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In the August issue of PLoS Medicine

The PLoS Medicine Editors, in the editorial for August 2007, focus on the role of qualitative methods in medical research. (We were promoted to write it having recently published another qualitative paper.) Our understanding is that it is now generally recognised that such methods do have an important role to play. Or have we got it all wrong; is there still a reluctance to accept that anything useful can be learned from research without numbers?

The International Journal of Social Research Methodology, a journal that is unlikely to be seen often by PLoS Medicine readers, recently published an optimistic article [1] claiming the ‘paradigm wars’ that have raged amongst social scientists over quantitative and qualitative methods are finally over, and that peace has been brokered not by the years of unproductive philosophical debate but by the emergence of pragmatism. Do we also have ‘paradigm peace’ in medical science or have our paradigm wars only just begun? It’s a point on which we’d like some feedback from our readers.

I have observed hostility towards both the two paradigms. I once took a nutrition course alongside a social scientist who was visibly distressed by her first statistical exercise – food aid was being distributed to villages in a fictitious country on the basis of whether the prevalence of malnutrition (based on an anthropometric index) was determined by a statistical test to be significantly greater than the national average. This approach was not only offensive to everything the social scientist had personally believed in but went against everything she had been taught. How could the complex situation faced by each child and each community be reduced to mere numbers?

But no doubt an equal degree of horror would be expressed by many a quantitative researcher at such aspects of qualitative methods as purposive sampling, an example of which is provided by a study by Green et al [2]. In a survey of how patients were coping with glaucoma they came to hear of a young woman was dealing with her situation in an unusual and successful way; they felt she had to be added to their sample, even though she was entirely unrepresentative. In research of this kind it is important to examine the full range of experience; at the far ends of the range one is more likely to discover something new, thus generating hypotheses and opening new directions for research

But, if qualitative research is to be published, it must be of good quality. There is no general agreement as to the criteria that we as editors should apply. Bryman1 argues for ‘bespoke criteria’; in other words each paper should be regarded on its own merits and in terms of the research question it is addressing. Most medical researchers would in contrast argue that there is a need to develop criteria that can be universally applied. (Appropriate criteria have been suggested, for example, by Greenhalgh.) Further debate is clearly needed and what better place for it than PLoS Medicine?

Elsewhere in the August issue can be found research that features a diversity of methods and specialties, not to mention what we are publishing in our ‘magazine section’. Having lived in Kenya and having slept under many a mosquito net there and elsewhere, I’m drawn to the Kenyan research reported in a paper by Noor et al. We already know that insecticide-impregnated nets (ITNs) are effective, but the best approach to adopt in order to ensure that all children at risk of malaria sleep under an ITN is a separate research question, and an issue that has been the subject of considerable controversy. This findings of this study provide convincing evidence that ITNs must be made available free, and that the expenditure involved can therefore be justified. The data in this study forms part of the evidence used by the World Health Organization to support its revised recommendations (issued 16th August 2007) on the promotion and use of bednets.

References

1. Bryman A. Paradigm Peace and the Implications for Quality, International Journal of Social Research Methodology, Volume 9, Issue 2 April 2006 , pages 111 – 126
2. Green J, Siddall H, Murdoch I. Soc Sci Med. 2002 Jul;55(2):257-67. Learning to live with glaucoma: a qualitative study of diagnosis and the impact of sight loss.

On behalf of Paul Chinnock

Discussion
  1. I’m not a health professional nor a scientist, “just” a patient. My disorder is Delayed Sleep-Phase. My favorite list is “niteowl” hosted at circadiandisorders.org.

    If no researchers use the content/archives of such lists in designing their “qualitative” studies, they should. By the types of questions asked and answers given, one can discover what patients do and do not understand about their disorders and treatments. Recent example (I’m not making this up): “The doctor said to continue taking it for a month, but it just seemed like a bad idea…” In this case I sided with the patient and tried to explain why.

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