Intended for healthcare professionals


An open letter to The BMJ editors on qualitative research

BMJ 2016; 352 doi: (Published 10 February 2016) Cite this as: BMJ 2016;352:i563

Re: An open letter to The BMJ editors on qualitative research

Dear Editors

I read the Open Letter by Trisha Greenhalgh et al with great interest and the reaction is impressive: tens of rapid responses. Behind the total number of responses lies a qualitative dimension, a brain storming session on qualitative research methodology and methods. That is despite the fact that not all respondents were in the same room at the same time.

Bridging quantitative and qualitative methodologies and methods can only improve on published results of any research, whether about an intervention, project, programme. This is how I understand the symbiosis:-

Clinically, no meta-analysis or network meta- analysis (NMA) can convey a research finding clearly and concisely without an excellent narrative. Narratives go beyond numbers. The qualitative dimensions of the results complement the graphical depiction of the quantitative component. The visual representation is powerful in its own right yet the narrative completes it. The example of Tamiflu is compelling evidence when researchers re-analysed the quantitative data for its efficacy. However, without the circumstantial evidence regarding its related economics (for stockpiling) and without their investigative journalism approach in obtaining supplementary data for secondary data analyses, little would we have found out about 1) the 'new' efficacy results and about 2) how stockpiling worked (or not) in this case. These 'qualitative' dimensions go beyond clinical practice deep into the world of health policy and health economics. To find out about such answers one requires to use qualitative research methods.

I could continue with many other examples, whether these are medicines or medical devices. The medical devices category does not undergo the rigorous RCT journey and many surgeons just call on qualitative reports. The fact is, whether it is an established technology (e.g. dialysis for renal replacement therapy) or whether it is about a hip, a knee prosthesis, practitioners and providers team up with commissioners and patients to ultimately decide what is best for the patient. When it comes to devices there are so many designs and of so many fabrication materials, with some faring better than others, that no quantitative method would sum up what works best and for whom.

From my own research experience there has been no quantitative output without a qualitative dimension. Key stakeholders interviews, Delphi method, Hanlon PEARL method (priority setting), participant observation, investigative journalism, they can be taught (like statistics), however, their art is learned by delving into team work or projects and by using each method in their own right. Given that no second case study resembles the first one, we can fully and openly acknowledge that researchers who would predominantly embrace qualitative methods are a fine addition to any respected multi-disciplinary research team.

The time has possibly come when quantitative and qualitative research dimensions can join ranks. Their methodologies and methods enhance each others' value. Perhaps one qualitative criterion can be added to any quantitative research paper which is submitted for publication to the BMJ or another journal for that matter. For example, why do some research findings come to light sooner than others even if two studies are similar in design? There is often the 'qualitative aspect', within the quantitative component. Take missing value analyses (MVA). We obtain the quantitative MVA results, but most of the time we don't know why those many data were missing from a data set to begin with.

I can only but support the Open Letter of all signatories with its call to giving qualitative research a deserved place in the medical research gallery. It could only lead to win-win situations.

Yours sincerely
Andreea Steriu
Public Health Doctor

Competing interests: No competing interests

24 February 2016
Andreea Steriu
Public Health Doctor
Onchan, Isle of Man, British Isles