Delivering the 1999 Conference Pharmacy Practice award lecture on September 13, Dr Felicity Smith (senior lecturer in pharmacy practice, School of Pharmacy, University of London) entertained Conference members to some snippets of Bach, and drew an analogy between the musical forms of toccata and fugue and quantitative and qualitative pharmacy practice research |
Felicity Smith: must select outcomes that can be measured |
The qualitative and quantitative aspects of health services and pharmacy practice research can be compared to the musical forms of toccata and fugue, Dr Smith told the Conference.
Toccatas were generally recognised by some rapid-running musical passages and had no rules regarding their structure. Like qualitative research, they had little predetermined form. However, also like qualitative research, toccatas were instantly recognisable by the techniques they employed. Toccatas were intended to sound like an improvisation, rather as if they were being made up as they went along. This feature perhaps reflected the undetermined structure of qualitative research, where it was important that a flexible technique was employed.
At the start of a toccata, it was unclear where the music might lead, and "a feature of qualitative, exploratory work is that you cannot predict what issues will be uncovered. This is the whole purpose of doing it," Dr Smith said.
A fugue, on the other hand, was in some ways the antithesis of unstructured musical form. They were highly structured works which followed many established convetions. They were generally polyphonic and there were many rules about what each part did. All the parts were individually interesting yet they all fitted together perfectly. Fugue writing was very clever — a bit like mathematics.
"Fugues reflect features of quantitative research," suggested Dr Smith. "Data collection and analysis are carefully planned and structured and follow important rules."
Dr Smith continued her analogy by saying that the parts of a fugue, or the variables in a matrix, could be analysed independently or listened to or assessed as a complex whole. And, as in research, when listening to a fugue, one could never be quite sure whether one should listen to the thing as a whole or concentrate on one of the parts.
Some fugues were very complex and the parts could be difficult to disentangle when one was listening to them — especially if they were double or triple fugues.
"But the parts might represent a complex web of variables in a research database and the relationships between them, and we may use univariate or multivariate analytical procedures," Dr Smith said.
She went on: "Fugue writing is an amazing technical achievement or intellectual exercise, but also great music. Perhaps this gives a clue about what we should select for our Research Assessment Exercise submission."
Dr Smith described the difference between qualitative and quantitative research. They differed in the processes involved in conducting the research and the types of research question or objectives to which they were applied. Qualitative and quantitative research also presented their own considerations in terms of achieving reliability and validity in data collection, processing and the research findings.
The most common examples of quantitative research included large sample or population surveys, analysis of databases or official statistics, cohort studies which followed up particular population groups, and randomised controlled trials. In terms of design, quantitative studies might be descriptive, providing information on the characteristics, activities or events in a population and associations between variables, or hypothesis testing, to provide evidence of differences between two or more population groups. An important feature which distinguished this approach from much qualitative research was the predetermined, standardised framework.
"If we wish to provide summaries or make generalisations, we have to ask the same questions and gather the same information from everybody," Dr Smith said. "And this predetermined, tightly controlled feature of quantitative research is sometimes viewed as a possible threat to its validity." Indeed, the tightly controlled framework imposed by the researcher could be too inflexible to allow a true picture of the phenomena or issues of interest to come through. This could be manifested when those given questionnaires felt that the range of possible response to questions did not reflect what they felt was the best answer.
"But," said Dr Smith, "in randomised controlled trials we have to select outcomes that can be measured. Outcomes for which valid measures are not available may be the ones most important to patients."
Turning to qualitative research, Dr Smith said that these studies were considered most appropriate for "how and why" questions exploring processes and patterns in people's thoughts and behaviour. The aim of qualitative research was to gain insights into situations, experiences and events from the perspective of the individuals concerned. It was generally context specific in that the researcher aimed to gain these insights in the light of the lives, outlooks and priorities of these individuals.
Thus, for this type of research, the questions and issues raised could not be standardised. Throughout, the research had to be sensitive to respondents' viewpoints and researchers had to be prepared to consider new issues and incorporate new questions.
"But this doesn't mean that qualitative resarch is unscientific," said Dr Smith. "The rigour in this research comes from observance of the principles of qualitative inquiry so that accurate and valid data are obtained and retained in the data processing, analysis and interpretation."
On the subject of whether it was wise to combine quantitative and qualitative methods, Dr Smith said that that was debatable, although, in pharmacy practice research, combining methods was common and there were a number of advantages. "Sometimes exploratory work, employing principally qualitative methods, may enable us to generate some hypotheses which provide a basis for a subsequent study. Or, we may find some interesting responses in a survey or unusual cases in a trial and use a more qualitative technique to explore these further," she explained.
Returning to her toccata and fugue analogy, Dr Smith said that, as with qualitative and quantitative research, toccatas and fugues could stand alone as great and independent works. However, many were written to be performed together and toccatas were often performed prior to a more structured work.
"As with research," she said, "they may be combined, and there are toccatas with fugal passages in them and (perhaps less commonly) fugues with toccata-like passages."