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Why People do What They Do: Qualitative Research

Explorations of personal and social aspects of medical care inevitably lead to areas of social sciences and qualitative research. Qualitative research investigates, interprets, and describes social events or experiences in relationship to their meanings and helps us gain insight into these often-complex phenomena.

In contrast to quantitative research, such as found in “evidence-based medicine”, there is no presumption of causality or predetermined variables. The hallmarks of the best qualitative research are the antitheses of quantitative: the rigor of the methods comes from the depth of the engagement of the researcher with the data, the credibility of their interpretations, and other researchers’ agreement with the narrative findings (, ). Results are capable of being evaluated; but they are appraised by insightful, topic-specific judgments, not statistics. In reality, a multitude of credible or incredible conclusions could be derived from the results.

Qualitative and quantitative methods can be complementary, used simultaneously, or performed sequentially. Whereas quantitative research relies on deductive reasoning, objectivity, and inferential testing, qualitative research relies on inductive reasoning, subjectivity, and descriptions. Yet, qualitative variables are the starting point for those variables that can be quantified, and inductive reasoning is used to convert the “maybe” answers to “yes” in RCT’s (, ). For more information, you may want to refer to the article Scientific Method of Investigation.

In deductive reasoning, the truth of the conclusion is dependent only on the soundness of the method. The premise may or may not be true. It takes a relatively broad statement and inspects its implications. To put it another way, it looks at a whole and analyzes its parts. To wit: All men are idiots. I am a man; therefore, I am an idiot. It is a perfectly valid deduction, but it may or may not be the truth. Deductive reasoning decides what must be true given the rules of logic and some starting premises (but the starting premises are the weak point between validity and ultimate truth).

In inductive reasoning, a conclusion is suggested that contains more information than any of the observations on which it is based. The conclusion is verifiable only when all possible instances have been examined. So, the more the conclusion is tested the more reliability it may possess. For example: These women are from the hormone replacement therapy study. These women are worried about heart disease. Therefore, all women who take hormone replacement therapy will worry about heart disease. In order to have more confidence in the conclusion, one would need to perform more experiments. Inductive reasoning decides what is likely to be true given a set of starting observations.

Both qualitative and quantitative approaches rely on systematic empirical observations to generate empirical evidence ().

Qualitative analysis, developing a useful empirical based theory, has been said to have 4 critical elements (, ):

Participant selection must be relevant to the research question.
Data collection methods must be relevant to the research.
Data collection (interviews, field observations, document analysis, etc.) must be comprehensive enough to support detailed descriptions.
Data analysis must be performed by more than one person to establish multiple possible interpretations.

Meta-analysis can also be used in qualitative studies where it is often referred to as metasynthesis (). For example, in 2001, 14 qualitative studies of caring among faculty and students were analyzed by Noblit and Hare’s meta-ethnographic metasynthesis (). They found that there are 5 themes that occur in caring nursing education. They are aspects of reciprocal connecting identified as presencing, sharing, supporting, competence, and uplifting effects of nursing care.

Meta-analysis of 292-qualitative research studies using a variety of interpretive methods, from various countries and disciplines was used to analyze the shifting perspectives of people with chronic illnesses (). The researcher used a technique he called Metastudy. Analysis showed that living with chronic illness results in shifting perspectives where sometimes illness is in the foreground and sometimes wellness is in the foreground. They conclude that this shifting perspective may help explain why people’s attention to their symptoms change with time in a way that seems to be not well advised or may even be detrimental to their health. This insight can help health professionals in providing better support for the chronically ill.

Again, with chronic illness, a metasynthesis of 158 out of over 400 published qualitative reports from 1980 through 1996 noted shifts in concepts of chronic illness (). They noted a shift from a focus on loss and burden to images of health within illness, transformation, and normality. Paralleling this shift was the change in health care relationships from client-as-patient to client-as-partner.

Here is an interesting example of a published qualitative study that reveals a pattern of disuse of evidence-based leaflets on informed choice in maternity care (). The researchers used non-participant observation of 886 prenatal consultations, and 383 in-depth interviews with women using maternity services and health professionals providing prenatal care. Women were chosen from women’s homes, prenatal and ultrasound clinics in 13 maternity units in Wales. The intervention was 10 pairs of Informed Choice Leaflets for the women and staff, and a training session for the staff in how to use the leaflets.

Although the staff was positive about the leaflets,

Time pressures limited discussions, and choice was often not available in practice.
A bias toward using technological interventions in childbirth to insulate against lawsuits influenced the staff in their discussions with the patients.
In a power hierarchy, obstetricians defined the choices by the norms of clinical practice.
Women seldom asked questions or made alternative requests.
Midwifes rarely discussed the contents of evidence-based leaflets and did not differentiate them from other literature.

The results were that there was little use of leaflets as evidence-based aids for decision-making. Instead of informed choice, informed compliance was the norm, largely due to the culture into which the leaflets were introduced.

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