Research Methods in Health and Social Care – Comparative Methodologies Assignment

Introduction

The purpose of this assignment is to aim to highlight in detail the similarities and dissimilarities between quantitative and qualitative research. The assignment will aim to do this by comparing two different research papers each one using a different style of research method.

According to Tingen et al. (2009) research has a huge impact on current and future growth of the nursing profession. Appropriate research helps to generate new knowledge or expand on pre-existing knowledge which can further help to improve nursing practices. This is in line with the initiative “improving general practice: A call to action” (NHS England, 2014).

The first of the two papers that I will be comparing for this essay is titled ‘Swab and instrument count practice: ways to enhance patient safety’ (Smith and Burke, 2014). The research undertaken in the paper is a quantitative study where the author produced and distributed surveys to the staff in theatre trained in surgery or circulating roles and focused on their perceptions of the policies that are in place at their trust and also the individual competencies of the person completing the survey. I will further refer to this research study as ‘paper A’ during the assignment. To begin conducting a quantitative study researchers first select a topic, a general area of study, issue or professional or personal interest and then narrow it down or focus on a specific research question which can be addressed in the study. A careful review of the research literatures and developing hypotheses is often needed (Neuman, 2014).

The second paper that I will discuss and evaluate is titled ‘An exploration of Operating Department Practice student experiences of placement support during their first perioperative clinical placement’ (Hinton, 2016). This paper focuses on a qualitative research approach where the author conducted a focus group interview question and answer session with well researched and planned questions. This paper will be referred to as ‘paper B’ for the remainder of the assignment.

While both of these research papers aim to enable improvements or changes to be facilitated within the healthcare setting, each style of research has certain strengths or weaknesses to it which can positively and negatively impact on the outcome of the research depending , a point that is raised in the research paper by L.T. Choy, “The Strengths and Weaknesses of Research Methodology: Comparison and Complimentary between Qualitative and Quantitative Approaches”. The paper suggests that both types of research, qualitative or quantitative approach; critics, debates or comments still happen between specialists of the two forms of methodologies. I will therefore aim to address and compare during this essay the differences in the types of research method.

Research Question / aim and core features

Paper A aims to address the processes around swab and instrument counts in theatre and attribute inaccuracies to a number of factors, including team fatigue, the complexity of the operation, if the surgery is an emergency procedure or distractions occurring during surgery.

As a way of recording the issues that are faced during surgery, the author created a survey using open ended and Likert-style questions (McLeod, 2019). Likert-style refer to questions where there are around 5-7 possible answers on a scale; sometimes referred to as a satisfaction scale, that ranges from one extreme attitude to another. Typically, the Likert survey question includes a moderate or neutral option in its scale.

This form of research is a quantitative method approach as it enables the researcher to get raw data from individuals which can be collated and used to form a picture of the overall feelings of staff in the theatre environment.

In addition to the questionnaires observations of the operating environment were undertaken on 15 surgical procedures chosen at random without the staff being made aware which operations were being monitored.

Thirdly the author examined development opportunities and practices in the operating department, as it is thought that by improving and developing workers in the NHS then the care that is given is greatly improved (NHS England, 2016).

By using three different quantitative approaches to the research, the author is able to get a wider range of information, although all three methods would fall into the ‘non-experimental, Descriptive’ type of research method, Non-Experimental research design is one of the broad categories of research designs, in which the researcher observes the phenomena as they occur naturally, and no external variables are introduced (Radhakrishnan, 2013). When accurately reported on, nonexperimental research can make a tremendous contribution for conducting research when experimentation is not feasible or desired. It can also be used as a tool to make recommendations for practice.

One of the recommendations that comes from research Paper A is that staff development and clinical supervision would help to improve and reduce the number of incidents.

Paper B looks at the experiences and feelings new Operating Department Practice (ODP) students after they have had their first clinical placement in a perioperative environment. The author invited students to attend a focus group meeting immediately following their first placement experience with the aim of exploring the different experiences that they faced.

This type of research is a common tool used by qualitative researchers as it allows the participants to discuss events that happened and ‘debrief’ with their peers in a non-threatening environment. There are many advantages of a focus group, including, being useful when obtain detailed information about personal and group feelings, perceptions and opinions, they can save time and money compared to individual interviews and they provide useful material for example quotes for public relations publication and presentations (Evalued, 2006)

The aim of research Paper B is to try and determine what knowledge and support future ODP students would find helpful to enhance their placement learning experiences.

Recruitment and sample

The survey in paper A, was offered to every member of staff in the main and day case theatres, who would undertake either a scrub or circulating role during operations. It did not say if the survey was a paper form, online form or how many questions were asked. All of these factors could have had an impact on if the member of staff completed the questionnaire. According to a study (Ward et. Al., 2014) they found that if anonymity of the respondent was important then the feeling was that online forms would give this better than a paper/pencil version of the same form.

The entire department had 139 members of staff and less than half (65) were scrub or circulating trained. This gave the study a sample size of 65 people, which would in-turn give a good indicator of the general feelings of the whole team. The author reported that just over 72% of the questionnaires were returned (47 out of 65) which is a good rate for comparison. Jack E. Fincham (Fincham, 2008) stated that a survey response rate of 60% or greater was satisfactory for most research.

Likert-style questions do bring issues to research as it is thought that by having a scale there is a risk of as this would significantly increase what is known as a ‘response bias’. Response bias is a type of bias which influences a person’s response away from facts and reality. This bias is mostly evident in studies interested in collecting participants’ self-report, mostly employing a questionnaire format. A survey is a very good example of such a study, and is certainly prone to response biases (Gaonkar, 2018).

The reasons are clear why the author decided to only include those trained in scrub or circulating. To include members of staff that do not have this training or who do not understand the role in theatre would potentially increase the number of un-returned surveys; this is termed a ‘non-response bias’, it is when there is a significant difference between those who responded to your survey and those who did not respond (TRC, 2009) There is also Participant bias which occurs when individuals act or respond in ways they believe correspond with what the researchers are looking for. Behaviour of the individual is uncharacteristic from how they normally would because they are responding in a way they think they are supposed to (Alleydog, n.d.)

Paper B recruited participants to join in the focus group by sending a written invitation to all 24 students from the same cohort. Each student received the same information prior to attending placement for the first time.

Due to the lower response from students who were willing to take part in the focus group, only 6 students agreed to be a part of the discussion out of the 24 students invited to take part (only 25% of the sample size) this meant that only one focus group discussion was held.

It is recommended that a focus group should consist of between six and ten people to be most effective (Howatson-Jones, 2007). Focus group sample size recommendations from books and journal articles range from as few as two focus groups per study to more than 40 groups (Fern 1982; Kitzinger and Barbour 2001; Krueger and Casey 2015; Morgan 1996; Vaughn et al. 1996). One common agreed guideline is that focus group research requires at least two groups for each defining demographic characteristic (Barbour 2007; Krueger and Casey 2015; Ulin et al. 2005), however none of these recommendations are supported by verifiable data. According to these “rules of thumb”, focus group projects most often use homogeneous people as participants, in this case the people taking part were all ODP students, should have a relatively structured interview with high moderator involvement, a group size of 6 to 10 participants per focus group, and normally have a total of three to five groups per project; although in reality, it would be rare for a research project to match all four of these criteria (Morgan, 1997).

Data analysis

Paper A breaks down all of the individual points that are raised in the questionnaires and looks at the statistics surrounding each set of answers. Quantitative research such as in this study has a number of strengths and weaknesses which can impact on the results.

Some of the strengths of quantitative research are that the study can be administered and evaluated quickly, it is also not necessary to spend time at the organization prior to administering the survey. This means that one survey can potentially be used across multiple hospitals saving time. Also responses from participants can be tabulated within a short timeframe because all of the respondents will have given answers that fit into a select number of fields.

Any numerical data obtained from a quantitative survey like this one can facilitate comparisons between organizations or groups if the survey is completed at multiple theatre settings for example (Yauch and Steudel, 2003: 473).  This would therefore provide a better level of feedback for the researchers and give a more in-depth idea as to how the count practice is followed in other hospital trusts.

Some weaknesses preventing quantitative research from being as effective as possible are the need for a large sample size; the bigger the sample then the more data that can be obtained, conversely, having a sample size too large can result in otherwise small differences in the results obtained (Faber and Fonseca, 2014) in this study the number of trained and qualified staff members in theatre was limited, accordingly a very small sample could potentially undermine the validity of the study (Faber and Fonseca, 2014). More weaknesses include the lack of resources which can often make large-scale research impossible and in many settings interested parties undertaking the research may lack the skills and resources needed to conduct a thorough quantitative evaluation (Dudwick, Kuehnast, Jones and Woolcock, 2006: 3).

Paper B had a very thorough approach to analysing the information firstly the authors read the transcript of the focus group a number of times to give familiarity, they then followed a framework devised by Colaizzi (Colaizzi Method of Analysis, 2015) which allows them to reveal emergent themes and their interwoven relationships (Wirihana et al., 2018). By following a distinctive seven-stage framework developed by Colaizzi (Morrow et.al., 2015), gives a methodical approach to interpreting the information from the study, before then using ‘Thematic Analysis’ to produce three main themes from the data; ‘Information’, ‘Placement’ and ‘Learning Experiences’. The author of the study then goes onto evaluate the information at the start of each section, before highlighting the responses of the participants.

One of the drawbacks of qualitative research, such as preformed in Paper B, is that researchers have a robust theory which underpins the way the research is conducted, often called methodology. Researchers need to have a high understanding of methodologies, to ensure alignment between their own bias or stance, research questions, and objectives. Some clinicians feel that qualitative research is inherently subjective or biased and that it does not produce generalizable findings (Austin and Sutton, 2014).

Philosophical Principles

Looking at the two methods employed by the researcher in papers A and B it is important to first realise the ontological and epistemological principles that the researchers followed. Ontology and epistemology are two different ways of viewing research. Ontology is knowing the reality, something that research is going to prove or the view point towards the reality. Whereas Epistemology is how to prove the view point or carry out the study in order to prove the view point which will contribute towards reality.

In paper A the research method was focused on the opinion of the person completing the survey and the responses they gave. Likewise, paper B was the subjective opinion of the students that participated in the focus group activity. Both of the papers displayed a good understanding of the ontology around the respective subjects and gave a good introduction and background of the current and historic issues or concerns, and the reasons for the studies to take place. They both gave an impartial non-bias response to the question being asked and attempted to highlight the issues that are known.

“Historically, qualitative research has been viewed as “soft” science and criticized for lacking scientific rigor compared to quantitative research, which uses experimental, objective methods. Common criticisms are that qualitative research is subjective, anecdotal, subject to researcher bias, and lacking generalizability by producing large quantities of detailed information about a single, unique phenomenon or setting (Bodenreider, Smith and Burgun, 2004).

The research in both studies then followed clear guidelines and aimed to highlight the points raised in the initial question, paper A by looking at the results of the survey and comparing this to national guidelines, paper B by putting the answers into concise short paragraphs, before including the responses from each participant in the study.

“However, qualitative research is not inferior research, but a different approach in studying humans. Qualitative research emphasizes exploring individual experiences, describing phenomenon, and developing theory” (Cope, 2013).

Paper B also highlights the known limitations of its own study pointing out that there were factors that would have potential impacts on the study; such as the small number of participants, purposively sampling instead of random sampling and the potential for coercion of the participants by the facilitator and moderator of the study (Hinton, 2016).

Conclusion

By comparing the two different types of research method, namely qualitative and quantitative you can see the individual strengths and weaknesses of both which can impact on the outcome of the research.

Paper A and the Quantitative research approach in my opinion has the least amount of weaknesses facing the study. Because the author was limited to only using members of staff that had knowledge of the area, and because they only applied the study to one hospital, there was limited amount of respondents available for this study which meant that the results were very limited. The main strength of this type of research however is that the information can be collected and facilitated quickly giving results on an almost real-time bases if the online version of the form is used.

Paper B and the Qualitative research approach had in my opinion more weaknesses, but was a more in-depth study over all. The weaknesses of the small amount of participants to the study and only being able to have one focus group meant that it would have been harder to get a non-bias evaluation as all of the results are coming from just one group of people. The data from this research is very open to bias as all of the focus group questions were open for interpretation by the participants and so open to opinion, this is a point raised by other researchers.

The main strength of this form of research is the fact that the information can be recorded and listened to a number of times by a large selection of facilitators and researchers and because it is a group discussion there is engagement so you are able to better judge the overall opinion of the group.

Therefore the type of research completed is very dependant on the type of information required from the study.

I think because both paper A and B focused on the opinion of people rather that factual physical evidence (for example equipment stability) I feel that either a quantitative or a qualitative study would have been appropriate in either of these two studies and would possibly have yielded the same types of answers.

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