Rewiev of the Article: Management of Type 2 Diabetes - Case Study Example

CRITICAL REVIEW 2006 CRITICAL REVIEW Colin G. Pooley, Catherine Gerrard, Sally Hollis, Stephen Morton and John Astbury. 2001. “’Oh it’s a wonderful practice ... you can talk to them’: a qualitative study of patients’ and health professionals’ views on the management of type 2 diabetes,” Health and Social Care in the Community, 9(5): pp.318–326 Introduction The article under review focuses on the problems associated with provision of care for people with type 2 diabetes. In the introductory paragraphs Pooley and his colleagues clearly state the purposes of their study, namely: to identify the issues which both patients and practitioners perceive as highly essential to the effective management of the diabetic condition, reveal the extent of coincidence between the views of both groups, and relate the findings to concepts of patient empowerment. These purposes give a clear notion about the hypotheses the study is built on, although no formulation can be found in the text. Firstly, the authors believe that both groups (diabetic patients and health practitioners) tend to demonstrate certain level of coincidence in perception of the issues that affect efficiency of the management of type 2 diabetes. Secondly, Pooley et al assume that the nature of the respondents’ views coupled with the level of coincidence between the views of professionals may elucidate the major characteristics of a highly effective patient empowerment approach. The authors provide a good synthesis of relevant information on the previous studies thus linking potential findings of their study to a wider framework of theoretical knowledge on the management of chronic conditions similar to diabetes. They also identify gaps in the existing body of knowledge thus fully justifying the need for their own research being performed. Methodological framework employed by the authors for their study deserves particular attention. Specific nature of the formulated research purposes raised a set of strict requirements to be addressed within a certain methodological framework. It might be misleading to discuss appropriateness of the methodology used in the study without mapping the basic characteristics of qualitative and quantitative techniques utilised by the researchers. Discussion Quantitative methodology employs methods historically applied in the natural (physical) sciences. The primary task of quantitative research is to ensure validity and reliability of results (Dingwall et al, 1998). The concept of reliability as applied in quantitative research can be defined as: “The extent to which results are consistent over time and an accurate representation of the total population under study is referred to as reliability and if the results of a study can be reproduced under a similar methodology, then the research instrument is considered to be reliable” (Golafshani, 2003: 598). Quantitative research implies standardized questionnaires and methods of data analysis, specific position of the researcher whom is considered external to the research he carries out, replicability of the results regardless of the context, etc (Wainer & Braun, 1998). While reliability and validity are the most often cited strengths of the quantitative methodology, poor applicability of this methodology to studying a phenomenon difficult or impossible to quantify is considered a serious weakness. The main drawback that limits applicability of quantitative paradigm in health research is the so-called ‘decontextualization’: models built using data obtained through quantitative methods do not take into account certain variables that act in the real world context (Patton, 1987). Qualitative methodology represents a distinct research paradigm that ensures the researcher’ immersion in the context of his study, makes him an active participant of the study. Qualitative framework utilizes a naturalistic approach seeking to understand phenomena in a specific context, such as “real world setting [where] the researcher does not attempt to manipulate the phenomenon of interest" (Patton, 2002: 39). The broad definition of qualitative research is “…any kind of research that produces findings not arrived at by means of statistical procedures or other means of quantification” (Strauss and Corbin, 1990: 17). Qualitative research reveals findings observed in the real world context where the phenomena being studied unfold naturally (Patton, 2002). Qualitative methods are designed to provide the researchers with highly contextual data explaining participants’ perception and understanding of various phenomena, experiences and motivations, etc. Extrapolation of the qualitative study results to other similar situations and contexts is also an important aspect of qualitative research (Hoepfl, 1997). Qualitative methodologies generate rich and highly detailed data without taking it out of the context where it has been gathered. However, the qualitative research paradigm has not yet received absolute recognition in the academic community. A number of public health practitioners keep questioning reliability, validity and generalisability of data obtained using qualitative methods (Henwood & Pidgeon, 1992). The context of study undertaken by Pooley suggests that using the qualitative methodology is more appropriate in this case. Such choice of methodology and research design is absolutely justified by the formulated research purposes and obtained results: the researchers explicitly express an interest in understanding the experiences perceived by the participants of their study and strongly emphasize the context in which the perceptions take place. the study involves in-depth exploration of the issue with the authors requiring from the participants comprehensive information. Both groups of participants – the patients and practitioners have long history of involvement in the issue under study. the nature of results obtained by Pooley et al suggests that the researchers have sought for both understanding and meaning. the type of reasoning utilised by Pooley and his colleagues is apparently inductive. As it has been mentioned in the beginning of this review, the authors fail to formulate a hypothesis or suggest a theory to be tested. Instead, they offer several research purposes that have apparently emerged from the data. Data gathering techniques chosen by the authors within the qualitative methodology are congruent with the purposes of their study: a series of semi-structured interviews provided the basis for the paper. Interviewing is a popular method of collecting qualitative data that has certain advantages and disadvantages as compared with other qualitative methods such as participant observation or focus groups (Mays & Pope, 2000). The advantages of interviews include ability of the researcher to involve participants whose viewpoints, status, experiences and/or knowledge of the issue being studies match the purposes of research best. The nature of interviews allows the researcher to retrieve as much information on the issue being studied as possible (Brown & Lloyd, 2001). Interviews are not as time-consuming and costly as other qualitative methods, while the data obtained via interviewing the participant is valid, diverse and reliable enough to ensure in-depth exploration of the issue being studied (Glesne & Peshkin, 1992). The method of interviewing shares the same set of drawbacks the other qualitative methods do. Thus, data obtained during interviewing is believed to be subjective and descriptive (Murphy et al, 1998). Probably the main drawback of this method is related to the language-imposed constraints: the researcher’s questions asked verbally during the interview are believed to frame responses of the participant being interviewed (Hancock, 2002). However, the method of interviewing seems to be an absolutely appropriate and justified choice for the study design type. The advantages of interviewing overweigh the drawbacks of this method considering the objectives set by the authors in the introductory section. Moreover, the sampling strategy designed by the researchers adds credibility to their choice of this method. The sampling strategy used by Pooley and his colleagues ensured highly relevant and well-reasoned selection of participants. The initial phase of sampling involved a solid quantitative survey of the target groups: patients with type 2 diabetes and health care professionals. The quantitative data obtained via the survey allowed the authors to construct a sample framework taking into consideration such parameters as list size, fund holding status and location (urban or rural) of the general practices through which the participants were contacted. Availability of such sample framework greatly improved the participants’ representativeness of the total population of patients with type 2 diabetes and relevant health professionals in the latter stages of the research (interviews). The sampling strategy is comprehensively described and soundly related to the purposes of the study. The authors also admitted under-representation of the very elderly patients. The process of data collection is not described in great details. However, the authors provide a synthesis of their findings using a lot of quotes so that the reader could have a sense of personal involvement in the issue being studied. The quotes highlight the most important elements of the research and strongly support the overall argument of the article. The researchers’ careful treatment of collected qualitative data is vividly illustrated by the statement that ‘quotes presented in the paper have been selected as typical of the perceptions and experiences recorded, they are not, however, statistically representative of a larger population’ (p.320). The total of 85 interviews carried out by the researchers apparently provided rich information on the issues being studied. Although the authors do not provide a description of strength and limitations of the method, the do, however, present an explanation of how the method is used and how the data obtained via the interviews is treated, analysed and interpreted. Thus, each interview is tapped, transcribed and carefully read several times; the authors claim to employ ‘well-established procedures for the rigorous analysis of data’ and ‘a structured coding scheme’ designed with reference to the study’s objectives. However, no description of these procedures or the coding scheme is provided in the article The data analysis provided by the authors follows the inductive paradigm, which is typical for qualitative research (Pope, Ziebland & Mays, 2000). While the framework for analysis of data is not explained, Pooley and his colleagues pay much attention to the interpretation of findings revealed during the analysis of data. They identify five major issues characterizing the relationship between the patient and health professional, and discuss these issues in detail throughout the body paragraphs. The issues and interpretations provided in the article are logically consistent and seem to be reflective of the available data. Interpreting the finding of their study the authors describe some relevant theoretical concepts and discuss the potential implications of their findings for those concepts. Thus, various approaches to the problem of patient empowerment are discussed in light of the study findings. Implications of the findings for the effective self-management of chronic conditions in general and diabetes in particular are also discussed by the authors. As a result, the reader is provided with a meaningful picture of the issues being studied. The concluding chapter provides a strong synthesis of the research data and findings. The authors draw three major points that are fully consistent with the main findings and reflect the objectives set in the introductory chapter. From the reader’s point of view, the conclusions of the study are formulated very clearly: they help understand the meaning of the research findings within a wider framework of health management. The authors also establish a link between their study and recent academic debates about the geography of health and health-care. Implications of the study for various practice situations are also mapped in the concluding chapter. Conclusion The study under review represents a solid piece of work written by the top-level professionals in health research. In terms of the research methodology the authors provide a brilliant example of how qualitative paradigm must be effectively used to achieve the research objectives. Despite certain limitations associated with qualitative methodologies, Pooley and his colleagues successfully avoid the traps waiting for inexperienced researchers. Firstly, the authors are fully aware of the limitations that are impossible to overcome within the framework of qualitative methodologies, and they explicitly acknowledge this fact listing these limitations. Thus, they admit that the relationship between patients’ age (or other characteristics) and their views of diabetes care are not explored; they use the data very carefully informing the reader about its representativeness or lack of such. Secondly, the choice of methods, sampling strategy and data collecting techniques perfectly fits the objectives the researchers aim to achieve. A combination of quantitative and qualitative methods greatly improves credibility to the study providing less experienced researchers with a very good example of how qualitative and quantitative paradigms can add to each other. Apparently, Pooley and his colleagues combined the two methodologies to address perhaps the most common criticism levied at qualitative research, namely poor generalisability of the qualitative findings to a large population. Thirdly, the authors provide a perfect example of how the qualitative research, if carefully applied, may contribute to the public health agenda. They link their seemingly narrow study of type 2 diabetes to a wider framework by discussing possible implications for management of other chronic conditions. Doing so they map potential research directions not only in the field of diabetes, but in the other fields of health research as well. References: Brown, C. & Lloyd, K. 2001, “Qualitative methods in psychiatric research”, Advances in Psychiatric Treatment, 7(5), pp. 350–356. Dingwall, R., Murphy, E., Watson, P., Greatbatch, D., Parker, S. 1998, “Catching goldfish: quality in qualitative research”, Journal of Health Services Research and Policy, 3, pp.167-72. Glesne, C. & Peshkin, P. 1992, Becoming qualitative researches: An introduction, New York, NY: Longman. Golafshani, N. 2003, “Understanding Reliability and Validity in Qualitative Research”, The Qualitative Report, 8 (4), pp.597-607. Hancock, B. 2002, An Introduction to Qualitative Research, Trent Focus Group. 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Gerrard, C., Hollis, S., Morton, S. & Astbury, J. 2001, “Oh it’s a wonderful practice ... you can talk to them’: a qualitative study of patients’ and health professionals’ views on the management of type 2 diabetes”, Health and Social Care in the Community, 9(5), pp. 318–326. Pope, C., Ziebland, S. & Mays, N. 2000, “Qualitative research in health care: Analysing qualitative data”, British Medical Journal 320, pp.114–116. Strauss, A. & Corbin, J. 1990, Basics of qualitative research: Grounded theory procedures and techniques, Newbury Park, CA: Sage Publications, Inc. Wainer, H. & Braun, H. I. 1998, Test validity, Hilldale, NJ: Lawrence Earlbaum Associates. Read More