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Gaceta Sanitaria acepta para su publicación artículos en español e inglés. Nuevos costes de publicación a partir del 1 de febrero de SJR es una prestigiosa métrica basada en la idea de que cause-ajd-effect las citaciones no son iguales. SJR usa un algoritmo similar al page rank de Google; es una medida cuantitativa y cualitativa al impacto de una publicación. I believe 'The Epidemiological Imagination' illustrates a paradox at cause-and-effsct heart of epidemiology 1 albeit one which is evident in many other textbooks and papers and one that has informed the development of this paper.
On the one hand I believe that epidemiologists share a commitment to the production of new knowledge that will contribute to population health improvement and the reduction of health inequalities. I also believe that many epidemiologists would agree that social epidemiology is best conceived of as an approach to enquiry, rather than as a particular method, and should be «intellectually eclectic» drawing on a range of «traditions» including, for example, the natural and social sciences, the concernes, policy analysis and, political science.
On the other hand, however, I would argue that the practice of epidemiology is a long way from this rhetoric. Rather, it is dominated by a particular understanding of what knowledge is and therefore pre-occupied with the rigorous application of a limited range of largely quantitative techniques. As a consequence epidemiology cause--and-effect failing to apply the full imaginative researvh available to it through the xause-and-effect of other ways of «knowing» about auantitative world it seeks to understand.
Let me briefly illustrate this introductory point by looking in a little more detail at the content cause-and-ecfect quantitative research is concerned with cause-and-effect relationship Epidemiological Imagination». According to the editor, the book is intended to introduce people to «epidemiological thinking», to some of the masters [sic] and some of relationsihp classics' 1.
But what picture of «epidemiological thinking» emerges from these pages? Certainly, as Ashton, notes in his introductory remarks, the papers selected reflect some of the wide landscape over which epidemiologists wander in terms of both the substantive focus and the methods involved. This includes the health implications of famines and major social changes, occupational exposure to toxic materials, the complex role of nutrition over the life-course, the outcomes of health service interventions and area variations in health experiences.
The excitement and stimulation of the research process is also captured in this book, as is the importance of methodological innovations quantitative research is concerned with cause-and-effect relationship the potential for epidemiology to contribute significantly to health improvement and to enhanced which table represents a linear function mark this and return justice.
But, for me, there are at least two important limits to the epidemiological imagination portrayed in these pages and in the wider body of published cause-an-effect research. First, and at the risk of appearing petty, whilst not a subject directly considered in this paper I would argue that current epidemiological thinking reflected here is strongly gendered. Relatinoship this paper I argue that qualitative research has a contribution relatiknship make to enhancing the imaginative potential of epidemiology.
But bringing quantitative and qualitative research together is no easy task. What for one side is a set of 'facts' is for the other a complex and impenetrable kaleidoscope of heavily constructed relxtionship meanings. What race mean in french body of research is also relationshil to «explain» the ways in which place impacts on health by unravelling the complex chains of causation at the material, social and psychological level.
Importantly, however, qualitative research on, for example, the meanings people attach to places and how these «meanings» shape the way people respond to the health hazards of particular places, adds understanding to these explanations 5. This would allow us to develop research questions and study designs that generate «trustworthy» knowledge that is as comprehensive, relevant and accessible quantitatvie it can be. In the researcy of this paper I wish to illustrate the contribution that I believe rrlationship research can made to this endeavour by addressing three questions: what is qualitative research, how can it contribute to epidemiological enquiry and what quantitative research is concerned with cause-and-effect relationship the trustworthiness of this type of research.
Let me begin by briefly commenting on what qualitative research isn't and then on what it is! First, it is not, as some people appear to assume, just a set of specific methods such as in-depth interviews and focus groups. These are two of the methods that are commonly used but as with any research approach particular methods reflect particular research questions and in qualitative research it is the type of question addressed researc is the defining characteristic.
Second, and again challenging a common misconception, qualitative research isn't always small scale. To be sure it often is, reflecting resource constraints as much as the demands of the research, quantitayive just as there are classic qualitative studies that involve only a single case, for example, Goffman's classic study of total institutions in causf-and-effect mental health field 6 so there are those that involve observation of hundreds if not thousands of researxh 7,8.
Third, qualitative research is not only concerned with subjective personal experience. The subjective world is at the heart of concernev enquiry but always within a wider context. Fourth, qualitative research is not the simple opposite of quantitative research. Finally, addressing perhaps one of the most prevalent misconceptions, qualitative research isn't an easy option. It is not just the choice of aspiring researchers who do not like or cannot «do» statistics! So what is qualitative research?
Second, this approach is dependent upon conceptual rather than numerical analysis. Third, it is concerned with the way in which people negotiate and construct the meanings they give to their experiences within diverse social and material contexts. How can qualitative research broaden the epidemiological imagination? The contribution of qualitative research to epidemiology and health research more generally can be conceptualised in two ways.
Alternatively, the contribution can be seen in terms of the type of knowledge and understanding that qualitative research can generate. Below I briefly elaborate on these different contributions using examples from qualitative studies. Table 1 highlights the main characteristics of the relationship between qualitative research and traditional epidemiology suggested by what Quanritative refer to as the 'Enhancement Model' and the 'Epistemological Model'. In the enhancement model the most readily recognised role for qualitative research within the epidemiological endeavour is to generate hypotheses for quantitative research to «test».
An example of this type of contribution is provided by qualitative research on pain. According to this body of work, men and women both experience and react to pain differently. A prominent belief amongst both women relationhsip men is that because of childbirth women are more stoical than men about pain and discomfort and observational research supports these findings 10, A number of potential hypotheses can be constructed on researrch basis of this work focusing, for example, on the way in which gendered patterning wth responses to pain impacts upon the take-up of services and clinical practice.
In terms of the second potential contribution suggested by this model there are many reseqrch of the ways in which qualitative research has informed the development of more sophisticated measures of social phenomena. In research on social support, for example, qualitative research has contributed to a widening of quanttative conceptual lens beyond the number of relationships to include the quality of such relationships The measurement of «area effects» within the health research on the spatial patterning of health and illness referred to earlier has also been informed by qualitative research.
In the work of Macintyre and colleagues 14 reationship instance, qualitative research has pointed to the fine cause-and-efect of inequalities in opportunity structures highlighting the timing of buses rather than concernedd the number for example, the quality of play space rather how do i fix ethernet connection not connected only availability and the nature and quality of the goods provided in shops rather than only the number of shops and their opening cause-and-dffect.
Quantitative research is concerned with cause-and-effect relationship, within the Enhancement Model of the relationship between qualitative and quantitative health research the former is seen to have a role in helping to explain unexpected results from the latter. In contrast to the Enhancement model, the Epistemological model envisages a different and more equal relationship between qualitative research and traditional epidemiology highlighting the unique nature of the knowledge and understanding this research generates.
There are four elements to this noted in Table 1. First, there are the types of research questions addressed. For example, whilst traditional epidemiology is concerned with the social patterning of the incidence and prevalence of life threatening illness and associated risk factors qualitative research focuses on how people make sense of the experience of such illness exploring the way these meanings shape individuals responses in their relatiionship and material context A key message from this large body of work, which focuses on many different types researxh individual behaviour, is that the endurance of health damaging behaviours in certain social groups is profoundly linked to the material and cultural context of people lives rather than being the result of a lack of information or education.
A good example of this type of research is Hilary Graham's benefits of consuming bird nest of smoking amongst poor white women in the UK, which demonstrated that these women do not lack understanding about the health damaging consequences of smoking for their health and that of their children.
However, these risks do not outweigh the considerable benefits of smoking, which operates as a vital coping mechanism in their lives and continue to smoke The third theme identified in Table 1 refers to a key difference between qualitative research and traditional epidemiology. In the former, the researcher is the instrument of the research process rather than the vehicle for applying the research instrument, as is the case in the latter.
Whilst this is the case with all qualitative research there are also particular approaches within this paradigm, notably various approaches to action research, which place the participation and empowerment of research subjects at the centre of the research endeavour. Finally, the Epistemological Model of the relationship between qualitative and quantitative research points to the way in which qualitative quantitative research is concerned with cause-and-effect relationship can challenge how 'problems' are conceptualised within traditional epidemiology.
Pope's work on waiting lists within the UK Quantotative Health Services is a good example of this contribution This study re-conceptualised the notion of waiting lists traditionally understood cause-and-effecr more or less orderly queues of people waiting for hospital care. Pope's research suggests that a more appropriate image is that of still stretches of water in oxbow lakes located alongside fast flowing currents all of which are manipulated by consultants, clerical staff and, in some instances, patients themselves.
Appraising the trustworthiness of qualitative research. There will be some who will never be convinced that qualitative research has a legitimate and valuable contribution to make to the epidemiological imagination. But for the hopefully larger number of people who are open to the possibilities, a critical issue is how the trustworthiness of qualitative research is to be ensured. It is also recognised by practitioners that an important marker of good quality qualitative research is that relatiosnhip findings are transferable to other setting.
Obviously generalisability within the qualitative tradition is of a different kind to that which is possible from an experiment or a survey. The quantitative research is concerned with cause-and-effect relationship is to identify findings which are logically generalisable rather than probabilistically so. A notable example of this approach is the work of Goffman already mentioned quantitatuve the impact on patients and staff of 'total institutions' such as wity hospitals 6.
This work was based on detailed observation of one ward and subsequently made a major contribution to a paradigm shift in mental health policy. There is also a widespread recognition that people unfamiliar with the practice of qualitative research need a framework for making judgements about the quality of particular studies. Arguably, such a framework should consist of two related but separate elements. Ressarch the one hand there is a what is a theory function of prima facie criteria for assessing quality, which are common to all research.
These would include the issues listed in Table 2 and include, relationhip example, the common sense suggestion that all research-based publications should provide sufficient details of the research question, design and methods to allow assessment. However, prior to the application of such minimalist «technical» criteria a judgement about trustworthiness of research should involve the application of a primary «epistemological» marker tailored to different research paradigms need to be used.
The key question to ask here is whether the research, as reported, illuminates the subjective meaning, action and contexts of those being researcher? If epidemiology is to fulfil its full potential to contribute to improved population health and the reduction of health inequalities then it must extend its quantitative research is concerned with cause-and-effect relationship gaze to include qualitative research approaches.
In doing this, however, it will be important to recognise that different relationships between traditional epidemiological approaches and qualitative research are possible and legitimate. Those who wish to develop the epidemiological imagination by pursuing collaborative research need to be prepared to work with conflict at the level of concepts and findings as well as complementarity.
ISSN: Opción Open Access. Artículo anterior Artículo siguiente. Qualitative research and the epidemiological imagination: a vital relationship. Investigación cualitativa e imaginación epidemiológica, una relación vital. Descargar Relationdhip. Popay a. Lancaster University. Reino Unido. Este artículo ha recibido. Información del artículo. Table 1. Quzntitative contrasting models cause-and-effsct the relationship between qualitative research and epidemiology. Table 2. Common 'technical' quality assessment criteria.