Part 8 – So how do you know if a piece of qualitative health research is good?
In the seven blogposts that have preceded this, I’ve set out a personal critique of some of the problems I see all too often in qualitative research. I read and review dozens of qualitative health research articles each year, and my broader interest in the sociology and philosophy of health means I also get to read a lot of really good stuff too. So I’m claiming that as my mandate to offer some critical comments.
So what makes for a good qualitative health research study, and how can you tell if you’ve found a diamond or just a bit of cheap plastic costume jewellery?
Well I would say that the first thing you need to do is to ask what it is you want from the research.
If you want the research to be useful you’ll want something different than if you want something inspiring. If you’re looking for research to validate a treatment approach or an assessment technique, you’re looking in the wrong place, and if you find a QHR study claiming proof of efficacy of some intervention, be very skeptical.
Good QHR should always take you in to unfamiliar territory, so if the research is good, validation will be the furthest thing from the researcher’s mind.
So maybe put aside the imperative to find ‘useful’ research, and focus more on ‘inspiring’.
Think of it like a holiday in an exotic foreign country. You don’t go there to see what you can see at home, and eat what you’d normally eat on a Tuesday night. You go there to discover new customs, new sights, smells, and sounds, and to taste a world that may be different enough to be disruptive, but also uncannily familiar.
So if you’re the researcher, your first task is to be the tour guide to this foreign land. You must, you MUST, situate yourself in the study and claim your place as a participant. You must also explain your philosophical perspective – the philosophies that defined why you did this study in this way, how you read your data, and arrived at your conclusions.
Without this, you lose perhaps the most important function of QHR, and that is to transport the data from the mundane, everyday, and obvious, into something shocking, disruptive, and transcendent.
Any suggestion that the researcher is attempting to assume the objective, detached, ‘voice from nowhere’ common to quantitative research should be viewed with critique.
And every QHR study is a conversation with power. That’s your power as the researcher or clinician, and the power of the participants. It’s about the way that power is manifested and managed throughout the study, and how you use it afterwards to bring about change.
A researcher who runs the whole show in an effort to maintain control over their research may well be blind to the voice of the ‘other’, and that’s a bad sign for any QHR.
QHR is not about methods. They’re really not that important. Leave the obsessive attention to the methods of reducing noise from EMG studies of tibialis anterior contraction to the quantitative researchers. Focus on an approach that is true to your guiding philosophy, your participants, you, and your questions. If you need to take photos, take photos. If you need study picture books, or join people reciting Robert Frost’s poetry in a swimming pool, do that.
So beware the formulaic and pre-prescribed. There are now many guides explaining how to ‘do’ qualitative research. Many are designed to help you simplify what can seem a bamboozling experience, but in simplifying QHR they can strip the approach of its beauty and sensuality.
Woody Allen once joked that he’d been on a speed reading course and the first book they’d read was War and Peace. “It’s about Russia”, he said. Guides to qualitative research can be like that.
So hasn’t this series been another of those guides that I’m cautioning against? Well, yes, I suppose it has. But I also hope that it’s retained a sense of the kinds of anarchic, energising, playful, un-contained promise of QHR. And I hope it’s also given you confidence next time to look askance at a study that interviewed 6 people and wrote up 3 themes in the results section.
I have really enjoyed this 8 part series on QHR. I am hoping to socialise this series to both my department and to my organisations’ journal club working groups here in Abu Dhabi.
David, you appear to be passionate about the radical potential of QHR to really shake up our existing paradigms, to challenge the hegemony of the status quo and to give voice to the marginalized. At its very best QHR can really be truly inspiring!
For me the bar for what I expect from QHR is lower. I think between parroting themes from transcripts to the necessity of busting paradigms and inspiring the reader are a few important milestones in between that are worthy of consideration and merit. Personally, I am interested in the concept of “connected care” and “connected leadership.” One such milestone for a QHR study to have achieved being fruitful for me is whether it has managed to find the voice of our patients in a profoundly human and elucidating way. Their values, experiences, needs, interpretations and emotions. A group of nurses once wrote a paper called “Defining the fundamentals of care” based on findings from interviews with patients. I think papers such as these, although not necessarily inspiring and radical, really help us to understand what it is that people truly need from a healthcare provider in different settings both in the care chain and in the stages of their illness.
For me personally, taking Daves advice, to do some ‘mental and emotional travel’ has been to look into QHR far more frequently, to keep a discpline of journaling that is reflective, and to take the time to be with foreign peoples and cultures. One change that I have experienced has been to to redefine this notion of professionalism. I think in the past people had a very depersonalized, wooden, emotionally unavailable approach to professionalism. Political correctness, codifying human relations be that those of Pakeha and Maori or male and female are ineffective and I would argue hugely damaging. I am glad that with globalization, QHR, the arts, philsophy, business, our engagement with indigenous peoples and foreigners both abroad and domestic that our understanding of each other as human beings is growing exponentially. I am glad too that we are beginning to see that there is more pain than healing when care is disconnected, distant and “objective”. As a consequence this has helped me to prioritise connection with people rather than tasks, to value and prioritise what is important to the other as well as what is important and valuable to me. I now understand that guidelins and algorhythms are important, they are ‘scientific’ but do not necessarliy carry meaning or acceptance to the human in front of me. That engagement, understanding and acceptance will be more beneficial in the longterm for impact and trust rather than trying to execute each episode of care according to some distant, objectified research study. Furthermore, I continue to work hard on my internals to be more compassionate to self and other, and it has given me the freedom to open up and share more of who I am with the people that I lead and the patients I treat. Care has felt more personal, connected and authentic since. My satisfaction at work and my resilience to burnout have been my personal successes here. I don’t know if that is inspiring, but QHR has certainly helped me with this process and it is certainly good enough for me 🙂