Qualitative Health Research - A guide for the perplexed: Part 5 - You

So far in this weekly series on qualitative health research, I’ve talked about where QHR came from, criticality, the ‘insider’ or emic perspective, and last week focused on power.

This weeks post continues the theme of power, but concentrates especially on your role as the researcher.

In most quantitative research, youare supposed to disappear, to recede into the background, and protect the data from your polluting influence. Of course, this is only possible to a degree, because you have often been involved in every stage of the design and development of the study.

But when it comes to the data collection and analysis stage, you are too heavily influenced by your own experiences, biases, and subjectivity to be trusted with the study’s data, which really should be handled like someone in hazmat gear holding a jar of radioactive iodine.

There are two major problems with this. On the one hand, how do you actually protect the data from your influence? Technically speaking, the lengths you have to go to to distance yourself from the data explain, in part, why quantitative researchers have an accountant’s fascination with methodological book-keeping.

But there is another problem too. Ethically speaking, is it right to assume the aloof, detached, ‘view from nowhere’? Especially in healthcare, where everyone has at least some skin in the game?

Qualitative research takes a different view. They believe that you are not only involved in the study, you are central to it. Not more central than your participants, but certainly right there in the middle with them. This means you have to think a lot about philosophically and methodologically.

How you’ve designed the study to situate yourself in there becomes vitally important. In quantitative studies there are really two active parties: the experimental hypothesis and the research subject. In qualitative research there are three: the research participant, the research question, and you. And there is no disguising or hiding the role you play in shaping the study design and analysis.

To be clear, qualitative researchers don’t see their input into a study as a flaw; something to be masked. It is something that enriches and enhances the study. Like the way wine grower put their love and passion into making a really great wine, or how a great football manager makes a team better.

In some ways, this makes qualitative research much harder for novice researchers, because in quantitative studies, the methodology is often so prescriptive it could almost be delivered by anyone. But in qualitative research it’s the exact opposite. ‘Who you are, where you’re from, and what you did’ - to quote the immortal Backstreet Boys - really does matter.

Perhaps an extreme example of this is auto-ethnography - a methodology almost guaranteed to make quantitative researchers roll their eyes in disbelief. Autoethnography has become really popular over the last 20 years, partly because it uses the researcher’s own experience as data. You are the researcher and the participant. It’s autobiography done with research rigour.

Now clearly, there are all sorts of methodological questions that arise when you enter the research study like Elton John at a Royal Gala, but perhaps the most important - and the one most often missing in the physiotherapy literature - is the role of perspective.

If you are going to take your place within a qualitative study, you must be very clear about your perspective. Because there are so many positions you could take in designing the study and reading your data (critical realist, feminist, Marxist, postmodernist, etc.), it’s vital that the reader knows where you’re coming from. Then they can do their part and read the findings through their own lens, bearing in mind that it will be different to yours.

So the position of the researcher in the study is one of the defining differences between quantitative and qualitative research. Physiotherapy researchers often get caught between wanting to be properly qualitative while subtly promulgating quantitative ways of working. You see this when a qualitative study is written up and you don’t get a detailed insight into the worldview of the researcher. That’s always a tell-tale sign of a weak study.