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By Pranee Liamputtong Rice and Douglas Ezzy
South Melbourne (Australia): Oxford University Press, 1999;
x + 295 pp; ISBN 0-19-550610-3; $37.95 (paper)
Qualitative Research Methods: A Health Focus
This text provides a concise undergraduate-level introduction to a number
of qualitative research methods and their theoretical basis, and does
so within the context of health research. Its timing is highly appropriate,
given the asymptotic rise in the popularity of qualitative research methods.
Indeed, this trend is perhaps nowhere more evident than in health-related
research, in which researchers, like the Australian-based authors of this
text, are making many useful empirical contributions using qualitative
methods and contributing to discussions of qualitative methodology.
Rice and Ezzy begin their book with a chapter entitled "Theory in Qualitative
Research: Traditions and Innovations," which provides an informed and
useful overview of the various theoretical perspectives guiding different
research methods, including logical positivism, ethnography, phenomenology,
symbolic interactionism, feminism, post-modernism and hermeneutics. This
background information is extremely useful as it helps the reader understand
the reasons for using the different qualitative methods presented in the
text and what they have to offer for both the researcher and the research
participants.
The second chapter, "Rigour, Ethics and Sampling," offers a theoretical
overview that nicely paves the way for understanding the diverse criteria
used to evaluate the quality (i.e. validity and reliability) of qualitative
research, criteria that differ among the various theoretical perspectives
discussed in Chapter 1. These criteria range from measures of inter-rater
reliability, audit trails, provision of direct quotes and triangulation
through to the relatively relativist and reflexive stance of post-modernism.
Combining the discussion of research rigour with ethics is a notably commendable
feature of the book in that, if nothing else, research must be at least
rigorously ethical. In the last section of this chapter the reader is
given a quick overview of various sampling issues, including sample size,
generalizability, a paragraph outlining each of 12 sampling strategies
(e.g. deviant case, maximum variation, typical case and criterion sampling)
and two pages on theoretical sampling.
The authors then devote one chapter (about 20 pages) to each of seven
qualitative research methods, including traditional methods (in-depth
interviews, focus groups, unobtrusive methods and ethnography), some more
complex approaches (narrative analysis and life history, participatory
action research) and one relatively novel approach, namely memory-work.
For each method, the authors locate the method within the various theoretical
perspectives described in the first chapter, define the key terms and
describe the basic steps and processes involved. In addition, the authors
provide brief but clear examples of each method in action in research
addressing a range of health concerns (e.g. AIDs, mental health, public
health, child health and women's health). They also present a concise,
but useful, list of the advantages and limitations of each method, a handful
of references for additional reading and a tutorial exercise asking readers
to apply what they have learned.
The seven chapters on qualitative methods are followed by one on qualitative
data analysis. Among the analytic techniques considered are content analysis,
grounded theory and semiotic and poststructuralist approaches, as well
as various coding techniques and computer-assisted analysis. In this section
the authors rightly clarify the distinction between deductive content
analysis and inductive qualitative analysis. Unfortunately, they also
blur the distinction between thematic analysis and grounded theory, claiming
that "the main difference between grounded theory and thematic analysis
is that grounded theory includes theoretical sampling, whereas thematic
analysis does not" (page 193). Given its focus on theory development,
grounded theory is substantially different from thematic analysis. As
Strauss and Corbin1 explain, "If theory building is indeed
the goal of a research project, then findings should be presented
as a set of interrelated concepts, not just a list of themes."
Writing a qualitative research proposal and a qualitative research report
are the topics of the last two chapters, and both are informative. Each
of the key components of a research proposal is clearly explicated, including
the significance of the proposed research, background and rationale, research
design, dissemination of findings, time frame and budget justification,
and in each case an example is discussed. Similarly, the key considerations
to bear in mind when writing up a qualitative study are articulated, such
as the audience to whom the paper is directed and the format of the manuscript
(i.e. reports versus journal articles or books). Unlike many other texts,
this one outlines the submission process. Also in this section is a practical
list of criteria for evaluating qualitative papers, a list that might
be a helpful reminder for all of us.
Overall, Rice and Ezzy have done a wonderful job explaining a diverse
range of qualitative methods and the theoretical rationale that underlies
them. Moreover, the accessibility of this text makes it likely that they
will achieve their goal of stimulating students' interest in doing qualitative
health research.
The expansive breadth, however, has necessarily been at the expense
of depth. As a result, the book is unlikely to be useful to people who
are already reasonably versed in qualitative research methods. However,
it may be a worthwhile read for quantitative health researchers who want
to understand the methods behind what may seem like the madness of qualitative
research. This is especially likely because, unlike some researchers whose
preference for qualitative methods is part of a reactive backlash against
the decontextualized, theory-driven nature of deductive research methods,
Rice and Ezzy (page 251) "do not suggest that qualitative research methods
should be employed in all health research and programs." As they say,
"there are many situations in which qualitative research methods are highly
inappropriate, such as those which require epidemiological data, when
randomized-controlled trials will provide broad-based information, or
when generalization across large populations is needed. There are also
situations where qualitative research methods need to be combined with
quantitative methods in order to respond adequately to the research questions.
Rather, . qualitative research methods . are valuable in trying to understand
and interpret the meanings people attach to the experiences of health
and illness. When it is important to know about this, then qualitative
research methods need to be used" (pages 251S252).
| Overall rating: |
Excellent |
| Strengths: |
Thorough and accessible survey of qualitative research
methods as applied to health research
Tutorials and glossary of terms extremely useful to instructors and
students |
| Weaknesses: |
Lack of depth |
| Audience: |
Undergraduate students and people unfamiliar with qualitative
research methods |
Reference
1. Strauss A, Corbin C. Basics of qualitative research: techniques
and procedures for developing grounded theory. Thousand Oaks (California):
Sage Publications, 1998:145.
Connie M Kristiansen
Associate Professor
Department of Psychology
Carleton University
Ottawa, Ontario K1S 5B6
Social Epidemiology
Edited by Lisa F Berkman and Ichiro Kawachi
New York: Oxford University Press, 2000;
xxii + 391 pp; ISBN 0-19-508331-8; $104.00 (cloth)
The past decade has been a fertile, if challenging, period for the discipline
of epidemiology. The classical epidemiologic paradigm focuses on the measurement
of exposures and risk factors in individuals and estimates the contribution
of these exposures to the risk of developing specific pathologies. Despite
the development of sophisticated techniques for measuring exposures and
the advances in analytic methods, the limitations of the classical paradigm
in providing comprehensive explanations for the incidence of disease in
individuals and the health of populations has been given significant critical
attention in the past decade.
In responding to these limitations, conceptual and methodological scholarship
in the epidemiologic sciences has advanced on two seemingly separate frontiers:
molecular epidemiology and social epidemiology. The former gives attention
to the interaction of individual exposures and individual biology at the
cellular or molecular level and increasingly integrates measures of genetic
variation across individuals in etiologic hypotheses. The latter gives
focus to the social environments in which individuals are located, which
both shape the nature of the exposures experienced by the individual and
influence the biological resilience of the individual's host defence mechanisms.
The collection of papers published in Social Epidemiology (edited
by Lisa Berkman and Ichiro Kawachi of the Harvard School of Public Health)
is among the most successful of a large number of recent volumes that
have attempted to synthesize the conceptual frameworks and empirical evidence
at this frontier. The volume has four prominent strengths.
The sixteen chapters collected in this volume provide a powerful illustration
of the interdisciplinary nature of social epidemiology. While a common
commitment to the empirical methods of epidemiology is present across
the collection, the authors are drawn from a diversity of disciplinary
backgrounds, ranging from sociology, psychology and political science
to physiology and medicine. Like the volume published earlier in the decade
by members of the Population Health Program of the Canadian Institute
for Advanced Research, Why Are Some People Healthy and Others Not?,1
this collection demonstrates the imperative for epidemiology to form interdisciplinary
unions with other human and life science disciplines in order to advance
understanding of population health.
The individual chapters give significant attention to the historical
work in the field. The tracing of this history is an important contribution
and is given direct attention in a chapter by the volume's editors and
in the preface by S Leonard Syme, who has had a substantial influence
on the development of the field (and who spent his childhood and adolescence
in the north end of Winnipeg).
Many of the contributing authors are among the leading international
scholars in the field of social epidemiology. The chapter by John Lynch
and George Kaplan on socio-economic position is an exceptionally strong
contemporary synthesis of the conceptual and empirical issues in understanding
the relationship between socio-economic status and health. The chapter
by Sally Macintyre and Anne Ellaway and the chapter by Michael Marmot
are very strong statements of the conceptual implications of incorporating
measures of physical and social environments in studies of the determinants
of disease. And the chapter by Eric Brunner provides an excellent summary
of the evidence for direct effects of social environments on the regulation
of homeostatic endocrine and immune functions.
The fourth strength of the volume rests with the conceptual organization
of the collection. Individual chapters describe the conceptualization
and measurement of the major social factors that influence health (socio-economic
position, income distribution, discrimination related to race/ethnicity
or sex, social networks and social support, social capital and social
cohesion, work environment, and life transitions) rather than category
of disease. The consequence of this organization is a strong statement
emphasizing the pervasive and persistent influence of social environments
on the distribution of health and well-being in human populations and
an emphatic emphasis on the importance of public policy actions that influence
the quality and form of the social environments we inhabit across the
stages of life.
Reference
1. Evans RG, Barer ML, Marmor TR. Why are some people healthy and
others not? Determinants of health of populations. New York, Aldine
de Gruyter, 1994.
Cam Mustard
Associate Professor, Public Health Science
Faculty of Medicine, University of Toronto and
Scientific Director
Institute for Work and Health
250 Bloor Street East
Toronto, Ontario M4W 1E6
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