Review article

Integrating qualitative research into evidence based practice

What is qualitative research?

As the other articles in this issue of the Endocrinology and Metabolism Clinics of North America have shown, the quantitative research of clinical intervention trials helps to ask and to answer questions of the general format “What is the chance that certain outcomes will result from certain courses of action in defined groups of people?” For example, “What is the chance that a thiazolidenedione, added to maximal sulphonylurea therapy in an obese, type 2 diabetic male, will achieve a clinically

Qualitative research designs

Unlike quantitative research, for which there are a limited number of well-known study designs, qualitative research employs a wide (and potentially infinite) range of techniques. As we see from the examples of quantitative research elsewhere in this issue, the selection of the appropriate research design for the question and the use of valid and rigorous methods minimize the introduction of unacceptable levels of bias, confounding, and poor measurement validity, which would render the study's

Where does qualitative research fit into biomedical research?

There are those who feel that all qualitative methods lie at the very bottom of the hierarchy of evidence and have no place at all in serious research, but such views are becoming rare. It is certainly true that qualitative methods are difficult to place in the hierarchy of evidence, but that is because the hierarchy of evidence is a hierarchy of clinical epidemiology. It is also true that if you are trying to answer a quantitative question (such as whether a drug has an effect on a disease

Exploratory (hypothesis-generating) qualitative research: health beliefs in British Bangladeshis with diabetes

If you work with a multiethnic population, you might have been surprised by the beliefs about health and illness held by certain groups (eg, that diabetes is caused by devils, germs, or sexual promiscuity). On the other hand, you might have found that people's beliefs about illness are surprisingly similar regardless of ethnic background, and that cultural stereotypes are frequently incorrect. You probably also know from experience that if your patient has no idea about why he should take a

Results

I have deliberately presented a lot of detail about the methods of this study to demonstrate how qualitative techniques can be used in exploratory work; however, detailed presentation of all the results (which have been reported in full elsewhere [4], [6]) is beyond the scope of this article. I would like to focus on two specific themes in the results to show how our qualitative data led to the generation of specific hypotheses, which were then tested further in quantitative studies.

Explanatory qualitative research: qualitative research in the development and evaluation of complex interventions

Diabetes is a complex condition, requiring a high degree of knowledge and skills from both patients and health professionals. Interventions to improve health status of course include drugs and technologies (“simple” or at least straightforward and easily defined interventions). Increasingly, clinical trials in diabetes care concern so-called “complex interventions,” to which the UK Medical Research Council applies the dictionary definition of “those made up of various interconnecting parts” [9]

Evaluative qualitative research: studies that address the question, “Why doesn't it work in practice?”

One of the most infuriating aspects of evidence-based medicine is the tendency of doctors and other health professionals to ignore the evidence. Millions of dollars are spent on high-quality primary research trials, and thousands more on the secondary research that produces systematic reviews, meta-analyses, guidelines, protocols, and care pathways. Yet time and again, patients do not receive the best care because doctors fail to implement the recommended evidence.

A number of studies have

Summary: The place of qualitative research in evidence-based practice

This article has attempted to provide an overview of qualitative tools and methods using mainly examples from diabetes research. The other articles in this issue of the Clinics have demonstrated the enormous contribution made in the past 15 years or so by rigorous quantitative studies of prevalence, diagnosis, prognosis, and therapy to clinical decision-making in endocrinology.

In the early twenty-first century, the state of qualitative research into such topics as the illness experience of