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

BMJ qualitative research policy: a challenge from health policy and systems researchers

On behalf of SHaPeS[1], EQUINET Africa, Emerging voices for Global Health, and 169 individual health policy and systems researchers in 38 countries, we support Greenhalgh et al’s challenge[2] to BMJ editors to re-evaluate the journal’s outdated position on qualitative research[3-5]. We are heartened by BMJ editors’ engagement[5, 6], but the contention that qualitative research is better placed in ‘special interest journals’[5] misses the point - marginalising qualitative contributions to audiences already aware of their value. Both letter[2] and editors’ response[5] focus on whether qualitative research is relevant to clinical decision-making. Of course it is. Clinical decisions are not truly individual, but inevitably part of broader organisational, health-system and socio-political contexts. Exemplary qualitative studies examine these dimensions of care, services, policies and systems at local, national, and global levels[7-16].

Although our feedback is condensed to respect word limits, we have committed to taking this discussion forward to create more inclusive academic engagement. Qualitative health research provides necessary evidence to inform clinical decision-making, deepen understanding of the policy-implementation gap, and give voice to marginalised service-users, thus encompassing the complexity inherent in health problems[17, 18]. Quantitative contributions to studying this complexity are limited[19, 20], making a quantitative-qualitative dichotomy no longer relevant to complex healthcare realities.

The BMJ, though rightfully proud of its commitment to enhancing knowledge, cannot continue to deprioritise crucial bodies of research that inform health policy and practice. Supporting high-quality qualitative contributions to studying health services, systems, and policies can only augment the BMJ’s relevance. Guidance for evaluating qualitative studies exists as do capable social scientists ready to help editors identify and review high-quality research. There is no valid reason to continue ignoring it. We thus challenge editors to engage with us in a broader discussion of the value of relevant qualitative methodologies and bodies of research.

1. SHaPeS, Social science approaches for research and engagement in health policy & systems. 2016:
2. Greenhalgh, T., et al., An open letter to The BMJ editors on qualitative research. BMJ, 2016. 352: p. i563.
3. Shuval, K., et al., Is qualitative research second class science? A quantitative longitudinal examination of qualitative research in medical journals. PLoS One, 2011. 6(2): p. e16937.
4. Loder, E., et al., The BMJ editors respond. 2016, British Medical Journal.
5. Loder, E., et al., Qualitative research and The BMJ. BMJ, 2016. 352: p. i641.
6. Pope, C. and N. Mays, Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research. BMJ, 1995. 311(6996): p. 42-5.
7. Ahlin, T., M. Nichter, and G. Pillai, Health insurance in India: what do we know and why is ethnographic research needed. Anthropol Med, 2016: p. 1-23.
8. Kruk, M.E., et al., What is a resilient health system? Lessons from Ebola. Lancet, 2015. 385(9980): p. 1910-2.
9. Bohren, M.A., et al., The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review. PLoS Med, 2015. 12(6): p. e1001847; discussion e1001847.
10. Glenton, C., et al., Barriers and facilitators to the implementation of lay health worker programmes to improve access to maternal and child health: qualitative evidence synthesis. Cochrane Database Syst Rev, 2013. 10: p. CD010414.
11. Gilson, L., et al., Challenging Inequity through Health Systems Final Report Knowledge Network on Health Systems. 2007, Geneva: WHO Commission on the Social Determinants of Health.
12. Axelsson, R. and S.B. Axelsson, Integration and collaboration in public health--a conceptual framework. Int J Health Plann Manage, 2006. 21(1): p. 75-88.
13. Charles, C. and S. DeMaio, Lay participation in health care decision making: a conceptual framework. J Health Polit Policy Law, 1993. 18(4): p. 881-904.
14. Feldhaus, I., et al., Equally able, but unequally accepted: Gender differentials and experiences of community health volunteers promoting maternal, newborn, and child health in Morogoro Region, Tanzania. Int J Equity Health, 2015. 14: p. 70.
15. Kim, J. and M. Motsei, "Women enjoy punishment": attitudes and experiences of gender-based violence among PHC nurses in rural South Africa. Soc Sci Med, 2002. 54(8): p. 1243-54.
16. Topp, S.M., J.M. Chipukuma, and J. Hanefeld, Understanding the dynamic interactions driving Zambian health centre performance: a case-based health systems analysis. Health Policy Plan, 2015. 30(4): p. 485-99.
17. Oke, M., Using narrative methods in crosscultural research with Mongolian and Australian women survivors of domestic violence. Qualitative Research Journal, 2008. 8(1): p. 2-19.
18. Catalani, C. and M. Minkler, Photovoice: a review of the literature in health and public health. Health Educ Behav, 2010. 37(3): p. 424-51.
19. Plsek, P.E. and T. Greenhalgh, Complexity science: The challenge of complexity in health care. BMJ, 2001. 323(7313): p. 625-8.
20. Gilson, L., et al., Building the field of health policy and systems research: social science matters. PLoS Med, 2011. 8(8): p. e1001079.

Competing interests: No competing interests

12 April 2016
Natasha Howard
Karen Daniels, Lucy Gilson, Bruno Marchal, Devaki Nambiar, Emma R Sacks
London School of Hygiene & Tropical Medicine
15-17 Tavistock Place, London, UK