How to read a paper: Papers that go beyond numbers (qualitative research)

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What is qualitative research? Epidemiologist Nick Black has argued that a finding or a result is more likely to be accepted as a fact if it is quantified (expressed in numbers) than if it is not.1 There is little or no scientific evidence, for example, to support the well known “facts” that one couple in 10 is infertile, or that one man in 10 is homosexual. Yet, observes Black, most of us are happy to accept uncritically such simplified, reductionist, and blatantly incorrect statements so long as they contain at least one number. Researchers who use qualitative methods seek a deeper truth. They aim to “study things in their natural setting, attempting to make sense of, or interpret, phenomena in terms of the meanings people bring to them,”2 and they use “a holistic perspective which preserves the complexities of human behaviour.”1 Summary points Qualitative methods aim to make sense of, or interpret, phenomena in terms of the meanings people bring to them Qualitative research may define preliminary questions which can then be addressed in quantitative studies A good qualitative study will address a clinical problem through a clearly formulated question and using more than one research method (triangulation) Analysis of qualitative data can and should be done using explicit, systematic, and reproducible methods Questions such as “How many parents would consult their general practitioner when their child has a mild temperature?” or “What proportion of smokers have tried to give up?” clearly need answering through quantitative methods. But questions like “Why do parents worry so much about their children's temperature?” and “What stops people giving up smoking?” cannot and should not be answered by leaping in and measuring the first aspect of the problem that we (the outsiders) think might be important. Rather, we need to listen to what people have to say, and we should explore the ideas and concerns which the subjects themselves come up with. After a while, we may notice a pattern emerging, which may prompt us to make our observations in a different way. We may start with one of the methods shown in box, and go on to use a selection of others. Box 1: Examples of qualitative research methods Documents—Study of documentary accounts of events, such as meetings Passive observation—Systematic watching of behaviour and talk in natural occurring settings Participant observation—Observation in which the researcher also occupies a role or part in the setting, in addition to observing In depth interviews—Face to face conversation with the purpose of exploring issues or topics in detail. Does not use preset questions, but is shaped by a defined set of topics Focus groups—Method of group interview which explicitly includes and uses the group interaction to generate data Box box summarises (indeed, overstates) the differences between the qualitative and quantitative approaches to research. In reality, there is a great deal of overlap between them, the importance of which is increasingly being recognised.4 View this table: In this window In a new window BOX 2 Qualitative versus quantitative research—the overstated dichotomy Quantitative research should begin with an idea (usually articulated as a hypothesis), which then, through measurement, generates data and, by deduction, allows a conclusion to be drawn. Qualitative research, in contrast, begins with an intention to explore a particular area, collects “data” (observations and interviews), and generates ideas and hypotheses from these data largely through what is known as inductive reasoning.3 The strength of the quantitative approach lies in its reliability (repeatability)—that is, the same measurements should yield the same results time after time. The strength of qualitative research lies in validity (closeness to the truth)—that is, good qualitative research, using a selection of data collection methods, really should touch the core of what is going on rather than just skimming the surface. The validity of qualitative methods is greatly improved by using a combination of research methods, a process known as triangulation, and by independent analysis of the data by more than one researcher. The so called iterative approach (altering the research methods and the hypothesis as the study progresses, in the light of information gleaned along the way) used by qualitative researchers shows a commendable sensitivity to the richness and variability of the subject matter. Failure to recognise the legitimacy of this approach has, in the past, led critics to accuse qualitative researchers of continually moving their own goalposts. Though these criticisms are often misguided, there is, as Nicky Britten and colleagues have observed, a real danger “that the flexibility [of the iterative approach] will slide into sloppiness as the researcher ceases to be clear about what it is (s)he is investigating.”5 These authors warn that qualitative researchers must, therefore, allow periods away from their fieldwork for reflection, planning, and consultation with colleagues.

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