Loder E, Groves T, Schroter S, et al. Qualitative research and The BMJ. BMJ 2016;352:i641.
3. Fuller J. Rationality and the generalization of randomized controlled trial evidence. Journal of Evaluation in Clinical Practice 2013;19:644-647.

Competing interests: No competing interests

18 February 2016
Jonathan Fuller
Research fellow
University of Toronto
1 King's College Circle, Toronto, Canada M5S 1A8