Qualitative Health Research - a guide for the perplexed

Part 1

The changes now taking place in healthcare should provide great material for really thoughtful, well-conduced qualitative health research (QHR). But sadly little of it is being produced, especially in physiotherapy, where the amount and quality of much of the qualitative research we have available is really quite poor.

So over the course of the next few weeks, I thought I’d try to tackle some of this in a similar way to the way I hacked at the biomedical model last year (see here). My hope is that in doing this, people will understand more about QHR, and that might, in turn, lead to some new and exciting research.

Before I begin, I should acknowledge that there are literally dozens of people in the CPN and elsewhere who use and teach QHR, and any one of them could have written these posts. So I hope they add their thoughts and comments as the story unfolds.

So let’s begin with a bit of context.

Qualitative health research is younger than many people realise. Although many of the ways of researching adopted by qualitative health researchers are as old as experiments and clinical trials, we’ve only had what we now know of as QHR since the late 1980s. That’s because it needed the a number of different events to coalesce to bring the pieces together and make QHR a real living ‘thing’.

Now although you can find evidence of people observing others and commenting on society in ancient Greek, Roman, Indian, and Chinese texts going back thousands of years, the ’systematic’ study of health in society only really began in 1920s America with the ‘Chicago School’. Anthropologists (‘anthro’ meaning ‘people’) and ethnographers (methods for studying ‘ethnos’ or cultures) especially, developed methods for recording their field observations, and developed ways to measure society as objectively and scientifically as they could.

The post-WWII period brought a major rupture though, as generations of young people rejected the values of their parents and “tuned in, turned on, and dropped out” ([link]). Civil rights, gay rights, disability rights, feminism, anti-war protests, anti-nuclear protests, rock ’n roll, acid, the contraceptive pill, the ‘white heat of technology’ ([link]), all fermented a generation of social activists that took up the tools of the arts, cultural studies, Marxist sociology, radical politics, and existential philosophy, and give birth to entirely new ways of looking at the world.

Health - as one of the biggest issues in any society - was not immune to these radical new ideas, and dozens of health professions (especially nurses), began to study sociology and philosophy, and began to adapt the methods they were learning to healthcare.

Then came another rupture.

The late 1970s was a pivotal time in modern healthcare, not least because governments began to ask serious questions about the economic cost of maintaining the healthcare system. Where doctors had acquired almost total control, governments began to take control back. Health service managers, accountants, policy makers, advisors, planners, and organisers began to multiply, rationalisation became the norm, wards closed, jobs were cut, and accountability and risk management became the norm.

Slowly people began to wrestle power away from (white, male) doctors and other health professionals and the public began to gain their voice. With this came a whole series of new questions about what patients wanted, what health meant, how systems worked to help or hinder healthcare; questions that were so much broader than whether treatment A is more effective than treatment B.

This was a golden dawn for QHR, and a lot of the research done then was radical, interesting, and innovative, (and sometimes quite bonkers). For a few years it hardly registered with the traditional health professionals. But then towards the end of the 80s it had gained enough fans among the health professions for quantitative health researchers to sit up and start paying attention.

Once quantitative researchers woke up to QHR, they began to question its credibility. They asked; “How can a research study be generalisable if it only has five subjects?”, and “How can we replicate this study when the methods are so woolly?” What a lot of QHR people did in response to these perfectly reasonable questions laid the foundations for qualitative health research as we know it today, something we’ll tackle in the next blogpost.