Psychology: the science of human behaviour. The hallmarks of sound Science are rigour, objectivity, and systematic study. A science is only as objective as the subject matter it studies. Then comes the contradiction: humans are complex and unpredictable. We are not objective subject matter, we are the antithesis; subjective.
“I am not a number! I am a free man!”
Perhaps we should stop attempting to objectify the subjective and, instead, embrace what makes this science unique from all others. We can embrace this subjectivity by applying qualitative analyses to the study of humans. That is not to suggest abandonment of quantitative analyses. Even a subjective science needs numbers. But we have more substance than numbers suggest, and the reductionism inherent in quantitative data, when humans are the focal point of the study, leads to an unfortunate waste of rich, insightful data. This gold dust serves to enlighten; explaining and illuminating the numbers. It compliments the numbers we produce through quantitative psychological research.
Why does psychological research need qualitative data?
Qualitative data is concerned with the how and why; it taps into the psychological processes that individuals engage in. Qualitative methodologies provide insight into how things occur, how we make sense of our surroundings and how we arrive at the decisions we ultimately make. In contrast to much quantitative research, qualitative designs allow researchers to investigate issues within a real-world context, rather than the controlled environment created by quantitative surveys which aim to yield only numbers. A paper critically appraising the use of qualitative research wrote that, “qualitative research aims to generate in-depth accounts from individuals and groups by talking with them, watching their behaviour, analysing their artefacts and taking into account the different contexts in which they are based.”1
“It’s ability to refine or criticise existing theories and provide us with rich descriptions to enhance our understanding of a certain process or phenomenon makes qualitative research increasingly important in healthcare today” – Dr Lorelei Lingard, Professor in the Department of Medicine at the University of Western Ontario.2
Healthcare research has found itself to be driven by the paradigm of quantitative research. This indicates missed opportunities to investigate the richer descriptions of phenomena which would allow us greater insight into human processes. A prime example of where qualitative research proves its greater utility is the pertinent issue of patients’ non-adherence to medications. Prevalence rates of non-adherence, yielded through quantitative designs, is undeniably essential to our understanding of the gravity of the issue. However, tapping into the thought processes underpinning the issue is essential. We cannot begin to transform non-adherence and create interventions to target this issue if we do not first obtain insights into the processes operating at its core. We do not dispute the continued use of quantitative research methods, but instead advocate the integration of qualitative methods into current designs; creating hybrid research designs that yield the best of both.
1. Kuper, A., Lingard, L., & Levinson, W. (2008). Critically appraising qualitative research. Bmj, 337
2. The importance of qualitative research in healthcare https://www.singhealth.com.sg/TomorrowsMed/Article/Pages/TheImportanceofQualitativeResearchinHealthcare.aspx
Adherence tools are often employed to improve our understanding of the practical and perceptual barriers which stand between patients and their medication regimes. Substance misusers are a notoriously difficult-to-treat client group. There is continued debate around whether drug addiction can be classified as an illness. For the purpose of this blog, let’s assume addiction to be an illness. Could applying a Perceptions and Practicalities Approach (PAPA™) help to improve our understanding of why adherence to prescribed heroin substitutes breaks down among this client group?
PAPA™ provides a conceptual framework that explains non-adherence based on the overlapping categories of intentional and un-intentional non-adherence. Unintentional non-adherence can result from barriers, beyond the control of the individual, inhibiting the individual’s ability to adhere. Practical barriers could include, but are not limited to, homelessness, unemployment, and thus a lack of/ no financial stability. Intentional non-adherence relates to perceptions which shape an individual’s motivation to adhere. Motivation among this client group generally fluctuates, and other self-perceptions tend to exacerbate this issue. A lack of self-efficacy in one’s own ability to maintain abstinence, a lack of self-worth, and the self-disabling belief that one is undeserving of a better quality of life, are all potential perceptual barriers faced by this client group.
Considering the resources necessary to achieve and maintain recovery; many individuals released into the community have little ‘recovery capital’ to draw upon. They transition from behind bars, back into a life of chaos and instability. This is where adherence breaks down. It could be argued that the individuals’ ability, or inability, to adhere is the crux of the problem. Efforts to rehabilitate substance misusing offenders typically focus on perceptual factors including motivation, but seldom attempt to address the practical barriers that stand between individuals’ and adherence.
Implementing aspects of PAPA™ into interventions for this client group, to ensure a focus on motivation and ability, could lead to more sustainable outcomes. If instability breeds inability then, without tackling the perceptual and practical barriers among this client group, could any rehabilitative effort be truly successful?