again brief - by triangulation I don't mean use of different paradigms, but
different methods - or interviewing different groups - can all be within a
qualitative paradigm - have used it myself and found very useful, when I
brought findings back to participants they felt the interpretations had been
strengthened by this method.
Sorry I can't go into more depth but will - in true health services research
mode - monitor this thread as it's very interesting!
Sarah Delaney
Research Officer
Health Services Research Centre
Department of Psychology
Royal College of Surgeons in Ireland
The Mercer Building
Mercer Street Lower
Dublin 2
00-353-1-4022121
[log in to unmask]
> ----------
> From: Toby Lipman
> Reply To: qual-software
> Sent: Monday, May 28, 2001 12:11 pm
> To: [log in to unmask]
> Subject: Triangulation
>
> In message <9921C1171939D3119D860090278AECA20206DC14@EXCHANGE>, Sarah
> Delaney <[log in to unmask]> writes
> >Try triangulation - use a number of different approaches - if patterns
> agree
> >using a number of different methods you have a strong case?
> >
> Although I'm relatively new to qualitative research I've been thinking
> about issues such as validity and reliability for a long time. As I
> become familiar with different research paradigms I am more and more
> struck by how each paradigm would see the reality differently.
>
> In the case of the patients with atrial fibrillation one way of
> examining the decisions would be to accept a positivist view - "the
> correct treatment for certain patients with atrial fibrillation is
> warfarin" - in other words that the evidence for effectiveness is true
> and should be applied. I could then compare real decisions with the
> recommendations of a guideline and interview GPs where they conflict. I
> could ask GPs to take a test or questionnaire to measure their knowledge
> of the evidence and see whether their score correlates with their
> proportion of "correct" decisions. I could see whether "wrong" decisions
> correlated with any particular characteristics of patients such as age,
> sex or co-morbidity. (this is not a joke - I know people who would think
> this a perfectly sensible way of going about things). I could also
> interview the GPs, do a straightforward thematic analysis, and then say
> that I have used triangulation.
>
> The problem is that I don't think this would improve understanding at
> all, and would certainly change the "reality" that I ultimately
> reported. By looking for ways to triangulate I would already have
> changed the way I looked at the problem so that the question itself
> changes from "how do GPs make decisions...." to "what factors influence
> GPs' to make incorrect decisions..."
>
> So, because each paradigm (and therefore method) necessarily views
> reality in a different way, I am wary of triangulation. I think that the
> strongest studies are those that stick to one paradigm whatever that is
> - but that one paradigm is never sufficient to explain "everything".
>
> As a researcher I need to find the paradigm that is closest to the
> "reality" that I want to investigate. If I want to find out the most
> effective treatment for a disease then the strongest research design is
> a randomised controlled trial - firmly positivist. But, as a user of
> research in practice, if I want to see what is the most effective
> treatment for an individual with a certain disease then my use of
> "positivist" evidence from an RCT must be post-positivist, as one is
> translating population effects to an individual and the effects for that
> individual can only be expressed as probabilities. If I want to study
> how the decision is made, then I must use a constructivist paradigm.
>
> One of the major issues in "service delivery" research in the health
> services is the place of different methods and paradigms. Developers of
> guidelines use RCTs to produce recommendations for each particular
> condition ("patients with angina below the age of 65 should be
> prescribed...") and use RCTs to measure the effects of implementation
> programmes, with outcome measures being "proportion of patients on drug
> X in intervention group compared to control". This approach suits the
> Department of Health very well as it produces a means of measuring
> "performance indicators" and fits in with a rational technical approach
> to quality control.
>
> However many of us feel that service delivery is complex, messy and
> ambiguous, and that even the management of a particular disease, for
> which there appears to be strong evidence for effective management from
> RCTs, has many ramifications to do with individuals' culture, their
> working environment, their personal circumstances and so on.
>
> Since the social environment is so complex, is it not better to focus on
> a particular viewpoint, explore it in depth and be explicit about its
> narrow focus? My own preference is look at a wider area (in this case
> "use of research evidence in primary care practice") by asking questions
> that are narrowly but clearly focussed one at a time, and accepting that
> while each question requires a clear theoretical stance, understanding
> of the social environment as a whole requires many questions to be
> studied, each in its appropriate paradigm.
>
> It's a bit like putting a book of photographs together about "Newcastle
> upon Tyne". One photographer might produce beautifully crafted
> architectural studies, another spontaneous shots of the club scene,
> another might spend a day at the races, and yet another might spend
> weeks getting to know people in a deprived neighbourhood in order to
> illustrate their lives. All would show the "reality" of Newcastle, but
> all would be different and none would show the whole - nor (and this is
> really my point) is it likely that any one photographer would be able to
> show all these aspects of Newcastle equally well, particularly if they
> tried to do it as a single project.
>
> Toby
> --
> Toby Lipman
> General practitioner, Newcastle upon Tyne
> Northern and Yorkshire research training fellow
>
> Tel 0191-2811060 (home), 0191-2437000 (surgery)
>
> Northern and Yorkshire Evidence-Based Practice Workshops
>
> http://www.eb-practice.fsnet.co.uk/
>
>
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