Various strategies are available within qualitative research to protect against bias and enhance the reliability of findings This paper gives examples of the principal approaches and summarises them into a methodological checklist to help readers of reports of qualitative projects to assess the quality of the research

In the health field--with its strong tradition of biomedical research using conventional, quantitative, and often experimental methods--qualitative research is often criticised for lacking scientific rigour To label an approach “unscientific” is peculiarly damning in an era when scientific knowledge is generally regarded as the highest form of knowing The most commonly heard criticisms are, firstly, that qualitative research is merely an assembly of anecdote and personal impressions, strongly subject to researcher bias; secondly, it is argued that qualiative research lacks reproducibility--the research is so personal to the researcher that there is no guarantee that a different researcher would not come to radically different conclusions; and, finally, qualitative research is criticised for lacking generalisability It is said that qualitative methods tend to generate large amounts of detailed information about a small number of settings

The pervasive assumption underlying all these criticisms is that quantitative and qualitative approaches are fundamentally different in their ability to ensure the validity and reliability of their findings This distinction, however, is more one of degree than of type The problem of the relation of a piece of research to some presumed underlying “truth” applies to the conduct of any form of social research “One of the greatest methodological fallacies of the last half century in social research is the belief that science is a particular set of techniques; it is, rather, a state of mind, or attitude, and the organisational conditions which allow that attitude to be expressed”1 In quantitative data analysis it is possible to generate statistical …

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Rigour and qualitative research.

Public health interventions tend to be complex, programmatic, and context dependent. The evidence for their effectiveness must be sufficiently comprehensive to encompass that complexity. This paper asks whether and to what extent evaluative research on public health interventions can be adequately appraised by applying well established criteria for judging the quality of evidence in clinical practice. It is adduced that these criteria are useful in evaluating some aspects of evidence. However, there are other important aspects of evidence on public health interventions that are not covered by the established criteria. The evaluation of evidence must distinguish between the fidelity of the evaluation process in detecting the success or failure of an intervention, and the success or failure of the intervention itself. Moreover, if an intervention is unsuccessful, the evidence should help to determine whether the intervention was inherently faulty (that is, failure of intervention concept or theory), or just badly delivered (failure of implementation). Furthermore, proper interpretation of the evidence depends upon the availability of descriptive information on the intervention and its context, so that the transferability of the evidence can be determined. Study design alone is an inadequate marker of evidence quality in public health intervention evaluation.

https://jech.bmj.com/content/jech/56/2/119.full.pdf

Criteria for evaluating evidence on public health interventions

Generating best evidence from qualitative research: the role of data analysis

Background The use of commercially available tests for genes linked to familial cancer has aroused concern about the impact of these tests on patients. Familial adenomatous polyposis is an autosomal dominant disease caused by a germ-line mutation of the adenomatous polyposis coli (APC ) gene that causes colorectal cancer if prophylactic colectomy is not performed. We evaluated the clinical use of commercial APC gene testing. Methods We assessed indications for APC gene testing, whether informed consent was obtained and genetic counseling was offered before testing, and the interpretation of the results through telephone interviews with physicians and genetic counselors in a nationwide sample of 177 patients from 125 families who underwent testing during 1995. Results Of the 177 patients tested, 83.0 percent had clinical features of familial adenomatous polyposis or were at risk for the disease — both valid indications for being tested. The appropriate strategy for presymptomatic testing was used in 79.4 p...

The use and interpretation of commercial APC gene testing for familial adenomatous polyposis.

Researching public health: Behind the qualitative-quantitative methodological debate

Health care delivery is undergoing intense scrutiny and pressure for change: people have high expectations and want value for money. Research can do much to evaluate the effectiveness of health care, but deeply rooted disciplinary preconceptions - about what should be done and how, and about what is scientific - have hampered relevant research. "Researching Health Care" brings together an international team of health researchers from the fields of clinical care, clinical epidemiology, bio-statistics, sociology, health economics and health policy. The problem of research method is central to the evaluation of health care, and the contributors therefore focus on the three most important methods in use at present: experimental methods, surveys and other quantitative methods, and qualitative methods. The strengths and limitations of each method are spelled out, and the contributors show how some methods are more appropriate for evaluating the technical aspects of medicine, others for social and community issues. They argue that complex health care problems can be adequately addressed only by an equally broad range of research study designs, as well as by a willingness to co-operate. This book should be of interest to researchers and professionals in training and practice in social policy, social work, health studies and sociology.

Researching Health Care: Designs, Dilemmas, and Disciplines

Researching Health Care

The contribution of a non-invasive test to clinical care. The impact of echocardiography on diagnosis, management and patient anxiety.

The development of chronic lymphocytic leuksemla makes no essential dilrerence to the chemotherapeutic management. Its rate of development, probably an index of the activity of the disease, will, however, determine the dosage schedule of the alkylating agent. The develop. ment of acute lymphoblastic Ieukesmla, on the other hand, is an indication for a change in drug therapy. A trial (If prednisone and an antimetabolite such as 6-mercaptopurine is recommended.

Isoproterenol in massive pulmonary embolism: haemodynamic and clinical effects.

Preliminary results from 2723 examinations to June 30,1987, at the first two installations that are participating in a broadly‐based prospective trial of the utilization and diagnostic value of magnetic resonance imaging are presented. Compliance by the investigators with the trial protocol was excellent. The head (60% of cases) and spine (31% of cases) were the most common regions that were examined, and such examinations were completed mostly in one hour. Active, mobile outpatients were predominant among those who were examined. Further reports will be directed to particular disease groups, cost studies and patient outcomes.

Ian McDonald

Papers

Researching Health Care: Designs, Dilemmas, and Disciplines

Researching Health Care

The contribution of a non-invasive test to clinical care. The impact of echocardiography on diagnosis, management and patient anxiety.

Isoproterenol in massive pulmonary embolism: haemodynamic and clinical effects.

Magnetic resonance imaging evaluation: preliminary utilization and application report