Qualitative health research 101

Part 3

Over the last two weeks I’ve been writing about some of the key principles lying beneath qualitative research.

A lot of people think that qualitative health research (QHR) is just about asking people about how they feel, and writing lengthy research papers that are ‘simply talking trivialities in high sounding language’ (Cheek 1998). But that’s because qualitative health research is often misunderstood, badly taught, and confusing for practitioners reared on the red meat of clinical trials. (There is an important ‘other’ reason, but we can’t get to that just yet).

In the first in the series (here), I explained a bit of the history of QHR, and in last week’s post (here) I talked about the the key principle of criticality. The second key feature of good QHR I want to tackle today is the emic perspective.

In quantitive research there are no ‘insiders’. Everyone is outside. The desire to eliminate polluting variables and bias is often so strong that it can sometimes feel like quantitative research is trying to take a ‘view from nowhere’. This is, of course, crucial to objectivity. It shouldn’t matter whether you are the research subject, the researcher, or the clinician reading the results of the study, quantitative research says that your lived experiences should have no bearing on whether the intervention reallyworks.

But real life is full of polluting variables (hence why quantitative research needs p-values). So rather than trying to hide one’s bias, QHR starts from the premise that we are allinsiders.

The emic perspective means the insider’s perspective and is a crucial point to understand if you want to produce and understand good quality QHR.

The emic perspective is the insider’s view of whatever you’re studying. That could be the experience of chronic pain, or your view as the therapist.

'Until recently, the investigation of health problems was dominated by the outsider perspective, in which important questions of aetiology and treatment are identified by the profession. Studies based on this perspective assume that professionals are the authorities on what wellness is and that they alone know what questions ought to be asked to investigate methods to promote and maintain wellness while preventing and treating illness' (Krefting 1989).

Which all sounds very obvious and intuitive, but the real challenge of the emic perspective is whether you can really represent the insider’s view? If it’s someone else, how do you ‘capture’ what they think and feel? Is it enough to transcribe what the person says and assume that the person’s words are ‘the truth’? Can you observe what goes on in a department and infer that you’ve grasped what it’s like being one of the clinicians? Can you even know your own mind?

So if we can accept that every one of us is unique, and we all have a different views of the world that are shaped by our culture and experiences, then is Harris right to suggest that ‘The way to get inside of people’s heads is to talk with them, to ask questions about what they think and feel’ (Harris 1976)?

As is often the case with qualitative research, the ways of capturing data are not especially hard to do, (especially, as is often the case with physiotherapists, that you are experienced talking with people and observing the world around you). Where things get complicated is when you start to think about how to represent the other’s reality in a way that is credible and trustworthy.

Because, as Green and Thorogood suggested recently, you are not looking just for a common-sense description of a person’s reality, perhaps not even just an ‘insider’s’ account, but a theoretical description (Green & Thorogood 2018, and that becomes complex when we are all, in one sense or another, insiders.

References

Cheek, J. (1998). Postmodern theory and nursing: Simply talking trivialities in high sounding language? In H. Keleher & F. McInerney (Eds.), Nursing matters: critical sociological perspectives. Sydney: Churchill Livinsgtone. 

Green, J., & Thorogood, N. (2018). Qualitative methods for health research. London: Sage. 

Harris, M. (1976). History and significance of the emic/etic distinction. Annual Review of Anthropology, 5, 329-350. doi:10.1146/annurev.an.05.100176.001553

Krefting, L. (1989). Reintegration into the Community after Head Injury: The Results of an Ethnographic Study. The Occupational Therapy Journal of Research, 9(2), 67-83. doi:10.1177/153944928900900201