Qualitative Health Research

Although the complexities inherent in human communication make it a difficult target for empirical investigation and systematic interpretation, it is well recognized that patientprovider communication can have either a powerfully negative or positive influence on the experience of cancer. Drawing on an extensive data set derived from interviews with 200 cancer patients, the authors examine the impact of information provided in numerical form within cancer care communications from the patient perspective. In this context, they present findings related to various uses and abuses of numbers within cancer care communication, and illustrate how numerical information constitutes a specialized communication form with considerable potency for shaping the cancer experience. In particular, accounts of the thematic relationship between numbers and hope, from the perspective of those on the receiving end of cancer care, provide a unique perspective from which to interpret issues of compassion, caring, and informed consent.

The authors analyze the pilot implementation of a statewide automated outcome monitoring system (OMS) in California, using the perspectives of substance abuse treatment providers responsible for its day-to-day operation. To gain a better understanding of changes experienced by staff and their perceptions of barriers and facilitators of implementation, they conducted 28 focus groups designed to inform midstream adjustments to the system prior to its possible roll-out. Qualitative analysis of the focus group data revealed five important factors influencing implementation: the treatment provider's ethos, the time-consuming nature of the OMS, staff buy-in, resources, and counselor and program discretion. Lessons learned underscored the importance of taking into consideration aspects of organizational change and institutional resources and infrastructure when implementing a major change such as an automated OMS. Findings might be useful to those designing and implementing similar systems or other large organizational change initiatives.

The authors examine the interaction between nurses and patients with type 2 diabetes during routine consultations in primary care settings in the United Kingdom. Through preconsultation interviews, the authors identified the patients’ expectations. The article draws on videotaped consultations with 25 patients with type 2 diabetes. Using conversation analysis, the authors examine the use of a rigid agenda, imposed via a computerized checklist, and consider how far this is able to suppress the patient's agenda. They consider the potential impact for the patient and the factors that might encourage the clinician, and the nurse specifically, to adopt a narrowly task-based approach to the consultation. They identify two potentially conflicting strands within contemporary diabetes care, patient-centered practice and an emphasis on biomedical audit, and suggest that achievement of the former might be compromised by the demands of the latter.

In this article, the authors present an empirical example of triangulation in qualitative health research. The Canadian Heart Health Dissemination Project (CHHDP) involves a national examination of capacity building and dissemination undertaken within a series of provincial dissemination projects. The Project's focus is on the context, processes, and impacts of health promotion capacity building and dissemination. The authors collected qualitative data within a parallel–case study design using key informant interviews as well as document analysis. Given the range of qualitative data sets used, it is essential to triangulate the data to address completeness, convergence, and dissonance of key themes. Although one finds no shortage of admonitions in the literature that it must be done, there is little guidance with respect to operationalizing a triangulation process. Consequently, the authors are feeling their way through the process, using this opportunity to develop, implement, and reflect on a triangulation protocol.

The evidenced-based movement has influenced medical research to the point that the agendas and methods of qualitative inquiry are often excluded from resources of medical granting agencies. Yet, its narrow definition of what constitutes evidence and its myopic vision about health must be challenged. In this article, the author argues that qualitative research does contribute to a reduction in morbidity and mortality without the cost in dollars and lives that are necessarily incurred in evidence-based inquiry. She asserts that we must reframe our definition of evidence to meet this new ethic of inquiry—which she calls the ultimate ethic—as a way of conducting research.

As it is, clinical trials are the gold standard of health care research, employed to prove that the care practices they study are good. Here, the author suggests that we would do better to develop research methods that work toward another goal: to improve care practices. This requires that we no longer foreground the effectiveness but, instead, investigate the various effects of interventions. If undesirable, they might then be tinkered with. As a part of this, the effects on bodily parameters and on the intricacies of daily lives should not be separated out but studied in connection. With examples drawn from studies into care practices for patients with diabetes or atherosclerosis, the author argues that instead of trying to turn the clinic into a laboratory, we should strive to support and strengthen clinical ways of working.

As qualitative researchers, we have not explored our own work from the qualitative evidence perspective. The author suggests that qualitative researchers need to explore the conflicting agendas of evidence-based medicine and qualitative inquiry, compare the anatomy of qualitative data and evidenced-based data, and explore the autonomy of qualitative inquiry within the context of evidenced-based medicine. By attending to and communicating the differences in qualitative and quantitative evidence, and by accepting the differences in our research agendas, qualitative researchers will achieve the legitimacy that they deserve and which they require.

One of the challenges facing qualitative researchers in a climate in which audit culture has permeated many facets of the institutions in which they research is how to establish the impact and quality of their research. When examining track records, granting institutions place significant emphasis on publication performance. Although the quality and impact of publications have traditionally been assessed by peer review, there is currently a global trend toward the development, refinement, and increased use of quantitative metrics, particularly citation analysis and journal impact factor. In this article, the authors share their experience of using the metrics citation analysis and journal impact factor in the preparation of an application for funding. Their aim is twofold: to raise awareness about potential issues in the practical application of these metrics; and to offer critique about and, they hope, “quality” to the writing and rhetoric concerning how to measure publication impact and quality.

Evidence-based practice (EBP) is more than the application of best research evidence to practice. Advocates for evidence-based medicine (EBM), the parent discipline of EBP, state that EBP has three, and possibly four, components: best research evidence, clinical expertise, and patient preferences and wants. Person-centered physicians also advocate for the person of the practitioner as a fourth component. In this article, the author shows the centrality of qualitative research to this fuller version of EBP. She also shows how qualitative research has four cornerstones that parallel the four components of EBP.

The publication of research findings is sometimes considered almost unrelated to the research, as something “coming after,” when the research is complete. The essence of this short article is an argument against this idea. However, a common problem is that the form of publication is ruled not by the research but by, for example, research tradition. In Sweden, it has been common to publish extensive findings in the social sciences as reports, whereas in medicine and in nursing science linked with medicine faculties, publication in the form of international articles is the dominant style. The author discusses the “pro” and “cons” of these two publication styles. As a conclusion, she argues that we need to make explicit the internal paradigmatic demands on qualitative research regarding validity, generalization, number of informants, and, not least, publication, instead of allowing the old, positivistic paradigm to continue to determine the styles of publication.