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Qualitative research methodology papers

Katrina BanniganI have chosen to focus on two methodological papers because in my experience it is easy to forget that, just as clinical practice develops, research practice evolves as well. The first paper is a discussion of the ideas underpinning qualitative research. Paley and Lilford (2011) were prompted by the growth in the number of qualitative papers being published in the medical literature to explore the claim that qualitative and quantitative research methods are philosophically different. They adopted an overtly sceptical stance in the face of what they perceive as uncritical acceptance by others.

They deconstruct the qualitative philosophical arguments outlined by Lincoln and Guba, that are widely referenced in the qualitative research literature. (Anyone who has studied an undergraduate degree in health and social is likely to be familiar with it). Paley and Lilford (2011) focussed on three aspects of qualitative research that they perceived as the most important – holism, trustworthiness and the construction of meaning. In my opinion their argument counters all of the qualitative arguments with a positivist perspective rather than really exploring the core of the qualitative endeavour. Paley and Lilford (2011) were one step ahead of me and stated “Some readers may argue that what we have outlined is just another positivist version of qualitative research.” (p958).  However just because they imply that this will be a criticism, it doesn’t mean the criticism isn’t valid. Despite this I found this an interesting and challenging paper. I am also inclined to agree with their comments about mixed methods, “The development of mixed methods research should be welcomed (and is a symptom of the breakdown of paradigm thinking)” (p958). This also seemed to be the perspective of Sally Read (2011) who wrote a letter in response to this paper.

[An aside – Paley and Lilford (2011) used the British Medical Journal (BMJ) to illustrate the increasing proportion of qualitative research in the medical literature. The proportion of qualitative articles peaked at 8% of all research articles published in the BMJ in 2002 and last year the figure was just shy of 5%. So although qualitative research is increasing in the medical literature it is still a small proportion of the overall research published.]

The second paper is a research study by Lewin et al (2009) which focuses on mixed methods, particularly the use of qualitative methods within randomised controlled trials. Just as Paley and Lilford (2011) are sceptical about qualitative methods I have my doubts about how far different data sources are really used to illuminate the other in mixed methods studies. This paper is a review of 100 randomised controlled trials of interventions to change professional practice or organisation of care. Of these 100 randomised controlled trials only 30 included qualitative methods and only 23 papers included actual qualitative methods rather than just collecting qualitative data. What they found confirmed my presuppositions, that is

  • “Qualitative studies remain relatively uncommon alongside trials of complex healthcare interventions.
  • Most of the qualitative studies identified were carried out before the trial so opportunities to understand better the effects of interventions and how they are experienced by recipients are not being fully utilised.
  • Most of the qualitative studies had important methodological shortcomings and their findings were often poorly integrated with those of the trial in which they nested” (Lewin et al 2009: 6).

This suggests that, whilst mixed methods are being used more, work is needed to ensure that this research strategy really increases understanding of the phenomenon studied. However, this study, as a methodological paper, is an interesting read in itself. I commend the paper to people who are relatively new to research and/or mixed methodology because it will develop an understanding of both.

If you would like to read these articles the full references are:

  • Paley J, Lilford R (2011) Qualitative methods: an alternative view. British Journal Medical, 342:d424.
  • Read SL (2011) Competing philosophies? (Letter) British Journal Medical, 342:d3038.
  • Lewin S, Glenton C, Oxman AD (2009) Use of qualitative methods alongside randomised controlled trials of complex healthcare interventions: methodological study. British Journal Medical, 339:b3496. doi:10.1136/bmj.b3496.