final exam prep

Why do researchers studying the same issue (e.g., mental health) reach different conclusions?

Differences in research are shaped by assumptions about:

• What reality is

• What counts as knowledge

• How we study the world

assumptions form what and what do they influence

assumptions form research paradigms, which influence:

• The questions we ask

• The methods we use

• How we interpret findings

how can a issue/disease be explored through

• biomedical

  • biological factors

• public health

  • population patterns

• socio-cultural

  • Social, cultural, individual contexts

Conceptualizing health

understanding health not just as a biological condition, but as something that is shaped by both personal experiences and larger social forces.

It expands our understanding of health and disease

Personal troubles in Conceptualizing health

• Refers to the individual and subjective experiences of health, illness, and suffering.

  • Seek to understand lived experiences of disease

  • How it affects individuals, families, communities

  • What is suffering? How do people understand illness and disease? How do they make sense of risk?

Public issues in Conceptualizing health

• Refers to the structural, systemic, and historical factors that affect health outcomes. 

  • Look beyond individual stories

  • Understand history, culture, economics, politics that shape capacity to live healthy lives

What is a research paradigm?

 Reflects one’s beliefs about what constitutes knowledge and how that knowledge is to be generated. 

the 3 dimensions of Research paradigm

• Epistemology 

• Ontology 

• Methodology 

Epistemology

• Branch of philosophy concerned with nature and definition of knowledge and truth

• Defines the types of data considered ‘valid’ and useful 

types of Epistemology

• Positivism

• Interpretivism

Positivism

Valid knowledge and truth is generated through scientific process based on observation/ measurement and generalization

• Analysis of cause and effect

• Testing hypotheses

• Generating principles/ laws

example of Positivism

• Clinical trials for a new drug

  • Assess causation

  • Measurable outcomes, e.g., biomarkers, survival rates, side effects

• Measuring population health through epidemiological studies

  • Identify patterns and correlations

  • Incidence and prevalence rates, mortality statistics

• Evaluating health policy effectiveness

  • Before-and-after comparisons of policy impact

  • Changes in quantifiable health outcomes, cost-effectiveness analyses

Interpretivism

Critique of positivism as applied to social phenomena, generate subjective understandings 

• Not measurement, but meaning

• Source of knowledge is complex/contradictory perceptions

• Not generalizability, but description

example of Interpretivism

• Understanding patient experience with chronic illness

  • Lived experiences of disease

  • Narratives, personal meanings, themes

• Exploring cultural beliefs about mental health

  • How different cultures conceptualize and respond to mental illness

  • Social norms, symbolic meanings, ways people make sense of mental health in everyday lives

• Studying impact of privatization on patient trust

  • Individual experience of private health care

  • Patient concerns, feelings of alienation or empowerment

Ontology

Branch of philosophy concerned with nature of reality

• Do we study ‘objective entities’? 

  • Things that have a fixed reality that is independent of our perspectives 

• Do we study ‘social constructions’?

  • Things that are fluid and change depending on point of view?

Ontology types

• Objectivism

• Constructionism

Objectivism

Phenomena exist as external objects 

• External reality exists independently of observation

• Reality exists independently of human perception

Objectivism example

• Disease as a biological entity

  • Disease is objective, measurable condition

  • Tumour exists whether or not a patient/ doctor recognize it

• Social determinants of health as objective factors

  • Factors like income, education, housing are objective determinants of health with direct, measurable impact on outcome

Constructionism

Phenomena are socially constructed objects

• Reality takes on meaning insofar as social actors agree on their meaning 

• Reality is socially constructed through human interpretation

Constructionism example

• Mental illness as socially constructed category

  • Depression is not* an inherent biological reality but shaped by social and cultural understandings

• Meaning of health and illness varies across cultures

  • What counts as ‘healthy’ differs across societies (e.g., spiritual well-being vs physical biomarkers)

Methodology

One’s approach to data collection and analysis

Methodological divide:

• quantitative vs qualitative

Quantitative

 Relies on numeric data and statistical analyses

• Guided by measurement, hypothesis testing, assessment of correlation/ causation 

• Generalize from sample to population

Quantitative example

• Measure effectiveness of a public health campaign

  • Does an anti-smoking campaign reduce smoking rates?

  • Pre- and post-intervention surveys with 10,000 participants

  • Analyze changes in smoking prevalence using statistical tests

  • Methods: surveys – structured questionnaires

Qualitative

 Relies on open-ended questions concerned with meaning and experience 

• Researcher in close contact with participants, places, events (“research field”)

example Qualitative

• Impact of medical racism on medical racism on patient trust

  • Does experience with medical racism shape willingness to seek care?

  • Patients’ stories of discrimination, attitudes towards healthcare providers, language used to describe trust/mistrust

  • Methods: Focus groups and interviews

if the reasearch question was:

What physiological and neurological factors influence pain intensity?

what would the Research paradigms be?

Predict or explain using biological mechanisms

Positivism: Pain is measurable, objective

Objectivism: Pain exists independently of human perception

Quantitative: Numerical data, experiments, statistical analyses

if the reasearch question was:

How do individuals with chronic pain make sense of their experiences?

what would the Research paradigms be?

Explore and interpret lived experience influenced by society and culture

Interpretivism: Experience of pain is subjective and shaped by individual/ social contexts

Constructionism: Pain is a socially constructed experience shaped by language and culture

Qualitative: Narratives, personal stories, thematic analyses

if the reasearch question was:

How does the frequency and intensity of physical activity impact recovery time and pain levels in patients after knee surgery?

what would the Research paradigms be?

Positivism: assumes cause-and-effect relationship between activity and outcomes

Objectivism: recovery and activity can be measured and quantified, effects are generalizable and predictable

Quantitative: step counts, range of motion measurements, pain levels, recovery time; statistical tests and group comparisons

if the reasearch question was:

Why do some patients resume physical activity after knee surgery while others do not?

what would the Research paradigms be?

Interpretivism: aims to understand patients’ personal reasons, not measuring a universal patter

Constructionism: no single truth about why people do or do not resume activities; context-dependent

Qualitative: interviews, focus groups to identify themes in patient narratives

Positivism or Interpretivism: Patient satisfaction with telehealth services using interviews to understand barriers to access

Interpretivism

Objectivism or Constructivism: Obesity as a biological condition caused by genetics and metabolism

Objectivism

Quantitative or Qualitative: Mental health treatment effectiveness as measured by symptom improvement using standardized depression scales

Quantitative

Qualitative research

• What happens in the everyday world

• Feelings, impressions, what is not readily quantifiable

• Beliefs and perceptions of truth

goal of Qualitative research

Attempts to find out what is going on, what is happening, and the nature of “something” from the perspective of those involved in the situation under study

the 2 characteristics of Qualitative research

• Naturalistic

  • Research takes place in the natural environment rather than a controlled setting (eg lab)

• Interpretive

  • Constructing meaning from data with the aim of explaining the phenomenon of study

How does qualitative research treat phenomena?

As naturally occurring, studied through empirical inquiry without manipulation.

• Naturally occurring → the situation exists in the real world without researcher intervention.

• Empirical inquiry → the study is based on direct observation or experience, not just theory.

• Without manipulation → researchers don’t change variables or create controlled test conditions; they aim to understand the phenomenon as it happens in its natural context.

How does qualitative research approach complex social experiences?

Through rich exploration and deep analysis of contexts, meanings, and human experiences.

In health research, what areas can qualitative methods explore?

• Identification of health care needs

• Patterns in health seeking behaviours or practices

• Experiences and practices of health care providers

• Experiences of recovering from illness

• Culture of health professions

“Meaning” matters

People’s personal beliefs, emotions, and interpretations shape their health decisions

process, interaction, relativism

“Meaning” matters in terms of Process

• Meanings can change over time

“Meaning” matters in terms of Interaction 

• Meanings are shaped through relationships (eg patient and doctor)

“Meaning” matters in terms of Relativism 

• Different people have different views

“Meaning” matters example

• low participation rates in colonoscopy

  • Quantitative research tells us colonoscopy is effective population screening tool

  • Qualitative research tells us reasons why participation rates are low

Traditional approaches to Qualitative research

• Ethnography

• Phenomenology

• Grounded theory

• Qualitative description

Ethnography purpose

The Purpose is to provide a detailed, in-depth description of everyday life and practice → thick description

Ethnography age and roots

• One of the oldest approaches

• Roots in anthropology

Ethnography focus

• Focus on exploration of culture

Ethnography perspective

• Uses an emic perspective: the insider’s point of view — trying to see the world as members of the culture see it.

Ethnography - where does it apply

• Cultures and subcultures are everywhere

  • Specific places (eg hospitals, health clinic)

  • Specific people who share similar experience (eg cancer patients, undergraduate students)

Why is Ethnography useful in health research

• Informs our understanding of cultural perceptions and experiences (matrix of meaning) of illness and disease

• Aids understanding of behaviour surrounding health and illness

Autoethnography

Links personal to cultural through self-narrative

Researcher becomes both participant and observer

Autoethnography focus

• Focus is on individual’s (ie researcher’s) experiences understood within social and cultural context for the purposes of extending understanding

Phenomenology - purpose

Purpose is to gain a deeper understanding of nature or meaning of our everyday experiences

Goes beyond surface descriptions — it aims to capture the essence (core meaning) of an experience.

Phenomenology Key Idea

• Seeks to explore, describe, and analyze the “lived experience”

• Aims to develop rich descriptions of the essences of those experiences 

• “experience, not as it is thought to be but as it is lived”

Phenomenology Process

• Researcher identifies object of human experience (e.g., pain) 

• Participants are recruited who have experienced the phenomenon

• Researcher works to develop description of “what” they experienced and “how” they experienced it: description of the essence of the experience 

Phenomenology Outcome

The final description should create a “phenomenological nod” in the reader — meaning the audience feels a resonance or “ring of truth” because it matches their own understanding or feels authentic.

Phenomenology Example in health research

If studying postpartum depression, phenomenology wouldn’t just ask about symptoms; it would explore:

• What daily life felt like

• How participants perceived themselves and their relationships during that time

• The meaning they attached to the experience

Grounded theory

Grounded theory is a qualitative research method focused on building new theories directly from the data collected about a social phenomenon.

Grounded theory Purpose

• To explain the underlying social processes and structures behind a phenomenon.

• Maximizes the explanatory power of qualitative research by creating a theory grounded in real-world data.

Grounded theory Key Features

• Theory developed inductively: Instead of starting with a hypothesis, researchers collect data first, then derive concepts and theories from patterns found in the data.

• Involves systematic comparison of data — researchers constantly compare new data with existing data to define categories and discover relationships.

Grounded theory Process

• Collect data (e.g., interviews, observations).

• Code the data by labeling chunks with concepts.

• Compare and contrast data to refine concepts and categories.

• Develop relationships between categories to form a conceptual theory.

• Continue this process until saturation: the point where no new information or insights emerge from additional data.

grounded theory Outcome

Produces a theory that explains how and why certain social processes work the way they do within the studied context.

Qualitative Description

Offers a comprehensive summary of an event/phenomenon in

every day terms of those events

Qualitative Description Purpose

• To describe events or experiences accurately and clearly without heavy interpretation or theorizing.

• Used when research doesn’t fit neatly into other qualitative types like ethnography or phenomenology.

• Resists “forcing” the data into a specific methodological framework

Qualitative Description Key Features

• Findings aim to provide an accurate account of the event or phenomenon — something others would recognize as true (this is called descriptive validity).

• Focuses on what happened rather than why or what it means in a deeper sense.

Qualitative Description Why useful

• Particularly well-suited for studies focused on policy, healthcare practice, and applied research where clear, practical descriptions are needed.

Sampling for Qualitative research -

Participants must be selected based relevance to the research topic/question, conceptual framework, method employed

• Participants that promise the greatest insights regarding phenomenon of interest

• Purposeful sampling

• Select best participants based on quality of their insights about and willingness to reflect on phenomenon of interest

• Who (or what) can give me the most and best information about my topic?

• Snowball sampling

• Participants are asked to invite others who meet sampling criteria

• Convenience sampling

• Select based on availability to participate

• Theoretical sampling

• Select based on emerging theoretical framework

• Select in order to elaborate and refine emerging categories and theory

Methods for Qualitative research

Finding and collecting data

• Flexible approach

• Data may be people, policy documents, maps, movement, images, text, sound, etc 

• Often involves human participants 

• Researcher is research instrument: actively makes decisions throughout the process about what to select and interpret 

• Research is not a passive process, but is actively (co)constructed

  • the researcher doesn’t just quietly observe and record facts like a camera or tape recorder. Instead, the researcher is an active participant in shaping the research

  • knowledge produced isn’t created by the researcher alone — it’s co-constructed with the participants and context.

Interviews

• Guided conversation

• Structured Interview

• Follows exact same sequence of questions

• Offers some consistency

• Useful when multiple interviewers

• Semi-structured Interview

• Specific predetermined questions, but interviewers can go ‘off script’

• Open-ended Interview

Allow participant to tell their story

• Focus groups

• Focused interview involving more than two participants (often 6-10)

• Group interaction on given topic

• Different way to understand how people think and feel about topic

benefit of focus group

• May generate more ideas than interviews because participants can build on each other’s insights

lmitations of focus groups

• Sensitive topics

• May distort responses

• Visual methods – photovoice

• Participatory action research (PAR): collaboration with community partners is central focus

• Social change that benefits community

• Provide access to silent themes associated with lives of under-represented people/ communities

• Visual methods – photovoice aims

• Empower people to document daily life

• Facilitate group communication and dialogue

• Identify important community issues

• Appeal to policy makers to enable change

Analysis for Qualitative research

Process of sorting, categorizing, grouping, and regrouping data into meaningful chunks

• Data collection and analysis are directly linked – iterative

• Non-linear!

• Constant comparison

• Relationships between conceptualized categories are tested through comparison and contrast of emerging ideas and the data

• Thematic analysis

• Identifying, analyzing, and reporting patterns

• Theme: captures something important pertaining to research question and represents a pattern within the data set

• Discourse analysis

• How language both shapes and reflects cultural, social, and political processes

• How people use language and how language shapes identities, activities, and relationships

Rigour for Qualitative research

refers to how trustworthy and well-conducted the research is

• Cannot apply same standards as quantitative research

Trustworthiness

Credibility ⇄  Internal validity

Transferability ⇄ External validity

Dependability ⇄ Reliability

Confirmability ⇄ Objectivity

Credibility ⇄  Internal validity

• (accuracy of interpretation/ conclusions) 

  • Are the findings believable and accurate from the perspective of the participants?

  • Did the researcher interpret the data correctly?

Transferability ⇄ External validity

• (generalizability) 

  • Can the findings be applied to other similar settings or groups?

  • Instead of broad generalization, qualitative research aims for contextual relevance

Dependability ⇄ Reliability

• (consistency) 

  • Are the research process and findings consistent and repeatable over time?

  • Would someone else looking at the same data reach similar conclusions?

Confirmability ⇄ Objectivity

• Objectivity

  • Are the findings shaped by the participants' views, not researcher bias?

  • Can others trace how conclusions were drawn?

• How to keep rigour:

• Keeping an audit trail: documenting research decisions and rationale

• Reflexivity: examining one’s place, biography, self and others to understand how they shape analytic exercise

• Prolonged engagement: extended time in field

• Member checking: exploring findings with participants

• Triangulation: check integrity of inferences by using multiple data sources, investigators, theories, and/or methods

• Peer debriefing: checking findings and interpretation with a peer

Study designs

Study design driven by study question, available population for study,

resources, and current state of research

• Designs vary in cost, time, complexity, evidence they contribute to establishing causal relationships

• May not be feasible to conduct elaborate studies

• Most designs can contribute something valuable

Quantitative study designs

• Randomized Controlled Trial (RCT)

• Cohort study design

• Case-control study

• Cross-sectional/ prevalence study

• Ecological studies

Randomized Controlled Trial (RCT) -

Used to evaluated therapeutic effects of treatments in diseased individuals OR beneficial effects of a protective agent or screening procedure 

• Experimental:

• researcher controls who receives the treatment or intervention (‘exposure’) and who gets the alternative 

• Control group:

• those receiving the alternative

  • Placebo: simulated agent or sham procedure that has no specific intended therapeutic effect but is intended to make the recipient think they might be receiving treatment 

  • No intervention 

  • Currently accepted treatment

• Prospective of Randomized Controlled Trial

• participants receive intervention or become controls and followed over time 

• Random:

• participants are randomly assigned to intervention or control (mitigate selection bias)