Investigating health
Session aims
• To increase your understanding of the
philosophical and methodological foundations of
health-related research
• To encourage you to consider which
methodology/s, design and methods are
appropriate to answer different types of research
questions and so be familiar with all of the stages
of the research process and therefore be able to
undertake a research project
• To analyse the nature of evidence and evidence
based practice
What is research?
• Research is an active and systematic process of inquiry
in order to discover, interpret or revise facts, events,
behaviours, or theories.
• Part of the research process is also making practical
applications with the help of the information gathered
through the research process.
• So research is a process by which questions can be
both explored and answered.
• Research is therefore a tool to explore, describe,
understand, explain, predict, intervene (change),
evaluate and assess impact.
Philosophical frameworks in research
• Research is underpinned by models of
understanding known as paradigms.
• A paradigm is a perspective and a way of
examining and understanding (therefore
researching) reality (Hennick et al 2011).
• There are two distinct paradigms and
philosophical traditions that underpin research.
• Positivism is associated with quantitative
research whilst interpretivism is used within
qualitative approaches (Seale, 2004).
Research paradigms
Assumptions of positivism
Assumptions of interpretivism
•Reality exists beyond our perceptions.
•This can be meaningfully conceptualized
and is therefore measurable.
•Deals with facts not values.
•There is a single ‘truth’ or reality.
•It possible to observe and measure
phenomena in an objective, reliable and
valid manner.
•The research process is neutral and value
free
•Understands things from people’s point
of view (insider’s perspective)
•Places emphasis on lived, subjective
experiences and acknowledges that there
can be multiple equally valid realities
which coexist.
•Reality is constructed by the social world
in which we live.
•Importance placed on understanding the
social context in which data are generated
and how social actors including
researchers influence this process
(adapted from Bryman 2001).
(adapted from Hennick et al 2011).
Key points about the philosophy of
research
• Researchers can use a specific paradigm and therefore apply its
associated techniques in practice. If you are trained in a positivist
position then you will use quantitative methods. Comparatively, if
you are trained in an interpretivist tradition then you will apply
qualitative tools of data collection.
• So there are different views of what social reality looks like. The
term to describe this is ontology. Ontology is defined as “the study
of the nature of reality” (Broom and Willis, 2007 p 25). There are a
range of ontological understandings each discussing the nature of
the social world in a different way.
• There are also different views about what represents knowledge,
how it is produced and how it can therefore be measured. These
are epistemological considerations, or “the study of the nature of
knowledge” (Schwandt, 2001, p. 71).
The research question
• All research starts with a question/s and this is an
essential part of the research process, with the aims
and purpose of the research needing to be clearly
defined at the outset of the process.
• Research question/s help the researcher to clarify what
they are investigating and guides the researcher
towards the most appropriate methods to address the
question.
• Questions arise in a variety of ways.
• Questions can be addressed using quantitative
methods, qualitative methods or a combination of
both approaches.
Quantitative Methods
• Experiments.
• RCTs.
• Surveys.
Quantitative sampling
• Sampling is the process of selecting units (e.g., people,
organizations) from a population of interest.
• Generalisability is the most common goal in quantitative
sampling.
• There are different types of quantitative sampling
strategies.
• Steps in quantitative sampling include
1. Identifying the population of interest.
2. Deciding what types of sampling strategy is possible
3. Considering if there will be difficulties in gaining access and
recruitment of participants
4. Considering how to improve response rates
Quantitative analysis
• Quantitative data involves the analysis of numerical
data and is best undertaken using statistical packages
e.g. PASW (formerly SPSS)
• Quantitative research is concerned with measurement.
Measurement is simply assigning values to outcomes.
• There are different levels and scales of measurement
which help researchers to decide upon the most
appropriate mathematical manipulations to undertake
on their data and to choose appropriate statistical
tests.
• Quantitative analysis involves working with statistics –
descriptive and inferential.
The value of quantitative health
research
• Quantitative approaches have provided large
data sets which document changing health
trends across the UK and further afield,
demonstrating which areas should be of
priority for practitioners.
• For example, the Health Survey for England
(2008) shows changing UK trends such as
increasing rates of obesity and rates of death
from alcohol associated diseases.
Qualitative methods
• Interviews.
• Focus groups.
• Observations.
Qualitative sampling
• Qualitative samples are mostly made up of people,
characteristics, experiences, documents, images and
settings (Mason 1996).
• Unlike quantitative research there is no set rule for
having a specific sample size within qualitative research
- the nature of the research question, the scope of the
study and the length of time available will influence the
size of any qualitative sample.
• Qualitative samples do not aim to be representative.
• Qualitative samples can be convenience samples,
quota samples, purposive samples, snowball/network
samples.
Qualitative analysis
• As a result of the data being in the form of
words, qualitative researchers do not have a
specific set of formulae to analyse their data.
• Can involve thematic analysis, which starts
with data being coded.
• Miles and Huberman’s (1994) framework for
qualitative analysis is that data is reduced,
then displayed and finally the researcher
draws and verifies conclusions.
The value of qualitative health
research
• Health related qualitative research has provided a wealth of data
about people’s experiences, how people experience pain, how they
feel about treatment and what is important from a patient’s
perspective.
• Qualitative approaches have enabled the voices of social actors to
be heard so that they can articulate their own stories and narratives
in relation to their health.
• Research has provided insights into interactions between health
care professionals and patients, so demonstrating the process and
power within them.
• Qualitative approaches have also been used to empower
participants for example, getting patients to think positively about
cancer whilst allowing researchers to explore patients’ talk
(Wilkinson and Kitzinger 2000).
Differences between quantitative and
qualitative research
Approach to research
Relationship between researcher and
Quantitative
Qualitative
Distant
Close
Researchers stance
Outsider
Insider
How theory and concepts are used
Confirmation (a theory is confirmed
Emergent (theories emerge from the
differently within the research
when a hypothesis is tested and proved) data once the research has been carried
subject
approaches
Scope of findings
out)
Generalisable
Non-generalisable
Image of social reality (the social world Static and external to actor
Processual and socially constructed by
is understood differently within these
the actor
paradigms)
Nature of data
Hard, reliable
Soft, rich and deep
Research tools
Experiments, RCTs, surveys,
Interviews, focus groups, observations
Combining qualitative and quantitative
approaches
• Despite the differences between these approaches, there are
also some similarities.
• It is possible to combine these different forms of research
within a single study in a mixed method approach.
• Accessing multiple sources of information, using a range of
different tools is likely to provide the researcher with a much
more comprehensive picture of the area that they are
investigating.
• Mixed methods are generally used to compare different
findings, to investigate different perspectives on issues and to
generate different types of data from both methodological
traditions, quantitative and qualitative.
• Combining research techniques in this way is commonly called
methodological triangulation.
Research ethics
• There are key principles relating to ethics that should underpin all
research projects.
• Research projects often require ethical approval and are expected
to adhere to specific codes of ethics.
• Principles of research ethics include
– Protection from harm - harm to both participants and researchers
should
– Informed consent - participants should be fully aware of the research
process and be able to consent freely. This is achieved by the use of
information sheets and consent forms.
– Anonymity – participants should not be able to be identified.
– Confidentiality – participants should be aware what happens to the
data they provide and who will see it.
– Right to withdraw - from the research process up to a clearly identified
point if they choose to.
Evidence based practice
• Research is essential within the field of health for practitioners to acquire
an evidence base.
• Evidence based practice is simply the application of research findings to
practice situations.
• Research has helped develop and improve practice in a number of ways:
–
–
–
–
By evaluating services and their effectiveness.
By evaluating the clinical effectiveness of interventions and treatments.
By determining the cost effectiveness of treatments.
By examining improvements for patients undergoing treatment using quality
of life measures.
• Gray (1997) suggests three stages that practitioners and students will
need to go through in order to draw on evidence to inform their practice.
1.
2.
3.
Finding evidence
Appraising evidence
Applying the evidence to practice
Summary
• Research is a systematic process drawing on
philosophical and theoretical concepts about
design and methods.
• In order to provide a rich understanding of
health related issues both quantitative and
qualitative research methodologies need to be
utilised.
• Different research questions can be addressed
by differing research designs and methods.