Research could be described as a systematic, organised attempt to find answers to worthwhile questions, using predefined methods or procedures which are clearly documented. It should be possible for other people to understand exactly what the researchers did to arrive at their conclusions. In this way, the results and conclusions can be assessed and analysed in terms of relevance and accuracy, bearing in mind any limitations or factors which the researchers may have highlighted.
Research is guided by theories. It builds on knowledge that has been acquired from previous studies with the aim of going one step further or responding to an observed lack of research into a particular issue. Theories, drugs and medical procedures are tested, people’s experiences are explored and new issues are uncovered and addressed. In the healthcare domain, the issues tend to be those which are important to the general population or to specific groups of people (e.g. patients, carers, healthcare professionals or policy makers).
A distinction may be made between the theoretical and empirical aspects of research. Theoretical research involves developing, exploring, testing and refining theories, whereas empirical research involves observing and measuring what actually happens.
This section provides details of philosophical assumptions behind research, a description of differences between main types of research (e.g. qualitative and quantitative) and details about different methods used (e.g. interviews, questionnaires, experiments, observation and long-term monitoring etc.)
Researchers have different world views or belief systems which guide them in their research, influencing the decisions they make about how to conduct their studies, what counts as valid knowledge, what is the right way to obtain that knowledge, how it should be analysed (e.g. using quantitative or qualitative-based methods) and what their own role in the process is. The various approaches to research are sometimes called research paradigms. The whole issue of paradigms can be traced back to Kuhn’s 1970 influential book “The Structure of Scientific Revolutions”.
For quite some time, the two main paradigms were the positivist/postpositivist paradigm (linked to quantitative research) and the constructivist paradigm (usually associated with qualitative research). A few decades ago, there were huge methodological debates as to which of the two paradigms was right. Some researchers argued that only the positivist/postpositivist paradigm was “real science”. Others argued that it was not suited to the study of complex human and social issues. This debate came to be known as the paradigm wars and there was an “incompatibility theory” which stated that the two approaches were irreconcilable due to their very different underlying philosophies.
The postpositivist tradition emerged in the 19th century based on the work of writers such as Compte, Mill, Durkheim, Newton and Locke. They challenged the positivist attempts to seek “absolute truth” arguing that this was not appropriate when studying the behaviour and actions of people. This led to an acceptance that absolute truth can never be found and that research evidence is not infallible or perfect. Researchers attempt to look for and describe associations, as well as cause and effect relationships. This is an ongoing process, whereby positive findings form the basis for additional research. Data which does not support their theory may result in necessary revisions followed by additional testing.
According to the social constructivist paradigm, people try to make sense of the world they live in. Through interaction with other people, they develop subjective understandings and meanings of their experience and they do this within a specific social, political, cultural and historical context. Social constructivists believe that there is not one reality but rather varied and multiple realities. Based on this theory of reality, researchers are interested in trying to understand the way people experience and make sense of the world.
However, there were also arguments in favour of a compatibility theory which acknowledged the different philosophical assumptions but stated that each approach had its strengths and weaknesses, that neither was right or wrong and that methods typically used by each could even be mixed in the same study. This is known as the pragmatic paradigm.
Quantitative research is generally associated with the positivist/postpositivist paradigm. It usually involves collecting and converting data into numerical form so that statistical calculations can be made and conclusions drawn.
Researchers will have one or more hypotheses. These are the questions that they want to address which include predictions about possible relationships between the things they want to investigate (variables). In order to find answers to these questions, the researchers will also have various instruments and materials (e.g. paper or computer tests, observation check lists etc.) and a clearly defined plan of action.
Data is collected by various means following a strict procedure and prepared for statistical analysis. Nowadays, this is carried out with the aid of sophisticated statistical computer packages. The analysis enables the researchers to determine to what extent there is a relationship between two or more variables. This could be a simple association (e.g. people who exercise on a daily basis have lower blood pressure) or a causal relationship (e.g. daily exercise actually leads to lower blood pressure). Statistical analysis permits researchers to discover complex causal relationships and to determine to what extent one variable influences another.
The results of statistical analyses are presented in journals in a standard way, the end result being a P value. For people who are not familiar with scientific research jargon, the discussion sections at the end of articles in peer reviewed journals usually describe the results of the study and explain the implications of the findings in straightforward terms
Objectivity is very important in quantitative research. Consequently, researchers take great care to avoid their own presence, behaviour or attitude affecting the results (e.g. by changing the situation being studied or causing participants to behave differently). They also critically examine their methods and conclusions for any possible bias.
Researchers go to great lengths to ensure that they are really measuring what they claim to be measuring. For example, if the study is about whether background music has a positive impact on restlessness in residents in a nursing home, the researchers must be clear about what kind of music to include, the volume of the music, what they mean by restlessness, how to measure restlessness and what is considered a positive impact. This must all be considered, prepared and controlled in advance.
External factors, which might affect the results, must also be controlled for. In the above example, it would be important to make sure that the introduction of the music was not accompanied by other changes (e.g. the person who brings the CD player chatting with the residents after the music session) as it might be the other factor which produces the results (i.e. the social contact and not the music). Some possible contributing factors cannot always be ruled out but should be acknowledged by the researchers.
The main emphasis of quantitative research is on deductive reasoning which tends to move from the general to the specific. This is sometimes referred to as a top down approach. The validity of conclusions is shown to be dependent on one or more premises (prior statements, findings or conditions) being valid. Aristotle’s famous example of deductive reasoning was: All men are mortal, Socrates is a man, Socrates is mortal. If the premises of an argument are inaccurate, then the argument is inaccurate. This type of reasoning is often also associated with the fictitious character Sherlock Holmes. However, most studies also include an element of inductive reasoning at some stage of the research (see section on qualitative research for more details).
Researchers rarely have access to all the members of a particular group (e.g. all people with dementia, carers or healthcare professionals). However, they are usually interested in being able to make inferences from their study about these larger groups. For this reason, it is important that the people involved in the study are a representative sample of the wider population/group. However, the extent to which generalizations are possible depends to a certain extent on the number of people involved in the study, how they were selected and whether they are representative of the wider group. For example, generalizations about psychiatrists should be based on a study involving psychiatrists and not one based on psychology students. In most cases, random samples are preferred (so that each potential participant has an equal chance of participating) but sometimes researchers might want to ensure that they include a certain number of people with specific characteristics and this would not be possible using random sampling methods. Generalizability of the results is not limited to groups of people but also to situations. It is presumed that the results of a laboratory experiment reflect the real life situation which the study seeks to clarify.
When looking at results, the P value is important. P stands for probability. It measures the likelihood that a particular finding or observed difference is due to chance. The P value is between 0 and 1. The closer the result is to 0, the less likely it is that the observed difference is due to chance. The closer the result is to 1, the greater the likelihood that the finding is due to chance (random variation) and that there is no difference between the groups/variables.
Qualitative research is the approach usually associated with the social constructivist paradigm which emphasises the socially constructed nature of reality. It is about recording, analysing and attempting to uncover the deeper meaning and significance of human behaviour and experience, including contradictory beliefs, behaviours and emotions. Researchers are interested in gaining a rich and complex understanding of people’s experience and not in obtaining information which can be generalized to other larger groups.
The approach adopted by qualitative researchers tends to be inductive which means that they develop a theory or look for a pattern of meaning on the basis of the data that they have collected. This involves a move from the specific to the general and is sometimes called a bottom-up approach. However, most research projects also involve a certain degree of deductive reasoning (see section on quantitative research for more details).
Qualitative researchers clearly identify a problem or topic that they want to explore and have clear research questions. They may also be guided by a theoretical lens - a kind of overarching theory which provides a framework for their investigation.
The approach to data collection and analysis is methodical but allows for greater flexibility than in quantitative research. Data is collected in textual form on the basis of observation and interaction with the participants e.g. through participant observation, in-depth interviews and focus groups. It is not converted into numerical form and is not statistically analysed, although many researchers now use computer programmes for qualitative data analysis (e.g. NVivo or Atlas.ti.) which help organize/manage large quantities of qualitative data.
Data collection may be carried out in several stages rather than once and for all. The researchers may even adapt the process mid-way, deciding to address additional issues or dropping questions which are not appropriate on the basis of what they learn during the process. In some cases, the researchers will interview or observe a set number of people. In other cases, the process of data collection and analysis may continue until the researchers find that no new issues are emerging.
Researchers will tend to use methods which give participants a certain degree of freedom and permit spontaneity rather than forcing them to select from a set of pre-determined responses (of which none might be appropriate or accurately describe the participant’s thoughts, feelings, attitudes or behaviour) and to try to create the right atmosphere to enable people to express themselves. This may mean adopting a less formal and less rigid approach than that used in quantitative research.
It is believed that people are constantly trying to attribute meaning to their experience. Therefore, it would make no sense to limit the study to the researcher’s view or understanding of the situation and expect to learn something new about the experience of the participants. Consequently, the methods used may be more open-ended, less narrow and more exploratory (particularly when very little is known about a particular subject). The researchers are free to go beyond the initial response that the participant gives and to ask why, how, in what way etc. In this way, subsequent questions can be tailored to the responses just given.
Qualitative research often involves a smaller number of participants. This may be because the methods used such as in-depth interviews are time and labour intensive but also because a large number of people are not needed for the purposes of statistical analysis or to make generalizations from the results.
The smaller number of people typically involved in qualitative research studies and the greater degree of flexibility does not make the study in any way “less scientific” than a typical quantitative study involving more participants and carried out in a much more rigid manner. The objectives of the two types of research and their underlying philosophical assumptions are simply different. However, as discussed in the section on “philosophies guiding research”, this does not mean that the two approaches cannot be used in the same study.
Pragmatic approach to research (mixed methods)
The pragmatic approach to science involves using the method which appears best suited to the research problem and not getting caught up in philosophical debates about which is the best approach. Pragmatic researchers therefore grant themselves the freedom to use any of the methods, techniques and procedures typically associated with quantitative or qualitative research. They recognise that every method has its limitations and that the different approaches can be complementary.
They may also use different techniques at the same time or one after the other. For example, they might start with face-to-face interviews with several people or have a focus group and then use the findings to construct a questionnaire to measure attitudes in a large scale sample with the aim of carrying out statistical analysis.
Depending on which measures have been used, the data collected is analysed in the appropriate manner. However, it is sometimes possible to transform qualitative data into quantitative data and vice versa although transforming quantitative data into qualitative data is not very common.
Being able to mix different approaches has the advantages of enabling triangulation. Triangulation is a common feature of mixed methods studies. It involves, for example:
- the use of a variety of data sources (data triangulation)
- the use of several different researchers (investigator triangulation)
- the use of multiple perspectives to interpret the results (theory triangulation)
- the use of multiple methods to study a research problem (methodological triangulation)
In some studies, qualitative and quantitative methods are used simultaneously. In others, first one approach is used and then the next, with the second part of the study perhaps expanding on the results of the first. For example, a qualitative study involving in-depth interviews or focus group discussions might serve to obtain information which will then be used to contribute towards the development of an experimental measure or attitude scale, the results of which will be analysed statistically.
People who take part in research involving experiments might be asked to complete various tests to measure their cognitive abilities (e.g. word recall, attention, concentration, reasoning ability etc.) usually verbally, on paper or by computer. The results of different groups are then compared. Participants should not be anxious about performing well but simply do their best. The aim of these tests is not to judge people or measure so-called intelligence, but to look for links between performance and other factors. If computers are used, this has to be done in such a way that no previous knowledge of computers is necessary. So people should not be put off by this either.
The study might include an intervention such as a training programme, some kind of social activity, the introduction of a change in the person’s living environment (e.g. different lighting, background noise, different care routine) or different forms of interaction (e.g. linked to physical contact, conversation, eye contact, interaction time etc.). Often the interaction will be followed by some kind of test (as mentioned above), sometimes before and after the intervention. In other cases, the person may be asked to complete a questionnaire (e.g. about his/her feelings, level of satisfaction or general well-being).
Some studies are just based on one group (within-group design). The researchers might be interested in observing people’s reactions or behaviour before and after a certain intervention (e.g. a training programme). However, in most cases, there are at least two groups (a between-subjects design). One of the groups serves as a control group and is not exposed to the intervention. This is quite similar to the procedure in clinical trials whereby one group does not receive the experimental drug. This enables researchers to compare the two groups and determine the impact of the intervention. Alternatively, the two groups might differ in some important way (e.g. gender, severity of dementia, living at home or in residential care, etc.) and it is that difference that is of interest to the researchers.
Surveys involve collecting information, usually from fairly large groups of people, by means of questionnaires but other techniques such as interviews or telephoning may also be used. There are different types of survey. The most straightforward type (the “one shot survey”) is administered to a sample of people at a set point in time. Another type is the “before and after survey” which people complete before a major event or experience and then again afterwards.
Questionnaires are a good way to obtain information from a large number of people and/or people who may not have the time to attend an interview or take part in experiments. They usually enable people to take their time, think about it and come back to the questionnaire later. With self-completed questionnaires, participants can state their views or feelings privately without worrying about the possible reaction of the researcher. Unfortunately, some people may still be inclined to try to give socially acceptable answers. People should be encouraged to answer the questions as honestly as possible so as to avoid the researchers drawing false conclusions from their study.
Questionnaires typically contain multiple choice questions, attitude scales, closed questions and open-ended questions. The drawback for researchers is that they usually have fairly low response rates and people do not always answer all the questions and/or do not answer them correctly. As they are usually anonymous, it is impossible to follow up and obtain the necessary information or clarity. Questionnaires can be administered in a number of different ways (e.g. sent by post or as email attachments, posted on Internet sites, handed out personally or administered to captive audiences (such as people attending conferences). Researchers may even decide to administer the questionnaire in person which has the advantage of including people who have difficulties reading and writing, and would not otherwise be able to take part in the study (especially people from marginalized groups). Participants might, however, be less honest when giving their responses to someone else. Questionnaires administered by Internet may have the advantages of reaching more people but may exclude certain groups of people.
Interviews are usually carried out in person i.e. face-to-face but can also be administered by telephone or virtually (e.g. by Skype or zoom). Sometimes they are held in the interviewee’s home, sometimes at a more neutral place. It is important for interviewees to decide whether they are comfortable about inviting the researcher into their home and whether they have a room or area where they can speak freely without disturbing other members of the household. It is also important that researchers feel safe going into the homes of people they do not know.
The interviewer (which is not necessarily the researcher) could adopt a formal or informal approach, either letting the interviewee speak freely about a particular issue or asking specific pre-determined questions. This will have been decided in advance and depend on the approach used by the researchers. A semi-structured approach would enable the interviewee to speak relatively freely, at the same time allowing the researcher to ensure that certain issues were covered.
When conducting the interview, the researcher might have a check list or a form to record answers. This might even take the form of a questionnaire. Taking notes can interfere with the flow of the conversation, particularly in less structured interviews. Also, it is difficult to pay attention to the non-verbal aspects of communication and to remember everything that was said and the way it was said. Consequently, it can be helpful for the researchers to have some kind of additional record of the interview such as an audio or video recording. They should of course obtain permission before recording an interview.
Kvale and Brinkmann (2009) describe different philosophical approaches to qualitative interviewing, through the metaphors of the miner and the traveller. The miner metaphor describes knowledge as being like a buried valuable metal which the miner unearths without contaminating it in any way. It is there, intact, waiting to be discovered. The traveller metaphor describes knowledge as something that is constructed as a result of the traveller walking along with people, listening to their experience of the world, trying to make sense of it and retelling it on his or her return. This difference is also a reflection of different research paradigms.
Case studies usually involve the detailed study of a particular case (a person or small group). Various methods of data collection and analysis are used but this typically includes observation and interviews and may involve consulting other people and personal or public records. The researchers may be interested in a particular phenomenon (e.g. coping with a diagnosis or a move into residential care) and select one or more individuals in the respective situation on whom to base their case study/studies. Case studies have a very narrow focus which results in detailed descriptive data which is unique to the case(s) studied. Nevertheless, it can be useful in clinical settings and may even challenge existing theories and practices in other domains.
Participant and non-participant observation
Studies which involve observing people can be divided into two main categories, namely participant observation and non-participant observation.
In participant observation studies, the researcher becomes (or is already) part of the group to be observed. This involves fitting in, gaining the trust of members of the group and at the same time remaining sufficiently detached as to be able to carry out the observation. The observations made might be based on what people do, the explanations they give for what they do, the roles they have, relationships amongst them and features of the situation in which they find themselves. The researcher should be open about what s/he is doing, give the participants in the study the chance see the results and comment on them, and take their comments seriously.
In non-participant observation studies, the researcher is not part of the group being studied. The researcher decides in advance precisely what kind of behaviour is relevant to the study and can be realistically and ethically observed. The observation can be carried out in a few different ways. For example, it could be continuous over a set period of time (e.g. one hour) or regularly for shorter periods of time (for 60 seconds every so often) or on a random basis. Observation does not only include noting what happened or was said but also the fact that a specific behaviour did not occur at the time of observation.
Observational trials study health issues in large groups of people but in natural settings. Longitudinal approaches examine the behaviour of a group of people over a fairly lengthy period of time e.g. monitoring cognitive decline from mid to late life paying specific attention to diet and lifestyle factors. In some cases, the researchers might monitor people when they are middle-aged and then again after 15 years and so on. The aim of such studies is usually to determine whether there is a link between one factor and another (e.g. whether high alcohol consumption is correlated with dementia). The group of people involved in this kind of study is known as a cohort and they share a certain characteristic or experience within a defined period. Within the cohort, there may be subgroups (e.g. people who drink moderately, people who drink heavily, people who binge drink etc.) which allow for further comparisons to be made.
In some cases, rather than following a group of people from a specific point in time onwards, the researchers take a retrospective approach, working backwards as it were. They might ask participants to tell them about their past behaviour, diet or lifestyle (e.g. their alcohol consumption, how much exercise they did, whether they smoked etc.) They might also ask for permission to consult the participants’ medical records (a chart review). This is not always a reliable method and may be problematic as some people may forget, exaggerate or idealise their behaviour. For this reason, a prospective study is generally preferred if feasible although a retrospective pilot study preceding a prospective study may be helpful in focusing the study question and clarifying the hypothesis and feasibility of the latter (Hess, 2004).
Studies using the Delphi method
The Delphi method was developed in the United States in the 1950s and 1960s in the military domain. It has been considered particularly useful in helping researchers determine the range of opinions which exist on a particular subject, in investigating issues of policy or clinical relevance and in trying to come to a consensus on controversial issues. The objectives can be roughly divided into those which aim to measure diversity and those which aim to reach consensus.
Different ways to employ this method have been devised but they tend to share common features, namely a series of “rounds” in which the participants (known as “panelists”) generate ideas or identify salient issues, comment on a questionnaire (constructed on the basis of the results from the first round) and re-evaluate their original responses. After each round, a facilitator provides an anonymous summary of the forecasts/opinions made by the experts and of their reasons.
There is no limit to the number of panelists involved but between 10 and 50 might be considered manageable. The panelists are chosen on the basis of their expertise which could take many forms (e.g. academic, professional or practical knowledge, personal experience of having a condition, being a service user etc.).