Rosaline S. Barbour

Checklists for improving rigour in qualitative research: a case of the tail wagging the dog?

Qualitative research methods are enjoying unprecedented popularity. Although checklists have undoubtedly contributed to the wider acceptance of such methods, these can be counterproductive if used prescriptively. The uncritical adoption of a range of “technical fixes” (such as purposive sampling, grounded theory, multiple coding, triangulation, and respondent validation) does not, in itself, confer rigour. In this article I discuss the limitations of these procedures and argue that there is no substitute for systematic and thorough application of the principles of qualitative research. Technical fixes will achieve little unless they are embedded in a broader understanding of the rationale and assumptions behind qualitative research. #### Summary points Checklists can be useful improving qualitative research methods, but overzealous and uncritical use can be counterproductive Reducing qualitative research to a list of technical procedures (such as purposive sampling, grounded theory, multiple coding, triangulation, and respondent validation) is overly prescriptive and results in “the tail wagging the dog” None of these “technical fixes” in itself confers rigour; they can strengthen the rigour of qualitative research only if embedded in a broader understanding of qualitative research design and data analysis Otherwise we risk compromising the unique contribution that systematic qualitative research can make to health services research In medical research the question is no longer whether qualitative methods are valuable but how rigour can be ensured or enhanced. Checklists have played an important role in conferring respectability on qualitative research and in convincing potential sceptics of its thoroughness.1–3 They have equipped those unfamiliar with this approach to evaluate or review qualitative work (by providing guidance on crucial questions that need to be asked) and in reminding qualitative researchers of the need for a systematic approach (by providing an aide-memoire of the various stages involved in research design and data analysis4). Qualitative researchers stress the …

Making sense of focus groups

Context This paper provides an overview of the contribution of medical education research which has employed focus group methodology to evaluate both undergraduate education and continuing professional development.

Sickness certification system in the United Kingdom: qualitative study of views of general practitioners in Scotland

Abstract Objectives To explore how general practitioners operate the sickness certification system, their views on the system, and suggestions for change. Design Qualitative focus group study consisting of 11 focus groups with 67 participants. Setting General practitioners in practices in Glasgow, Tayside, and Highland regions, Scotland. Sample Purposive sample of general practitioners, with further theoretical sampling of key informant general practitioners to examine emerging themes. Results General practitioners believed that the sickness certification system failed to address complex, chronic, or doubtful cases. They seemed to develop various operational strategies for its implementation. There appeared to be important deliberate misuse of the system by general practitioners, possibly related to conflicts about roles and incongruities in the system. The doctor-patient relationship was perceived to conflict with the current role of general practitioners in sickness certification. When making decisions about certification, the general practitioners considered a wide variety of factors. They experienced contradictory demands from other system stakeholders and felt blamed for failing to make impossible reconciliations. They clearly identified the difficulties of operating the system when there was no continuity of patient care. Many wished either to relinquish their gatekeeper role or to continue only with major changes. Conclusions Policy makers need to recognise and accommodate the range and complexity of factors that influence the behaviour of general practitioners operating as gatekeepers to the sickness certification system, before making changes. Such changes are otherwise unlikely to result in improvement. Models other than the primary care gatekeeper model should be considered.

The Case for Combining Qualitative and Quantitative Approaches in Health Services Research

A judicious combination of qualitative and quantitative methods can play a valuable role in health services research. This paper reviews the main reasons for combining methods: for different stages in a project; to compensate for the shortcomings of individual methods; and for the purpose of ‘triangulation’. It examines the potential for qualitative approaches to contribute to quantitative work — by providing insights into the process of data construction, identifying relevant variables to be studied, furnishing explanations for unexpected or anomalous findings, and generating hypotheses or research questions for further investigation. Similarly, qualitative work can be enhanced by using quantitative techniques — albeit often in a modified form — in analysing data, developing sampling strategies, and amalgamating findings from separate qualitative studies. Although there is potential to develop multi-method approaches, there remains an important role for rigorous studies employing either qualitative or quantitative methods.

Senior health professional’s perceptions of variations in medical practice: a qualitative and quantitative study

Following the introduction of the UK General Medical Council’s regulations on the handling of poor medical performance, an interview and survey study was carried out among senior health professionals in the National Health Service (NHS). The aims of the study were to explore the respondents’ perceptions of poor medical performance and to seek their experience of handling poorly performing doctors. Sixteen interviews were held face to face, followed by 28 telephone interviews. Subsequently, using similar questions to those in the interview schedule, a survey was carried out among senior health professionals across the NHS. Interview results identified a number of barriers to resolving poor performance, such as the unwillingness of some doctors to seeek advice and the protective culture which prevented complaints being made against doctors. Survey respondents had high standards by which they judged poor performance, but they were more hesitant about considering poor consultation skills as being of the same significance as poor technical skills. However, problems with communication skills were the most frequently reported type of poor performance. The new arrangements for handling NHS doctors whose performance is perceived to be poor have much to do to overcome the barriers to effective action expressed by the respondents in this study.