In message <[log in to unmask]>, Hopkin, Rachel2
<[log in to unmask]> writes
> Lincoln and Guba (1985)
>(Naturalist Inquiry), suggest that the ideas of
>credibility, transferability, dependability and
>confirmability are more appropriate for research which
>claims to recognize the relativist perspective
>of individuals expereinces. Admitting your own preferences,
>bias, knowledge and experience can in fact prove most
>useful when analyzing data without getting you all tied up
>on the question, can I reliably say that this is what the
>respondent is wanting to tell me. Don't forget that the
>'expert' you can return to with your codes can also be the
>respondent, for who else can 'expertly' say "yes that is
>the essence of what I was trying to get across".
This observation is of particular relevance to my own current research.
The background is that people suffering from atrial fibrillation, an
irregularity of heart rhythm whose prevalence increases with age, are 3
or 4 times more likely to suffer a stroke than patients with a regular
heartbeat, and there is evidence from randomised controlled trials that
anticoagulation with warfarin can reduce the risk of stroke in these
patients by up to 60%. However, despite much advocacy and exhortation by
experts, studies consistently show that a substantial proportion of
patients at risk do not receive the treatment.
Of course there are many possible reasons for this, including dangerous
side effects and inconvenience, but I felt that an interpretive approach
might throw light on how decisions to treat or not treat were arrived
at.
I decided to study the viewpoint of an atypical group of general
practitioners, who are active in research or evidence-based practice (I
chose this group in order to focus on a group that might be expected to
be most enthusiastic and knowledgeable about using the RCT evidence).
The methods are straightforward - I interview them, usually in their
surgeries (offices to Americans!) about their experiences with
individual patients. The interviews are recorded and transcribed and
imported into N.Vivo for analysis.
The problem I have (not really a problem, more a conundrum) is how to
interpret my own input and reactions. I share their culture, know many
of them personally, and am deeply involved (and known to be deeply
involved) in teaching and developing evidence-based practice. I think
this has many advantages, in that I can understand and empathise with
what they are saying, but the downside is that:
1) they may tell me what they think I want to hear in order to seek my
approval
2) I may not challenge shared assumptions about the nature and value of
evidence (during analysis rather than during the interviews)
3) my experience as a clinician may be too close to theirs to see issues
that a more detached researcher might detect more easily
So far I have found things that surprised me, such as that those GPs who
have the most sophisticated understanding of the evidence are also the
most relaxed about accepting decisions by high risk patients not to have
the treatment. This begins to reassure me a little, but I'd be
interested in others' views on studying one's own culture.
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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