7. Research Methods in Health and Social Care
(This is the final part in my series looking at different aspects of health and social care in the UK, which I originally wrote back in 2016. I hope you find it interesting!)
Epistemology and Ontology: Definitions and Meanings in Health and Social Care
Epistemology comes from the Greek word for knowledge, episteme and is “concerned with the criteria used to distinguish knowledge claims, or assess their rigour and validity” (Orme and Shemmings 2010, p.84). It is about ascertaining knowledge claims and “how we can then assure the credibility of such claims” McLaughlin (2012 p.25). An epistemological approach, however, whilst seeking out knowledge does not always identify the social and psychological factors which could influence the potential outcomes of any research. For example Evans and Trotter (2009) looked at the propensity of some medical trainees to systematically “over” or “under” investigate when patients present with nonspecific somatic complaints, such as chronic fatigue. Further, Grad (2009, p.356) argued that “a physician’s epistemology may be flexible, moving back and forth depending on the context of our clinical encounters.” Thus personal and professional experiences may influence the direction of research and interpretation of findings (in other words, their own subjectivity and values). In simple terms, knowledge may be constructed as well as discovered.
Ontology is a branch of psychology concerned with the study of the nature “the nature of the world and what we can know about it” (Orme and Shemmings, 2010, p.84). In health and social care contexts, research is primarily concerned with what happens with, between and to people (their health and wellbeing, their feeling of independence, quality of life and so on). Social researchers particularly are faced with questions which they cannot avoid. Behaviour cannot always be governed by the same generalised “laws” as the physical elements and knowledge may only be specific to certain situations. In addition, researchers approach their topic from a particular position and understand the world in a certain way. This is because we all hold an “ontological position”, knowingly or unknowingly, and our values affect our research at every level.
Evaluating Research Methods Specific to Health and Social Care
The choice of research method will be greatly determined by the type of questions that are being proposed by the researcher, the size of the population being studied and practical considerations such as the resources in time and funding that are available. The three broad approaches to collecting research data are qualitative, quantitative and mixed-methods.
Quantitative research “is a means for testing objective theories by examining the relationship among variables” (Creswell 2009, p.3). Quantitative data can therefore be counted, measured, analysed and presented in statistical form. The advantage of this method is that the study can be repeated, offering the opportunity to generalise and replicate the findings. However, there remains the possibility of bias either through chance (hence importance of sample size), misinterpretation of data, withdrawals or ethical objections.
Qualitative research in contrast is “a means for exploring and understanding the meaning individuals or groups ascribe to a social or human problem” (Creswell, 2009, p.4). These methods are much more flexible and sensitive to social context and findings can be easily translated into policy planning and implementation. Qualitative data is therefore less to do with measurement and more to do with meaning. For example, when researching service provision, a researcher’s data might be broken down into gender, age, ethnic groups etc. One advantage of qualitative research is that it is able to capture an individual’s perspective of care provision and enable professionals and providers to understand the individual’s perceptions. One disadvantage is that this method can produce conflicting or inconsistent results. It can also be very time-consuming.
Most researchers will use a triangulated approach that combines both research methods. This is known as the mixed method “in which the investigator collects and analyses data, integrates the findings, and draws inferences using both qualitative and quantitative approaches or methods in a single study or program of enquiry” (Tashakkori and Creswell, 2007 pp1–3).
When gathering data, medical researchers commonly use Randomised Control Trials (RCTs), in which participants are randomly allocated one or other of the treatments under study. There is a treatment (or intervention group) and a control group. The random allocations reduce the risk of bias and the additional use of a “double blind” can mean that neither the participants nor the researchers know to which group they belong, reducing this risk even further. Larger RCTs produce better results, whilst smaller trials can produce uncertain results with a higher risk of error. However, RCTs may not always be suitable on ethical grounds (e.g. where one group may be asked to drink alcohol and the other to abstain, since the drinking group could be subject to harm).
Surveys are commonly used in health and social research, with each respondent receiving same questions and can be conducted face to face, telephone, postal or online. These allow swift data analysis, but findings can be distorted because only those sufficiently motivated or enthused by a topic are likely to respond, leaving potential for distorted results.
Interviews can enable more complex issues to be discussed and clarified, but are time-consuming, dependent on the skill of the interviewer and are subjective, with no guarantee that another interviewer would yield the same answers. Likewise, observational methods can provide the researcher insight into behaviour or culture, but observer bias can occur when the researcher allows their own opinions to affect their judgement.
Planning a Research Project in Care
Successful research routinely follows a set of predefined stages from conception through to completion. Briefly these stages are: identifying and formulating the research question(s), selecting the research method(s), data collection, analysing the data and reporting and disseminating the findings.
Firstly a researcher has to choose a topic for a project, which may be from their own practice or personal interests. Sometimes they may be attracted to a particular field of research because it attracts money and resources (for example, cancer research).
Initially, the topic for research may be broad, but the researcher must begin narrowing the field into a more specific project, utilising existing literature on the topic and using it to inform the construction of the research question. A literature review can bring clarity and focus to the research problem and broaden the knowledge base in the research area. In addition, past studies can improve methodology and help to contextualize the findings. The procedure is simple: search the literature in your area of interest, review the selected studies, and develop a theoretical framework for the research study. A good research question, therefore, needs to make sense, be relevant and have a reasonable scope. In other words, the more specific the research question, the better.
Selecting the right research method needs careful consideration and, as mentioned previously, might involve the use of more than one type of method. The choice of method will be greatly influenced by the research questions. For example, qualitative research methods may be more applicable to social care since these are more to do with meaning rather than measurement.
Data collection is the critical part of any research and how data is collected and analysed will be greatly influenced by the research methods used. Data collection need not necessarily involve people, researchers could look through case records, statistics or operational guidelines.
Data Analysis and Assimilation in Health and Social Care
Once all of the participants have completed the study measures and all of the data has been collected, the researcher must prepare the data to be analysed. Organising the data correctly can save a lot of time and prevent mistakes. Most researchers choose to use a database or statistical analysis program (e.g. SPSS) that they can format to fit their needs in order to organise their data effectively. Once the data has been entered, it is crucial that the researcher check the data for accuracy. This can be accomplished by spot-checking a random assortment of participant data groups, but this method is not as effective as re-entering the data a second time and searching for discrepancies.
No matter how well a researcher designs the study, there always exists a degree of error in the results. This error can be due to individual differences both within and between experimental groups, or due to systematic differences within the researcher’s sample.
Different research methods yield different types of data and no single method will fit all purposes. All research must be rigorous, open and ethical. A badly conducted observation or flawed experiment could easily create a “false picture.” For example Andrew Wakefield’s (1998) notoriously small sample of just 12 children in his study on links between the MMR vaccine and autism , the ethics of being funded by a lawyer, and the absence of a “control group. To date, no-one has ever been able to replicate his findings.
It often seems the case that a piece of research one month contradicts the findings of a piece of research published the month before. For example, one week working mothers are told that preschool care benefits their child and the next they are told that it is better for the child to stay at home. This can be due to the media portrayal of the research in which a complex set of results is reduced to a simplified message. However, it is also due to the fact that any one individual piece of research, or indeed any single piece of health care information, is like just one part of a large jigsaw.
References
Creswell, J. W. (2009): Research Design: Qualitative, Quantitative and Mixed Method Approaches, London, Sage
Dickinson, H. (2008): Evaluating Outcomes in Health and Social Care, Bristol: Policy Press.
Dodd, S.J. and Epstein, I. (2012): Practice-based research in social work, London: Routledge.
Evans, L. and Trotter, D.R. (2009): “Epistemology and Uncertainty in Primary Care: An Explanatory Study” in Family Medicine Journal Vol. 41, №5 pp319–26, Leawood, Society of Teachers of Family Medicine
Grad, R.M. (2009): “What’s Your Epistemology? Think About it” in Family Medicine Journal Vol. 41, №5 pp356–7, Leawood, Society of Teachers of Family Medicine
Jesson, J.K., Matheson, L. and Lacey, F.M. (2011) Doing your Literature Review: Traditional and Systematic Techniques, London: Sage.
McLaughlin, H. (2012): Understanding Social Work Research, London, Sage
Orme, J. and Shemmings, D. (2010): Developing Research Based Social Work Practice, Basingstoke, Palgrave
Pawson, R., Boaz, A., Grayson, L., Long, A. and Barnes, C. (2006): Types and Quality of Knowledge in Social Care, Knowledge Review 3, London: SCIE.
Royse, D.D. (2008): Research Methods in Social Work, 5th edn, Belmont, CA: Thomson Higher Education.
Tashakkori, A. and Creswell, J. W. (2007): “Exploring the Nature of Research Questions in Mixed Methods Research” in Journal of Mixed Methods Research Vol.1, №3 (July 2007), London, Sage
