Health services research is a multidisciplinary field which involves policy makers, health care providers, as well as quality outcomes professionals of the health services provided in an organizational setting to name some. Using qualitative research methodology to get insights of both the provider and patient experience down the pipeline can help strengthen what is lacking. Bridging the gap of translation research by not just surveys 1 might be an appropriate research methodology, however, inclusion of case studies, ethnographies might help stakeholders in the field, to visualize in depth phenomenon occurring in health services research field. Telly medicine, commercial digital health status trackr might be some of the inetrventions to improvise health care services, however, knowing what are the actual needs at individual level might efficiently help in redistribution of resources or policy laws. Recruiting for clinical trials through story telling communication technology2,3, might help in recruitment for novel drug therapies to explore possibilities, however, exploring the barriers to enroll for the clinical trials, or why the drug might work effectively in some cultural population and why not on others, can only be efficiently explored through qualitative research methodologies.
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Copyright © 2020 Naiya Patel
The authors have declared that no competing interests exist.
Health services research is a multidisciplinary field which involves policy makers, health care providers, as well as quality outcomes professionals of the health services provided in an organizational setting to name some. Using qualitative research methodology to get insights of both the provider and patient experience down the pipeline can help strengthen what is lacking. Bridging the gap of translation research by not just surveys1 might be an appropriate research methodology, however, inclusion of case studies, ethnographies might help stakeholders in the field, to visualize in depth phenomenon occurring in health services research field. Telly medicine, commercial digital health status trackr might be some of the inetrventions to improvise health care services, however, knowing what are the actual needs at individual level might efficiently help in redistribution of resources or policy laws. Recruiting for clinical trials through story telling communication technology2,3, might help in recruitment for novel drug therapies to explore possibilities, however, exploring the barriers to enroll for the clinical trials, or why the drug might work effectively in some cultural population and why not on others, can only be efficiently explored through qualitative research methodologies.
Qualitative Research Paradigms and Methodologies in Health Services Research
There exist several merits of conducting a qualitative research4which includes being able to describe how different individual see the world and hold diverse perceptions, observing how every process within a research unfolds, concentrating on small sample sizes, ways to explore a research phenomenon, build and develop a complex understanding, a way to lift voices which are overpowered (marginalized population), being able to study sensitive topics. Qualitative study methodology aids in understanding a phenomenon/central topic over measuring the phenomenon or issue at several levels consisting of micro, meso, and macro-level5. Qualitative methodologies help understand and describe deeply human experiences in specific settings, their opinions and equip a researcher to interpret different people’s voices and its associated meaning as well as experiences firsthand6. It also equips the researcher to understand how culture molds one’s experiences and helps collect data that is detailed and subjective along with flexible research design6.
The qualitative paradigms, also known as worldviews or personal beliefs, can be categorized into four main paradigms Post positivism, Critical theory, Constructivism and Participatory4. The paradigms are constructed of fundamental beliefs like theory components, each explaining their role in the entire theory. The fundamental beliefs are Ontology, Epistemology, Axiology, Methodology and Rhetoric4,5. The ontology describes how investigators differ in their perception of the reality and existence of things in the world. Epistemology describes the connection between the investigator and the research/phenomenon itself4,5. Axiology describes perception differing between each investigator regarding the use of bias and values in their research. The methodology describes the research process itself and Rhetoric describes the personal views in terms of using a language that can be either formal or informal and varies from one worldview to another4,5.
The investigators who follow Post positivism believe in the existence of a single reality and holds an independent relationship with the phenomenon they are trying to investigate. Hence their values in the study are unbiased, objective and they prefer to use scientific language in a deductive research process they undertake4,5. Followers of Critical theory hold beliefs that any phenomenon is shaped by its social, political and cultural events and have a strong inclination of a personal relationship with the phenomenon being investigated4,5. The research observations involve the investigator's values/beliefs while the research method is flexible and is inclusive of participant's opinions and language reflective of power oppression issues4,5. The researchers who strongly believe in Constructivism have a perception that every person differs in their viewpoints. That involves inductive research methodology using personal participant's language as well as their subjective viewpoints4,5. Finally, followers of the Participatory paradigm hold a belief that every phenomenon is affected and molded by race, class gender or combination of either. The relationship of the researcher with its participants is collaborative and the research observations include both the investigators and its participant's values. The research process is collaborative and uses language, which depends on the stakeholder's or participant's choice4,5.
Our worldviews shape and guide the qualitative design we use for our research. The paradigms shape our methodologies, which helps guide the data collection technique and the type of interpretation we make as a qualitative researcher. Each methodology, which includes Narrative research, Phenomenology, Grounded Theory, Ethnography and Case Study, has its own merits and demerits.
Narrative research methodology expresses an experience in a storytelling manner. It provides more in-depth insights and expressive perceptions to the phenomenon in which data collection methods are interviews, observations and documents of personal experiences4,5. The end product of this methodology to describe the turning point of one's personal experience involving the phenomenon in question with the setting of the participant as a context. Phenomenology, on the other hand, demands its investigators to be open-minded while using this methodology and reflects how participant's experiences towards the phenomenon make sense7. The data collected is in any one of the forms or its combination of interviews, observations and documents. The product of it is to make sense of an experience every participant has towards the issue which eventually helps develop a worldview4,5. Ethnography methodology adopters analyze the formation and structure of a social group by exploring cultural and social aspects that surface behavior patterns or describe several aspects of the social group itself 7. They collect data of beliefs, rituals, language and behavior by interviews and observation in the field4,5. The investigators who use Ground Theory methodology have a strong ability to be flexible in their research design as it involves an inductive approach, analysis of a situation critically, potential bias identifications, abstract thinking and sensitive analysis towards participant’s responses8. It provides in-depth thematic coding concepts and requires researchers to be present in the field to analyze the new phenomena, questions and establish abilities of its proponents to be able to contrast with old ideas8. In order to determine chronology data is collected via interviews and memos4,5. Finally, Case study methodology helps to determine the magnitude of a phenomenon by analysis of individual or group’s experiences towards the issue4,5. The data collection includes time and space bounded interviews, documents, observations or visual materials.
Some of the limitations of qualitative research methodologies for data collection methods include expensive process, a requirement of strong interviewing skills, inability to measure the honesty in responses of participants, smaller sample size, difficulty in data quantification in some instances. Sometimes the observer, if himself gets involved in the activities, they might lose their objectivity or the observer, might not possess strong observation skills required for the research data collection. Moreover, the researcher's perception and interpretation of the respondent's answers cannot be generalizable due to differing interpretations among individuals.
Role of Researcher in Health Services Research
Every researcher’s perspective differs from one another. Thus, researchers must take into consideration the fact and try to link the research findings with theoretical understanding5. As worldviews are personal beliefs that shape the field, the research community a researcher belongs to provides interpretive tools from studying a specific phenomenon to preferring a specific method to conduct the research4. Hence researchers’ paradigms inform their research4.
A researcher should be able to communicate clearly what worldviews they believe in and how those worldviews shaped their research in any shape or form while presenting their research findings. Since not every researcher might be aware of the essential elements of the worldviews, the other researcher believes in. A short description of the paradigm in a methods section or some relevant section on philosophy for publication work might serve the purpose for readers. Another choice is to be vocal while presenting the research4.
Every researcher undertaking research involving human participants must be able to anticipate ethical concerns and issues arising at each stage of the research project. The ethical issues raised before research begins, during data collections and data analysis or after the research is over during the dissemination phase4. The investigators must be aware that they would be collecting potential personal data that includes voice records, videotaping etc. which can help identify the participants. For that case, the researcher should be aware of the Institutional Review Board applications and procedures both available on campus or in some instances, outsourced IRB. One must prepare a blueprint of required documents for applying, protocols required, and the informed consent content. The application must involve project details, safeguard details as well as protocols and interview guides if any. The researcher must be familiar with all the risk classifications associated with the project and must be able to describe what preventive steps they would be taking to avoid ethical concerns4.
Not just the research participants, but the researchers at the beginning of the study must be able to define the authorship, investigator roles in order to avoid ethical issues later at the dissemination stage of the study. The content borrowed for the research must also be acknowledged or cited after receiving permission from the lender, wherever required4.
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