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:
In some cases, there is only one reality. If someone points a gun at me and threatens to pull the trigger, I am not going to get into a discussion about how he defines a gun. I am not going to argue that his faith in his gun is determined by a questionable philosophical stance and … BANG! I have lost the argument. He has proved his point. So, for a lot of things − for example, the ‘realities’ of the physical world – I am not going to question most of it. I believe in bricks and walls and roofs etc. I depend on these every day to live in. And whilst I might debate the qualities of bricks and walls and roofs with you, at the end of the day we would probably agree that they are there and that we can reach out and touch them. They are hard, and if one falls on your foot it will hurt. Facts. We share a common physical universe which we can live in and experience and we can check that out with other people. You could say that they were objective in that they exist whether we believe in them or not.
But in some things, there is more than one interpretation of reality. And there are some things which are more negotiable in terms of their ‘reality’. People's thoughts, feelings, senses, and experiences are definitely subjective. These belong to the individual who owns them and, although we can find out what they are, we may never be able (at least, at this point in our ‘scientific’ development) to fully understand the other's experiencing of life. Furthermore, our ability to understand – to get as near as possible to ‘knowing’ – the experiences of others, will be determined by our own situation in the social world.
One of the examples that I have used in teaching this, is that of pain. If you look up ‘measuring pain’ in Wikipedia (not my favourite source, but an interesting one), you will find the following story:
In 1940, James D. Hardy, Harold G. Wolff and Helen Goodell of Cornell University introduced the first dolorimeter as a method for evaluating the effectiveness of analgesic medications. They did their work at New York Hospital. They focused the light of a 100 watt projection lamp with a lens on an area of skin that had been blackened to minimize reflection. They found that most people expressed a pain sensation when the skin temperature reached 113°F (45°C). They also found that after the skin temperature reached 152°F (67°C), the pain sensations did not intensify