In the authors’ view, the advantages of ‘hard’ data in the context of decision making in the health services is that it may generate a tendency of acceptance through objective analysis, free from biases and subjectivity. Quantitative research usually involves large numbers of respondents in tightly structured investigations where the primary concern of the researcher is to establish incidence and to ascertain patterns which indicate structural regularities (Stanley and Wise 1990). However the quantitative research debate raises the fundamental question and asks:
“Can human beings and their social endeavours be studied in the same way as rats, plants, and planets?” (Hunt 1993)
Hard data obtained from surveys can be problematic. Even if a questionnaire design is sound, and the questions asked are clear and appropriate, the answers given may not necessarily be accurate (Stanley and Wise 1990).
Sheehan (1986) admits that nursing research is perhaps facing the biggest challenge; that of applying it to nursing practice. According to Bond (1993), it is always advantageous therefore to evaluate researches in order to provide relevant information for decision makers to set priorities, allocate the necessary resources, and to modify and refine project structures and processes. He (Bond 1993) states that a major criterion (in the context of decision making) in considering whether the evaluator has done a good job appears to lie in the truth of the findings. Can the researcher be believed regardless of any other value the research may hold? In order to validate evaluative research, it appears to be necessary to conform to strict principles of science and measurement. Bond (1993) strengthens the argument and confirms that:
“Like most of the social science, early evaluation looked to logical positivism to justify its method choices. Congruent with this approach was the performance for using goals articulated in advance as a basis for formulating causal hypotheses which could then be tested experimentally.”
Soft Data
Qualitative methods facilitate the study of selected issues in depth or in detail. Qualitative research can be naturalistic, that is, it can take place in a setting in which the respondent is comfortable at home. Events which then occur are natural in the sense that they are not planned or constructed by the social scientist. This kind of research is often referred to as fieldwork. This encompasses becoming involved in the social interaction or group in a way that prevents detachment. Objectivity of the researcher is highly questioned. However, Hewson (1995) states that closeness does not automatically indicate bias, and distance is no guarantee of detachment. Also it can be argued that without empathy there cannot be comprehensive understanding. In the absence of pre-determined categories into which responses must be fitted, a more meaningful and valid account can emerge. Analysis can be more difficult because responses are not systematic or standardized and are difficult to categorize. Yet this approach can allow the researcher to see the world as the respondent sees it. It is highly labour intensive, and therefore an expensive self limiting strategy (Polit and Hungler 1995).
Qualitative work is essential to the knowledge development of the health care disciplines. If credence is given to the creativity and intellectual agility required in qualitative research then this does not allow for methodological or intellectual slappinness. Intuition, creativity and intellectual agility are most often found within the context of careful and vigorous attention to method (Burns and Grove 1993).
Only until recently there has been awareness and debate for the “process involved in knowledge creation or the different philosophical positions that underpin the choice of qualitative research methods” (Hunt 1993). Although qualitative research is expressive and time consuming, its comprehensiveness enables decisions to be made about the most appropriate policy to adopt and also an understanding of where the policy may be most successfully implemented. Gortner (1984) cited by Treece and Treece (1986) call for greater explanatory power in nursing research as a means of influencing policy formation. Such explanatory power also gains the respect of researchers in other disciplines as they recognize the contribution that nursing qualitative research makes to new knowledge. The expansion in understanding the human being - the focus on all nursing - cannot be comprehended at the present status of nursing research. But as nursing investigators develop new modes of inquiry through description and induction as well as prescription and deduction, the answers to why and the meaning will result.
According to Pollock (1993) unless researchers show clearly the methods they use in order to manage the large amounts of qualitative data collected, the advancements of knowledge within the social sciences and the conclusions drawn are not considered reliable. If available tools to manage data are not utilised, analysis and presentation of findings may not take place. Pollock (1993) admits though that
“Qualitative analysis is not easy and the findings of such studies can be challenged on the grounds of questionable reliability and validity”.
Discussion
Hewson (1995) cites the Medical Research Council and the Welcome Trust who both have different views towards health services research. The medical Research Council defines health services research as:
“the identification of the health and needs of a community and the study of the provision, effectiveness and use of the health services.”
On the other hand the Welcome Trust has referred to it as:
“...the identification and quantification of health care needs and the quantitative study of the provision and use of health services to meet them.”
Naturally not everybody would agree with the emphasis on quantification apparent in the second definition.
The qualitative or soft approach in research relies on concentrated observation and judgment (Hewison 1995). For example, data is collected in an unstructured way through free-ranging interviews which will then be the source of information. According to Reid (1989) the information collected and the conclusions reached will rarely be generalized beyond the immediate context. Conversely in the quantitative or ‘hard’ research approach, well defined hypotheses are generated, results will often be generalised, and their conclusions are based solely on empirical evidence (Reid 1989).
Problems arise however concerning the acceptability and credibility of evaluation using such approaches either on the part of the professions themselves, or on the part of the policy makers, or both. The qualitative approach tends to have high face validity with the professions concerned. There is close involvement of researcher and researched, while the information that is obtained tend to be of considerable interest and acceptability to professional practitioners. On the other hand it makes less impact with the policy makers who control and allocate resources because of the ‘soft’ nature of the information collected (Reid 1989).
Contrastingly quantitative data appeals to resource allocators because it tends to measure identified components of professional practice. Reid (1989) argues that this approach however tends to be less attractive to the professions themselves. Reid (1989) further states that this may be caused since the caring professions
“place great store by the ethos of qualitative provision, as examplified by such concepts as vocationalism”.
To carry out evaluation research demands the application of research principles to the evaluation process. However this activity is of an entirely different order to other approaches of evaluation that lack scientific rigor and may “amount to no more than a group of professionals sitting around a table and passing opinions.................. .........unfortunately, all too often decisions are taken before evaluations are reported or without due attention to their findings” (Bond 1993) irrespective of whether the data were ‘soft’ or ‘hard’. Bond (1993) concludes however with the assumption that services are difficult things to do research on since they are multidimensional, complicated, elusive, and always ‘on the move’.
One might postulate that there seem to be a ‘trade off’ between ‘hard’ quantitative data on one hand and ‘soft’ qualitative approaches on the other. The authors believe that health services should be free to combine whatever parts of whatever methods health carers think are promising for their research goals. Also, the same careful skills in analytical reasoning are needed by the qualitative researcher as those required by the quantitative researcher. The debate between qualitative and quantitative research techniques is not new. In fact Glaser and Strauss (1967) indicate that this dialogue has been ongoing for several decades.
Referring to quantitative research, Duelli Klein (1989) argues that after years of traditional education it is hard to shed the layers of indoctrination of what is declared ‘good’ and ‘up to standard’ research.
Triangulation
Jick (1983) describes the combination of quantitative and qualitative research as triangulation. He believes he can uncover a unique variance that might not have appeared in a single method of investigation. He (Jick 1983) suggests that this increases confidence on results and allows for creative methods. At the same time, new ways of seeing a problem that may have been overlooked before may be balanced with common methodologies, and a new dimension of the problem may be uncovered. Although there are clearly recognized differences between qualitative and quantitative research methods, the two can overlap at times. It would seem reasonable that within the structure of health services a move should be made to undertake triangulated research. This would provide the researcher with the numerical, statistical, and scientific data in order to meet the quantitative analytical needs of health services directors and also meet the needs of nursing personnel who wish to explore a more holistic, explanatory research in order that they may provide an improved quality of care. Strauss and Cortin (1990) argue that qualitative and quantitative research could be effectively used in the same research project. Jayaratne (1989) advocates the use of qualitative data in conjunction with quantitative data to develop, support, and explicate theory. She (Jayaratne 1989) postulates that the appropriate use of ‘both’ methods in health services can help in achieving their goals more effectively than the use of either qualitative or quantitative methods alone. Jayaratne (1989) also argues that this is a political issue. From a political perspective, all quality social research ought to be used in policy decisions. Obviously the role of the researcher is to contribute knowledge of completed and ongoing studies relevant to the targeted problem, to help policy makers frame their questions in research terms, and to develop research designs which incorporate mechanisms for ongoing evaluation (Tangri and Strasburg 1979). They also stress the need for researchers to be more aware and employ those methods which make their data more useful to policy makers and to change academic structures so that there is support for the use of these methods.
However Morse (1994) expressed concern over mixed methods of research. He felt that it was not impossible to undertake such a research but that this mixing violates the assumptions of data collection, techniques and methods of analysis of all the methods used. He felt that the product was not a good science, rather it was a sloppy mismatch. Morse (1994) found that countless studies combining quantitative and qualitative techniques in a triangulated design, only rarely attempt to integrate the two components of the study. This treatment was felt to be unfortunate because even a simple comparison of the results of the two components could lend confirmation to and thus strengthen the argument.
Conclusion
If indeed scholars want to be ‘agents for change’ rather than simply investigating health issues as a new topic; if indeed they want to work towards a future that
“is not merely an extension of the present but significantly a qualitative transformation of the present” (Westkott 1989);
then health researchers need to consider which methods are best suited to their quests. One should also bear in mind that data presentation plays an important part in the process of decision making. Cormack and Benton (1993) argue that
“Unless results are presented in a clear and visually dynamic format, readers may have difficulty in interpreting findings, or worse still they may not be read.”
The way health carers build their future will influence its outcome.
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