Jeanne Daly

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

Objective: To outline the importance of the clarity of data analysis in the doing and reporting of interview‐based qualitative research.

What have sampling and data collection got to do with good qualitative research

Objective: To highlight the importance of sampling and data collection processes in qualitative interview studies, and to discuss the contribution of these processes to determining the strength of the evidence generated and thereby to decisions for public health practice and policy.

The essential role of social theory in qualitative public health research

Objective: To define the role of social theory and examine how research studies using qualitative methods can use social theory to generalise their results beyond the setting of the study or to other social groups.

Perils and possibilities: achieving best evidence from focus groups in public health research

Objective: Focus group research is often seen as a cost‐effective way of gathering evidence from multiple research participants about the diversity of their views, experiences or beliefs. Our objective is to argue that focus group research only fulfils its potential if analysis of individual views is extended to include analysis of interaction between participants, so that we learn more why people hold these views.

Research methods, evidence and public health

In theory, our research questions should drive our choice of method. In practice, we know this is not always the case. At various stages of the research process different factors may apply to restrict the choice of research method. These filters might include a series of inter‐related factors such as the political context of the research, the disciplinary affiliation of the researchers, the research setting and peer‐review. We suggest that as researchers conduct research and encounter the various filters they come to know the methods that are more likely to survive the filtering process. In future projects they may favour these methods. Public health problems and research questions may increasingly be framed in the terms that can be addressed by a restricted array of methods. Innovative proposals — where new methods are applied to old problems, old methods to new areas of inquiry and high‐quality interdisciplinary research — may be unlikely to survive the processes of filtering. This may skew the public health knowledge base, limiting public health action. We argue that we must begin to investigate the process of research. We need to document how and why particular methods are chosen to investigate particular sets of public health problems. This will help us understand how we know what we know in public health and help us plan how we may more appropriately draw upon a range of research methods.

Caught in the web: The social construction of menopause as disease

Abstract This paper reports the results of a qualitative study of 150 womens experience of menopause, in this case focusing on the experience of 20 women who experienced difficulties so intense that their lives were seriously disrupted. A hierarchical framework is proposed which allows for the interaction between the individual experience (biological, behavioural and personal), the family situation, social structure and the culture. Women who experience serious disruption of their lives during the menopause attribute their problems to depression, sometimes complicated by serious physical, family or social factors. For these women a disease construction of menopause offers their best chance of access to help and treatment. At the same time, a construction of menopause as a normal social transition is needed to account for the experience of women who do not suffer intense, disruptive problems.

Technological innovation and the labour process in health care.

The process of technological innovation in health care is explored in this paper using labour process theory. Taking the specific case study of diagnostic imaging technology it argues for the utility of labour process theory for analysing the professional labour process as a means of delineating the social contexts in which technological innovation provides a means of empowering workers.

Watching the watchdogs

Recently, the journals Science and Nature have retracted several papers from the same research group, acknowledging that the research was fraudulent.1-4 This possibility is a nightmare for any editor. There are two traditional ways of avoiding the problem. The first depends on the rigour of the review process in which selected peers are asked to assess the quality of a paper and the contribution it makes to a field. The second requires that the authors provide a clear account of both the research methods used and the analysis of the data so that reviewers can assess the research process. These are standard procedures for any peer-reviewed journal. Both processes work well, although they are notably unsuccessful in identifying fraudulent research.1-4 While these standard journal processes are well understood, and are usually honoured, there is less consideration of an additional issue: the formal rules that govern decision making by journal editors. What processes should be in place to ensure that editors do not make biased decisions in accepting or rejecting papers for publication? In this editorial we set out the processes we use in this Journal. In a multidisciplinary field such as public health, it is, we believe, an advantage to have editors from different disciplinary backgrounds and our backgrounds in medicine (JL) and sociology (JD) could, arguably, hardly be more different. While we both have a broad interest in public health research methodology, one of us (JL) is more experienced in epidemiological research and the other (JD) is more experienced in research using qualitative methods. Because we make joint, face-to-face decisions about papers, both disciplinary and methodological preconceptions are tempered. If a diversity of views in editors is an advantage in reducing bias, then so is a diversity of reviewers. For each paper sent for review, we select from our database three reviewers from different backgrounds to represent the public health fields with an interest in the topic of the paper. This might include, for example, a reviewer to comment on clinical issues in a health field, a reviewer able to comment on relevant policy issues and a reviewer expert in the research methods used. It is worth noting here that our reviewers are exemplary in providing assessment of papers where the substantive concerns may fall outside their present research interests but where we require specific information about aspects of a paper. We place great weight on the views expressed by reviewers. These include the written comments for authors as well as the graded recommendation seen only by the editors. A paper may be classified as Accept, Minor revision, Major revision with or without re-review or Reject, but reviewers also indicate on a scale of 1 to 5 ratings of the contribution the paper makes to public health, aspects of the methods and the validity of the conclusions. Where reviewers are in agreement, we accept their decision. Where there is substantial disagreement, we are required to make an editorial judgement. Given the important issue of research bias, if there is damaging criticism of the methods used or the validity of the conclusions, we might over-ride a positive recommendation by a reviewer with a different perspective and reject the paper. More often, if the paper addresses an important area of public health or is the subject of current debate, we might seek additional reviews to ensure that we reach an informed decision. We lean towards allowing authors to revise a paper to address concerns raised by reviewers and we are diligent in checking that each issue has been addressed, preferably in the paper itself. If a reviewer has asked to re-review a paper, it is returned to this reviewer. There are issues that raise hackles and divide the public health community. In these (fortunately rare) cases the well-informed comments from one side may be strongly resisted by the other and it becomes very difficult to achieve a revision of a paper to address points raised by a reviewer. Such controversies are worthy of public debate and our preference then is to publish both opposing views. In these cases, we welcome further debate in the Letters section. So far, we have considered only issues where the editors have no vested interest. A different procedure is needed when one of the editors has a conflict of interest, either because of professional or personal connections or because she is an active participant in a research field. That leaves the remaining editor making decisions in an area where she may not be well informed of the niceties of the field or the research method used. Our database of reviewers lists areas of interest and this provides a good guide. If the authors are asked to revise a paper and the remaining editor has difficulty in assessing whether a reviewer’s comments have been addressed, she has the option of returning the revision to the original reviewer. Alternatively, and this applies to all difficult decisions, one or more members of the editorial board can be asked for their assessment. Membership of the editorial board is required to represent all States and Territories and to cover a diversity of disciplines and interests. Finally, editors have to be able to justify their editorial decisions when called to account, whether publicly or in private. We are aware that there are periodic concerns about the balance of views represented in the Journal, with suggestions that we are favouring epidemiological research and neglecting research relevant to practitioners and policy makers. Given the confidentiality of the review process, it is difficult to counter these claims. We depend substantially on the papers submitted to us and these tend to favour certain topics and approaches. We accept for publication about 40% of the papers submitted to the Journal and papers addressing neglected topics do not necessarily survive the review process. Often the concerns are methodological and during 2006 we will be devoting some of our editorials to discussion of methodological approaches that enhance the chance of acceptance of papers.

A complex Aboriginal health project and the challenges for evaluation

Indigenous ill-health is a source of concern internationally. The Australian government is committed to reducing the 17-year gap in the mortality rates of Indigenous and non-Indigenous Australians. Kidney disease is of particular concern because its prevalence in Aboriginal Australians is more than six times that of other Australians and the discrepancy is even higher in communities living in the remote interior of the country. The treatment of kidney failure by dialysis or transplant is expensive. Patients from remote areas have to relocate to cities for treatment and here they are isolated, dislocated and distressed. Given these problems, it makes sense to concentrate on devising effective prevention programs. The Western Deser t Kidney Health Project (www. artshealthfoundation.org.au/westerndesertkidney/) was designed to address the need for early detection and prevention of kidney disease. It also addresses Type 2 diabetes which is both a precursor for kidney disease and itself a significant source of ill-health. The current focus of this project is on ten remote, predominantly Aboriginal communities, near Kalgoorlie, in the Western desert of West Australia. The project has evolved over many years, with considerable institutional support. As far as possible, team leaders are well known in the community. They include a paediatrician and an experienced Aboriginal Health Worker both of whom have long worked to improve the life and outcomes of the community. A local arts worker has been trained as a health worker. A key team member from outside is a project designer and lobbyist with a long association with team members. Together the core team members have high levels of clinical skills, social skills and some have cultural authority in these desert communities. They understand the complexities of the communities and share the grief and dismay caused by these diseases. Additional team members (volunteers, rural medical students, and visiting artists and performers) share as many of these characteristics as possible. The approach of the team was piloted and refined in consultation with the communities who therefore have a sense of ownership. It goes without saying that a project as complex as this does not happen quickly. The first aim of the project is to screen everyone in the ten communities, assessing the prevalence of, and risk factors for renal disease and Type 2 diabetes, starting with children, then adults. A first obstacle that the team faced was the lack of space, resources and services in many of the communities – there may be no clinic, no accommodation for team members, precarious supply of utilities such as water, electricity and communications. The team turned to institutional funders to cover the cost of two large, special-purpose, self-sufficient trucks. The first truck is a mobile screening unit from which test results are available on the spot in about ten minutes. A second truck provides accommodation for project staff, and material for additional activities. Included in the aims of the Western Desert Kidney Health Project is an assessment of the age at which disease or indicators of risk first appear in children. At the start of the program, staff were startled to find both diabetes and the early stages of kidney disease in primary school children, younger than 12 years. Anyone with significant risk factors or established disease is referred to local medical services for further assessment and treatment. While treatment can arrest the decline in kidney function, the drugs are expensive and have to be collected once a month. The drugs can be obtained free from an Aboriginal Health Service clinic but there are often long queues and time delays to access the service. Some communities do not have an outlet for this scheme and people have to travel hundreds of kilometres to get free access. Ideally clinical treatment is accompanied by prevention programmes, educating patients about risk factors with a view to reducing exposure to risks. A comprehensive diabetes program of this method, demonstrating that the settings in which the method is employed vary widely. See, for example a more recent article about falls-related injury in older people. We remind you that our new publication policy places more emphasis on the importance of our Letters to the Editor and the letters in this Issue are no exception. M. Mofizul Islam and colleagues support the conclusion of Tim Adair and colleagues above: it is important to co-locate primary care with treatment centres for injecting drug users. We have a Letter pointing out the potential of Smartphone applications for control of obesity (Ka Ooi Gan and Margaret Allman-Farinelli) and a suggestion that it is worth analysing the relationship between displays of energy-dense food and their consumption (Lukar E. Thornton and colleagues). In the Book Reviews we have a review of a book addressing both euthanasia and disability and another about research subjects in studies conducted by ‘Big Pharma’. Researchers please note!

Ethical review and the assessment of research proposals using qualitative research methods

AbstractThe role of Human Research Ethics Committees (HRECs) in health research is well established. Ethics committees have the good of research participants in mind but they must also assess scientific merit including the design and conduct of studies. In this article the authors’ focus is on qualitative research method and the challenge that the National Statement on Ethical Conduct in Human Research (2007) poses for ethics committees when they assess proposals using the methods outlined in the National Statement.We set out a process for judging the standard of qualitative research proposals and propose that qualitative health research can be assessed using a hierarchy designed for evaluating interview studies. We contrast well-designed studies with those that have design flaws in order to focus on the hallmarks of research merit in studies that use qualitative research methods. Finally, we show that our proposal is compatible with the National Statement.Ethics review provides an early opportunity to identify and redesign inadequate studies that will not contribute to our knowledge base. The challenge for members of ethics committees with little experience in qualitative studies is to be able to assess research excellence by assessing research merit in proposals, recognising the special design features of qualitative research methods.