There are a number of excellent introductory textbooks available on qualitative
research, so the decision to produce yet another one perhaps needs justifying.
We have written this one in response to frequent requests from our students,
who are predominantly postgraduates with considerable professional experience but little prior knowledge of the social sciences. They come from almost
all countries in the world, and want an introduction to qualitative methods that
is sensitive to the practicalities of doing sound research on health topics in a
wide variety of settings. Although the principles of research design and conduct
may be the same wherever it is happening, and whatever the topic studied,
clearly the practice is not. First, the context of health research may be rather
different from that of general social research. It is increasingly undertaken
within multi-disciplinary teams, in which the legitimacy of using qualitative
methodologies is still challenged. It is undertaken in institutional contexts
(medical schools, health authorities, hospitals) in which the assumed model
of research may be clinical, rather than social. Although none of this has any
impact on the principles of ‘doing good research’, it does demand a particular
range of skills from the researcher, including the ability to explain those principles to a wide range of collaborators and potential users, and an understanding
of why the most common conflicts over issues such as research design may
occur. Second, most of the social research texts on the market assume a
Western setting, and it may be difficult for a reader to grasp the principles if
their initial reaction is ‘But that wouldn’t work in my country!’ The first
incentive for producing this text was, then, to provide an introduction to
qualitative methods that used examples of health research from a number of
different settings, so that we can demonstrate how key methodological issues
may have different implications in different contexts. We have been aided in
this task by colleagues from the London School of Hygiene and Tropical
Medicine who work across the world, and we have used examples from
their research liberally to illustrate key points.
Having taught methodology courses to students from a range of low-,
middle- and high-income countries, we have realized that there is a huge
amount to learn from reflecting on the differences and similarities between
what is possible and productive in diverse contexts. Being forced to reflect on,
for instance, different assumptions made about research interviews can aid an
awareness of the cultural specificity of the interview format in any setting –
something we can easily forget if all our interviewees share similar cultural
backgrounds to ourselves. Thinking through how the methodological aims
may be shaped by practical constraints can be a very useful way of clarifying
exactly what our aims are in using particular designs, or particular methods of
collecting data. Confronting examples from work in different settings helps all
of us challenge our assumptions about what we are trying to do in conducting
qualitative research of and for health.
A second incentive for writing this book was to bridge a gap that is sometimes apparent between policy-orientated field guides that aim to provide
‘toolboxes’ for novice researchers and theoretical introductions to social
research that may appear to have little relevance to researchers working in
applied areas. A key argument of this book is that good-quality applied qualitative work has to be theoretically informed: doing policy-orientated studies is
no excuse for poor design, or inadequate attention to methodology. But it is
not always obvious how this is to be done, particularly if faced with the
constraints of short-term funding or inadequate training in social science methods. We hope this book will help more practically minded researchers to see
the value of attending to theoretical issues, both for producing more useful
findings and for unpacking some of the debates they will inevitably have about
the validity, generalizability and implications of their findings.
Following from this, a third aim of this book is to explore the contribution
of qualitative methods to understanding health and health behaviour. Although
there is now largely an acceptance of the value of qualitative methods in public
health research, many of our students and colleagues still report having to
‘justify’ their use to collaborators who are sceptical or simply poorly informed.
Qualitative researchers still face questions about the validity and generalizability
of their methods, and lack of understanding of what qualitative research aims to
do. Throughout this book we have suggested how this kind of scepticism
can be met – not to convince our readers, who are presumably already convinced, but to help in potential discussions with colleagues from other research
traditions.
This book is intended primarily, then, for public health, primary care, health
promotion and nursing practitioners and managers, in both developed and
developing countries, with little previous experience of social science theory,
who need to commission, use or conduct qualitative research. The aims are to
introduce readers to some of the debates in qualitative methodology, to
demonstrate the uses of qualitative designs and methods of data generation
in a wide range of health research projects, and to suggest ways of improving
their own research practice. We also hope it will be a useful text for social
research students, in introducing some of the particular methodological possibilities and challenges of researching health.
The structure of the book is straightforward. The chapters in Part 1 deal with
methodological principles, research designs and ethics. They introduce some of
the key terms used in methodology, and some of the underlying principles of
qualitative approaches. Those in Part 2 discuss four common strategies for
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producing or collecting qualitative data: in-depth interviews, group interviews,
observation and documentary research. These chapters provide overviews of
these methods of generating data and suggestions for improving research practice. The final chapter in this section is an introduction to some common ways
of analysing qualitative data. Part 3 highlights the practical issues raised by
‘doing’ qualitative health research, with chapters on working in multi-disciplinary settings and on writing and reading qualitative work. Throughout the
book we have drawn on examples of social research on health from a number
of settings. Some of these are extended case studies, which are summaries of
published research. It would be helpful to look at the sources of these wherever
possible, as a good way of learning about methods is to read how others have
approached questions of design and conduct. Even better as a learning tool is
doing research, and there are suggestions for exercises to develop your own skills
at the end of each chapter.
Finally, we should like to acknowledge the input of our past and current
colleagues and students from the London School of Hygiene and Tropical
Medicine, whose experiences, both published and unpublished, have been
drawn on widely in writing this book. We are particularly grateful to: the
students who have taken Qualitative Methodologies over the last few years,
whose lively discussions and comments have contributed to many of the ideas
here (often in ways they may not approve of!); Helen Marshall, for comments
on several chapters; Simon Lewin and Gillian Hundt, whose research experiences have been drawn on in a number of chapters; Geraldine Barrett, for her
contributions to Chapter 8; and Simon Carter, for contributions to Chapter 10.
Judith Green and Nicki Thorogood