than those in the control group, then we conclude that the new drug or treatment is better than the standard – or no treatment. There are many issues involved in RCTs and I shall discuss these in depth in Chapter 5.
Qualitative Approaches
These are approaches which do not involve numbers. Often the topic does not lend itself to quantifying – for example, when we are interested in studying people’s belief‐systems, or feelings. Sometimes the conventional approaches to sampling are not possible or do not make sense and therefore we chose a different approach from the ones described above. There are very many qualitative approaches, but for simplicity, I shall focus on the three most commonly used approaches.
1 Grounded Theory: Grounded Theory was developed by Barley Glaser and Anselm Strauss. Their book The Discovery of Grounded Theory was written at a time (1968) when there were very few academic books on qualitative research, other than ethnographic ones. Their aims in writing this book were to provide research students with a textbook to cite in defence of their qualitative approach, and to challenge the orthodox dominance of quantitative researchers in social sciences. They had conducted studies of death and dying in US hospitals – which is where I came into contact with them (I was working on the Life Before Death study and we wrote to ask them for any advice they could give – see Chapter 8). They describe an approach in which theory arises from and develops from the data as it is collected – for example, from observations, interviews, etc. I shall go into depth in these in the Chapter 14.
2 Ethnographic approaches: Ethnographic approaches have their roots in Anthropology. In particular, the work of early anthropologists to document and analyse societies and cultures in the developing world. The most common practice in this sort of research was for the researcher to go to a particular society and study it – as a participant observer. This meant living with and being part of the system that they are studying. By immersing themselves into and observing the life of that group of people and the events which happened to them – including the sense, or meaning that they attributed to them – they were able to try to make sense of that social system, So, what's this got to do with modern healthcare? Well, this approach has been adapted to researchers getting involved with particular social groups or situations – such as being admitted to hospital, working in care homes, etc., in order to get an ‘insider’ view of the experience and what is going on (see Chapter 11).More common, now, is to try to make sense of the cultural aspects of a group or situation by interviewing people – either individually or in focus groups – to capture their beliefs and practices. I shall go into depth and provide some rich examples of these in the Chapter 12.
3 Phenomenological approaches: Note how we are progressing to bigger and more difficult to pronounce terms! Sorry about that, but we need to be able to understand what others are saying, so I shall try to explain their meanings. First, let's try pronouncing the term:
Phen – om – en – ol – ogy
That's right. Try practising it a few times to get the hang of it. (I still stumble over this one occasionally!)
Phenomenology is the study of people's ‘lived experiences’. So, if we want to understand what people's experiences of an aspect of healthcare are, and the sense, or meaning, they attribute to these, then we are in the business of doing phenomenology. We usually do this using in‐depth interviews to access people's experiences. There are two schools of phenomenology – descriptive and interpretive phenomenology, but we'll wait until Chapter 13 before getting into the detail.
There are more variations of qualitative research, but I don't pretend to understand them all – and you don't have to.
Mixed‐Methods Approaches
I shall limit this section to discussing three of the most important of these approaches.
1 Case study approaches: In these, our aim is to focus on a single event or ‘case’ and by doing this we are able to provide a very detailed analysis of this case. Usually, we will combine quantitative and qualitative data in our examination of the case. For example, if we are looking at the impact of change in a GP practice, we would probably collect statistical data on the hours worked, the numbers of patients seen, etc., and we might interview a small number of staff and/or patients to find out what their views and experiences have been. Or we might take an individual patient and analyse them as a case, looking at numbers such as blood pressure, viral counts, etc., as well as qualitative data on the thoughts and feelings of the patient and those around her/him. Thus, we can obtain a full and detailed view of what is going on in this ‘case’. I shall go into depth in these in Chapter 15.
2 Policy analysis: In a policy analysis we are usually concerned with one (or both) of the following questions:What are the forces or pressures which led to the introduction of a new policy?What are the likely, or actual, effects of the introduction of a new policy?As you can imagine these are important issues for the development of health services and take us into more political issues, such as what interest groups might influence a country's decision about whether or not to introduce a new vaccination campaign, etc. Again, we usually deal with both types of data in considering these. I shall go into depth in these in Chapter 16.
3 Multi‐stage studies: There is an increasing trend towards mixing quantitative and qualitative approaches. For example, small‐scale, qualitative studies are often used as pilot studies or feasibility studies to test methodologies and to identify the issues to be addressed in the main, quantitative study. This is very common in survey research. Often, clinical trials will incorporate the collection of qualitative data alongside the quantitative data. For example, the statistics about the effectiveness of a new treatment may be complemented by gathering data about patients' experiences and their feelings about their experiences of it. These are covered in Chapter 17.
The ‘Sciences’ of Research
It might seem odd to you that I have said ‘SCIENCES’. First of all isn't there just ‘science’, so why have I put it in the plural ‘sciences’? To tell you the truth, I was a bit nervous about putting this section in. In a book titled De‐Mystifying Research Methods, my aim is to make things as simple, as understandable as possible. Yet here I am with the most complex sets of ideas that there are in research and I am struggling to make it simple! Anyway, here goes. I shall try to make it simple and to keep it brief.
I want to introduce you to four terms which are inter‐related, and to show you how they are related. There are: ontology, epistemology, methodology, and methods.
Ontology
Ontology is the study of ‘being’ and what constitutes ‘reality’. Now this is complex, so don't even go to Wikipedia and hope to find a simple version. There is none. The main philosophical debate is about whether there is one absolute reality or whether there are multiple realities. I have struggled with this for years and still do. I have reached these conclusions:
