Qualitative methods used for effect studies and evaluations of healthcare strategies?

In effect studies and when healthcare strategies are evaluated traditional quantitative methods are usually used. Quantitative methods provide figures/ measurements as results, which are relatively easy to understand and include in the discussions about prioritization and possible introduction of new healthcare activities. I will advocate for thinking in new ways and encourage politicians to consult more qualitative studies and as a consequence include results from qualitative studies in the ongoing assessment. Why is that? The reasons are manifold but some barriers also exist. The well-known quantitative research studies in primary care can be and will often be initiated by healthcare planners. Questions like ‘‘What do we gain by implementing screening for breast cancer? ’’ ‘‘What is the effect of educating GPs in advising on prevention of cardiovascular disease’’ are typical in this field. To obtain the answers randomized studies are designed and outcomes characterized by the phenomenon that they are measurable (e.g. survival, stroke, levels of cholesterol, number of prescriptions, etc.) are used. The weakness of using the traditional effect design is related to the fact that the research study takes place in the real world, where participation depends on the interest, economy, and feasibility of the study. Moreover, there is a logistical barrier, when the study as a rule does not originate from one centre but from many, as is often seen in general practice research. Another very important obstacle to carrying out effect studies is the risk of non-participation, when the randomization has to be done before acceptance of participation. Therefore it can be very hard to secure the power in the study and negative results will possibly be wrongly interpreted. Using qualitative methods can perhaps add another interpretation. When the qualitative approach has been used in primary healthcare research, it has often been done by persons affiliated with the area, such as for example general practitioners, who have a great deal of experience in handling healthcare activities, a surgery, staff, and patients. They are interested in having answers to everyday questions like ‘‘Why does Mrs Jensen act as she does? ’’ or ‘‘How can we improve our diabetes care? ’’, where the obvious method to use is the qualitative approach. As a result of increased focus on the need for development at all levels of the healthcare system, more resources are channelled into research and more qualitative studies are carried out and published. This has also been the trend in the Scandinavian Journal of Primary Health Care and during the last year subjects such as chronic fatigue syndrome [1], cardiovascular risk [2], depression [3], students’ consultations skills [4], motivation for visiting physicians [5], prescribing of antibiotics [6], urinary incontinence [7], and general health [8] have been touched upon in a qualitative setting. The way of gaining information from patients and providers has also widened, including for example focusgroup interviews, single interviews, narratives, video recordings, and written life histories. Traditionally, qualitative methods have been used by ethnographers, anthropologists, and sociologists to describe cultures, and they represent the inductive way of seeking out theories. As the qualitative method is used more and more in healthcare research and by researchers raised in the classical medical scientific methods (normally using deductive logic), it is being developed towards a ‘‘handy’’ and better known method in our field.