Getting the Story, Feeling the Facts: Qualitative Research Methods for Oriental Medicine

von Claire M. Cassidy

9.1 Introduction

Qualitative research is the term given to the branch of scientific research that emphasizes the collection and study of perceptions and experiences - the "stories" - of living people. Stories are powerful. Some years ago, I was sitting in the treatment trailer at a city jail listening to women receiving acupuncture detoxification talk about their lives, their addictions, and their experiences of acupuncture care. All of it was interesting. But near the end of the visit, one woman uttered a few poignant words that encapsulated everyone's hopes and reminded the practitioners of their deep task: "I chose acupuncture because I figured if a needle got me into this mess in the first place, maybe a needle could get me out."

Words can be needles, too. By gathering the thoughts and feelings of people -- patients, practitioners, lawmakers, teachers, students -- one can learn more about the "why" and "how" of people's preferences and decisions, the images that compel, and the emotions that propel, than by any other method. Qualitative research encourages people to speak their lives, beliefs, dreams, and visions, their experiences and interpretations of events, their motivations. From their words comes a better understanding of "what matters" to those who speak. This is information that those who listen can put to work usefully to solve problems.

This chapter introduces the basic ideas and methods of qualitative research for practitioners of Oriental medicine. Because some qualitative techniques use skills already familiar to clinicians, office-based practitioners can easily adopt them in assessing elements of their own practice and in planning for survey research.

9.2 Qualitative Research is Scientific

There is a tendency among quantitative researchers to view "stories" as anecdotes -- minor if interesting sidelights on the "real" stuff, that is, distributions expressed as statistical probabilities. Qualitative researchers take a rather different view, one which we must understand from the outset.

The "anecdote" is a single story without context. It is used to make a specific point. The quotation that appears in the first paragraph above is anecdotal because it is segregated from the other data gathered that same day, on subsequent days in the same locale, and from other settings in which jailed women received detox acupuncture. Anecdotes are not scientific; at the same time, they are not worthless: they draw one's attention, help memory, provide imagery, succinctly summarize complexities, and often serve to "put a human face" on medicine. The fact is, everyone relishes a good anecdote.

However, the focus of qualitative research is not on anecdote. Instead, like quantitative researchers, qualitative researchers apply the usual rules of science:

• to gather and analyze information systematically
• with attention to minimizing bias
• so as to achieve data that is accurate, valid, credible, and usable to answer questions, predict behaviors, and plan for the future.

As we move through this chapter, each of these points will be dealt with again and again. In sum, qualitative research is as scientific as quantitative research, but it starts from different premises and demands different techniques for both data gathering and data analysis. Frequently, qualitative and quantitative methods are applied in the same research task. As might be expected, this is called "mixed qualitative-quantitative" research.

9.3 Gathering Qualitative Data

9.3.1 Identifying the Research Question

As in all research, the qualitative researcher first must identify an appropriate study question. The best uses of qualitative research are in finding out the parameters of a new subject (exploratory research) and gathering detail about the meanings of events. Table 1 compares the kinds of questions best asked of quantitative and qualitative research. Note that only qualitative and experimental laboratory research can answer the questions "why?" and "how?" -- that is, provide explanations. Other research -- archival, survey, clinical outcomes, and clinical trials research -- provides rich descriptive data, including statistical distributions that define "who, what, where, when, how many, and how much" but cannot detail the linkages that explain behaviors. Therefore, if you are interested in people's perceptions and motivations, use qualitative research methods.

When very little is known about a topic, qualitative research is cost-effective for finding out generally what people think is going on. Oriental medicine is full of such areas of mystery: Does needle depth matter? Do the patients of practitioners of TCM, Dorsally Five Element, French Energetic, and Toyo Hair styles have significantly different experiences with acupuncture? Are students at schools that provide a cultural context for Chinese medicine more secure in their knowledge afterwards than students from schools that do not? What does it mean when practitioners claim to be "holistic" healers? Are the concepts of "energy" and "qi" combined for American practitioners? What factors help make for successful practitioners 5 years out of school? What do qi gong practitioners experience when they "throw" qi? What do patients understand about the theory of Oriental medicine after a course of treatment?

There are also many situations where it is useful simply to know what people perceive and interpret and what experiences they take away from an event, for example, acupuncture care. Such information can be used immediately to remedy fault lines in the design of an office or in the delivery of care, or it can be used to help create survey and clinical trials designs that accurately reflect the wants, values, and needs of patients and practitioners who are to be participants in research.

To illustrate the latter use, suppose a group of practitioners in a large private clinic suspected that all was not well with their clients and wanted to identify points of strain in their receipt of Oriental medical care. The practitioners could sit down and create a survey questionnaire containing dozens of questions concerning the waiting room, practitioners' behavior, attitudes toward needles, quality of parking, and so forth. Once a sufficiency of clients had ticked off answers on this survey form, the practitioners would receive data -- quantitative data. But would these really answer the core question they hoped to ask? Perhaps not, for the questions the practitioners thought to ask might not cover the whole range of issues important to the patients. Something crucial might have been left out. In order to get at the clients' issues -- which are after all what matter most if clients are showing signs of discomfort and distress -- these practitioners must make it possible for the clients to tell them what is right and not so right with their clinic. How?

The classic approach is via depth interviews with a sample of the patients, the gathering of qualitative data. The practitioners could use the analyzed results of a series of interviews either to make immediate modifications in their office procedures or, if they wanted more data on a larger sample, to construct a high quality survey form that both reflected the clients' issues and phrased them in the clients' language. The quantitative data from this new questionnaire would more accurately report client issues (the technical term is "be more valid") and therefore could more safely be applied to making effective changes in clinic arrangements.

A similar procedure is appropriate when, for example, an Oriental medicine professional organization wants to survey members or a school wants to survey alumni: first collect a detailed, small scale qualitative sample and use the qualitative data later to create a large scale survey questionnaire to sample the whole membership. A questionnaire designed this way -- with a firm understanding of the importance of knowing respondents' issues and reflecting their language habits -- has (another technical term) high model fit validity. Validity is a measure of whether a piece of research gathers data that actually answers the research question asked. The model one wishes to fit, in this case, is the model of reality held by the respondent population. This is partly conscious and expressible, partly unconscious, which brings us to the next issue: how do you actually collect experiential data from people? ……

Aus: Stux G, Hammerschlag R (Eds.)2001: Clinical Acupuncture Scientific Basis. Springer-Verlag Berlin Heidelberg