By X. Kayor. University of Houston, Downtown.

Revised statement 2: The aim of this research is to find out how many relatives of Alzheimer’s patients use the Maple Day Centre order 25 mg clomiphene overnight delivery women's health urinary problems, and to ascertain whether the ser- vice is meeting their needs cheap 100 mg clomiphene with amex menstruation 24. The research population is limited to relatives of Alzhei- mer’s patients who use the Maple Day Centre. One clue 22 / PRACTICAL RESEARCH METHODS to the methodology is in the words ‘how many’ which suggests a quantitative study. However, he is also inter- ested in finding out whether the service meets their needs, which requires some more in-depth inquiry. Original Statement 3: We want to find out how many of the local residents are interested in a play scheme for chil- dren during the summer holiday. The tenants’ association thought carefully about the is- sues in which they were interested, eventually coming up with the following revised statement: Revised Statement 3: This research aims to find out how many people from our estate are interested in, and would use, a children’s play scheme in the school summer holiday. The tenants’ association wanted to obtain funding for their play scheme and felt that it was important to gather sta- tistics which they could take to possible funding organi- sations. SUMMARY X The research methodology is the philosophy or general principle which guides the research. HOW TO DECIDE UPON A METHODOLOGY / 23 X Examples of qualitative methodologies include action research, ethnography, feminist research and grounded theory. X Quantitative research generates statistics through the use of large-scale survey research. X Neither qualitative nor quantitative research is better – they are just different. X Your own intuition and the words you use will give pointers to whether qualitative or quantitative research is more appropriate for your chosen project. X The term ‘triangulation’ is used when a combination of qualitative and quantitative forms of inquiry are used. FURTHER READING The theoretical and philosophical issues raised in this chapter are detailed and complex and cannot be discussed in depth in this book. However, if you wish to pursue any of these topics, some of the useful publications are listed below under the relevant topics. Qualitative research Over recent years there has been a great deal of innova- tion in the use of qualitative methodologies. Listed below are some of the more traditional texts and a selection of the newer, innovative texts. Before you de- cide which would be the most appropriate methods for your research, you need to find out a little more about these tools. This chapter gives a description of the meth- ods of interviewing, focus groups, questionnaires and par- ticipant observation. Chapters 7–10 will go on to describe in detail how to use each of these methods. The most common of these are unstructured, semi-structured and structured interviews. If you want to find out about other types of interview, relevant references are given at the end of this chapter. Unstructured interviews Unstructured or in-depth interviews are sometimes called life history interviews. This is because they are the fa- voured approach for life history research. In this type of interview, the researcher attempts to achieve a holistic un- derstanding of the interviewees’ point of view or situation. For example, if you want to find out about a Polish man’s experiences of a concentration camp during the war, 27 28 / PRACTICAL RESEARCH METHODS you’re delving into his life history. Because you are unsure of what has happened in his life, you want to enable him to talk freely and ask as few questions as possible. It is for this reason that this type of interview is called unstruc- tured – the participant is free to talk about what he or she deems important, with little directional influence from the researcher. As the researcher tries to ask as few questions as possible, people often assume that this type of interviewing is the easiest. Re- searchers have to be able to establish rapport with the par- ticipant – they have to be trusted if someone is to reveal intimate life information. Also, some people find it very difficult to remain quiet while another person talks, sometimes for hours on end.

On the contrary generic clomiphene 25 mg otc menopause vertigo, it reflects the outlook of a society which has abandoned any grand project discount 50 mg clomiphene overnight delivery womens health partnership indianapolis indiana, in which the horizons of the individual have been reduced to their own body: No matter what goes wrong in life—money, work or relationship problems—good health helps sustain us. How often have we all heard somebody say that although things may not be going well—at least they have their health. In a society of low expectations, the goal of human existence is redefined as the quest to prolong its duration. Once health is linked with virtue, then the regulation of lifestyle in the name of health becomes a mechanism for deterring vice and for disciplining society as a whole. The new government health policies no longer focus on health in the familiar sense of treating illness and disease, but rather encourage a redefinition of health in terms of the ways in which we live our lives. Under cover of the dubious notion that an extended life (at whatever cost to ourselves and to society) is good for us, the government is providing, and even imposing, its version of the good life. This good life is not simply a longer life, but a longer life lived healthily, which is to say, virtuously. This process is nonetheless insidious for being both well- intentioned and well-supported by many doctors, medical bodies and voluntary organisations. While answering the deep need of some for a framework through which to pull society together in troubled times, for those who are unable or unwilling to respond to the demands of the new public health, it may well be experienced as paternalistic if not overtly oppressive. One of the few writers to comment on the moralising of disease from a liberal humanist viewpoint is the American critic Susan Sontag. In Illness as Metaphor, published in 1978 following her personal experience of cancer, she discussed the way in which the myth of individual responsibility has shifted in modern times from tuberculosis to cancer. In her 1989 sequel, Aids and its Metaphors, she noted that the main theme in the response to Aids in the USA is the backlash against the ‘permissiveness’ of the sixties: ‘fear of sexuality is the new, disease-sponsored register of the universe of fear in which everyone now lives’ (Sontag 1989:159). She regretted the impact of the Aids panic in America in both reinforcing moralistic attitudes towards sex and the wider culture of individualism. Sontag also reflected on the reasons why the Aids panic had such a resonance in modern America. She noted the popularity of apocalyptic scenarios such as nuclear holocaust and ecological catastrophe, reflecting a sense of cultural distress and of society reaching a terminus: ‘There is a broad tendency in our culture, an end-of-an-era feeling, that Aids is reinforcing; an exhaustion for many of purely secular ideals’ (Sontag 1989:164). While people with Aids adopted programmes of self-management and 8 INTRODUCTION selfdiscipline, diet and exercise, Sontag recognised that the wider Aids panic connected with a public mood of restraint, ‘a positive desire for stricter limits on the conduct of personal life’, encouraging attitudes such as ‘Watch your appetites. The prevailing climate of impending doom provided ideal conditions for health scares and for the promotion of virtuous life-styles. In response to criticisms of the ‘victim-blaming’ character of much health promotion propaganda, its leading advocates have attempted to soften its individualistic emphasis. Thus the 1998 Green Paper insisted that ‘health is not about blame, but about opportunity and responsibility’ (DoH February 1998:28). In the same spirit, the 1999 White Paper Saving Lives acknowledged that past health promotion initiatives placed too much emphasis on simply trying to change individual behaviour and explicitly recognised the contribution of the government and local agencies — councils, health authorities, voluntary organisations, businesses— towards achieving targeted improvements in health. However, a glance at the detailed proposals suggests that the opportunities largely fall to the government and local agencies and the responsi- bilites fall on the individual. Where there are opportunities for individuals, these turn out to be opportunities to fulfil responsibilities as defined by the government. The White Paper elaborates at considerable length the roles of different ‘players’ in the contract for health. In addition to providing the policy and legislative framework, the government also undertakes to evaluate the health implications of all its policies. Indeed it seems inclined to review its entire programme through the prism of health. Thus, for example, its ‘tough measures on crime’ may gain in popular approval by being presented as a contribution to public health. For local ‘players’, collaboration between health and local authorities in ‘health action zones’ and in the pursuit of ‘health improvement programmes’ is the central theme. When it comes to the individual there is little left to be said: ‘it is finally up to the individual to choose whether to change their behaviour to a healthier one’ (DoH February 1998:48). The vaguely menacing tone is complemented by a reminder that ‘individual responsibility is not just about our own health’ and a warning about 9 INTRODUCTION the dangers of passive smoking, setting a bad example to others— particularly by parents to their children. The authoritarian dynamic in New Labour’s public health policy becomes increasingly apparent as we move from the discussion of aims and targets to the local ‘healthy settings’ in which the policy will be implemented and contract compliance enforced. In ‘healthy schools’, children will have their eating habits monitored to promote ‘healthy eating’ and be dragooned into physical exercise. Meanwhile in their ‘healthy workplaces’ their parents will be following the government’s list of precise instructions for ‘employees’.

Illustrating his taken the degree of Bachelor of Science generic 100 mg clomiphene overnight delivery women's health center peterborough, while resourcefulness buy discount clomiphene 100mg on line women's health big book of yoga download, it is related that, on setting out still a student, he started his teaching career as a for Alexandria with other RAMC officers, he demonstrator [“instructor” in the United States] found that none could go aboard ship unless of biology. This experience stood him in good properly dressed in spurs; whereupon he managed stead, for he later became an outstanding teacher to acquire a rusty pair at a marine store, and, of surgery. Following his graduation in 1895, his having himself embarked, tossed them ashore first interests were in obstetrics and, after experi- repeatedly for the use of each of his colleagues in ence in different parts of England and a period of turn. But he did small group of surgeons who met together at not stay long in general practice. His search dinner at the Cafe Royal in London to consider for surgical knowledge and experience was what steps should be taken to found an associa- insatiable. At that time In 1896 he married Miss Frederica Anderson, Hey Groves did not regard himself as an ortho- who had been a nurse at St. Bartholomew’s, and pedic surgeon in the accepted sense of the term; together they made their home into a private hos- but, at the invitation of Robert Jones, he had pital. Here, with the help and encouragement of already entered the fold by taking surgical charge his wife, Hey Groves established his reputation as of the Military Orthopaedic Centre at Bristol. To his students he used to say that this intrusion into orthopedic surgery was viewed by episode in his life had its darker side, for tales certain purists of the Alder school with consider- were spread abroad that “Butcher Groves lured able misgiving, and, by a narrow doctrinaire women into his home, operated upon them, and interpretation of what constituted a “real” ortho- would not remove their stitches until they had pedic surgeon in the year 1917, his name was paid their money. It was not long before Royal College of Surgeons of England and the the association made amends by sending a special degree of Master of Surgery of London Univer- invitation to Hey Groves to join in the capacity of sity, he was elected to the staff of the Bristol an original member. While thus engaged in surgery, became a loyal and powerful advocate of the he was still able to work as senior demonstrator cause of orthopedic surgery; and, during the of anatomy in Bristol University. He never earlier years of the association, this small spe- deserted general surgery, but his mind soon cialist body gained prestige from the fact that one tended to concentrate upon the mechanics of bone of its most distinguished active members held a and joint surgery. He was indeed most ingenious University Chair of Surgery, was the editorial sec- and skillful, and “Hey Groves” splints and appli- retary of the British Journal of Surgery and later ances became a byword. Indeed his early work became a Vice President of the Royal College of anticipated much that followed in the field of Surgeons. Before the days of the should in due course be chosen as President of the Smith–Petersen nail, he fashioned pins from beef British Orthopedic Association, and his second bone and horns for use in fractures of the neck of year in that office (1929) was notable in the annals the femur. In 1913, he described transfixion pins, of the society as the occasion when a strong con- which, passing through fragments, were fixed to tingent of the American Orthopedic Association external bars, thus with Lambotte anticipating came to London to take part in a joint meeting Roger Anderson, Haynes, and others who later with their British colleagues. These pins were again Hey Groves became President of the Association used by him in the treatment of gunshot injuries of Surgeons of Great Britain and Ireland, thus of bones; he wrote a primer on this subject in attaining to the dual honor that Robert Jones had 1915. During the war of 1914–1918, he served previously achieved, and thereby forging another in the Royal Army Medical Corps (RAMC), link between general and special surgery. It has a large and ever-growing membership, but there has been no schism. Orthopedic surgery remains within the fold of surgery as a whole, and the tradition of unity founded by Robert Jones and fostered by Hey Groves still endures. At Bristol, Hey Groves had been promoted to the Chair of Surgery in 1922. An old student writes: He had a vivid character, full of imagination and energy; he was an excellent teacher who brought a great sense of humour to his well attended ward rounds and operations. He was naturally very popular among the students; for, youthful himself, he was very fond of young company and always enjoyed a party, particu- larly dancing. Not infrequently his students, staff, and ward sisters were invited to join him—he was so Clarence Henry HEYMAN charming. Heidelberg College in Tiffin, Ohio, where he As a writer, Hey Groves was prolific; several received a BS degree in 1911. He then attended standard textbooks on surgery for students and Harvard Medical School, obtaining his MD nurses came from his pen. His inquisitive mind led him to surgeon, his concern was no less great, particu- spend much of his leisure time at the Huntington larly his desire to advance the treatment of Memorial Hospital studying the use of radium fractures and operative technique. While in medical Treatment of Fractures, written in 1916, was fol- school and during the internship that followed lowed by many authoritative articles on these at Boston City Hospital, he produced his first themes, and in 1935 he published his translation major publication, an article on the treatment of Lorenz Böhler’s work, of which he was a of anthrax, published in the Boston Medical wholehearted supporter. After his intern- Groves emphasized the fundamental principles ship, he served with the United States Army that Böhler had demonstrated: “the necessity (1918–1919). During this time, he was detached for unity of control, loyal and efficient team to obtain orthopedic training under Royal work, accurate knowledge of the after-results, and Whitman at the Hospital for Special Surgery, meticulous attention to detail. Throughout his life, both in surgical practice At the end of World War I, he became associ- and in teaching, his mind was alert to the needs ated with Walter Stern in the practice of orthope- of the “everyday” problem, the thorough teaching dic surgery in Cleveland, Ohio, and joined the of the student and younger surgeon in ground- staff of Mount Sinai Hospital at that time.

If a market re- searcher has stopped you on the streets order clomiphene 100 mg fast delivery women's health center newark beth israel hospital, or you have filled in a questionnaire which has arrived through the post safe 25 mg clomiphene breast cancer 88 year old woman, this falls under the umbrella of quantitative research. This type of research reaches many more people, but the con- tact with those people is much quicker than it is in quali- tative research. Qualitative versus quantitative inquiry Over the years there has been a large amount of complex discussion and argument surrounding the topic of re- search methodology and the theory of how inquiry should proceed. Much of this debate has centred on the issue of qualitative versus quantitative inquiry – which might be the best and which is more ‘scientific’. Different meth- odologies become popular at different social, political, historical and cultural times in our development, and, in my opinion, all methodologies have their specific strengths and weaknesses. At the end of this chap- ter references are given if you are interested in following up any of these issues. Certainly, if you were to do so, it 16 / PRACTICAL RESEARCH METHODS would help you to think about your research methodology in considerable depth. Deciding which methodology is right for you Don’t fall into the trap which many beginning (and ex- perienced) researchers do in thinking that quantitative re- search is ‘better’ than qualitative research. Neither is better than the other – they are just different and both have their strengths and weaknesses. What you will find, however, is that your instincts probably lean you towards one rather than the other. Listen to these instincts as you will find it more productive to conduct the type of re- search with which you will feel comfortable, especially if you’re to keep your motivation levels high. Also, be aware of the fact that your tutor or boss might prefer one type of research over the other. If this is the case, you might have a harder time justifying your chosen methodology, if it goes against their preferences. EXAMPLES OF QUALITATIVE RESEARCH METHODOLGIES Action research Some researchers believe that action research is a re- search method, but in my opinion it is better under- stood as a methodology. In action research, the researcher works in close collaboration with a group of people to improve a situation in a particular setting. The researcher does not ‘do’ research ‘on’ people, but instead works with them, acting as a facilitator. There- fore, good group management skills and an under- standing of group dynamics are important skills for HOW TO DECIDE UPON A METHODOLOGY / 17 the researcher to acquire. This type of research is pop- ular in areas such as organisational management, com- munity development, education and agriculture. Action research begins with a process of communica- tion and agreement between people who want to change something together. Obviously, not all people within an organisation will be willing to become co-researchers, so action research tends to take place with a small group of dedicated people who are open to new ideas and willing to step back and reflect on these ideas. The group then moves through four stages of planning, acting, observing and reflecting. This process may hap- pen several times before everyone is happy that the changes have been implemented in the best possible way. In action research various types of research meth- od may be used, for example: the diagnosing and eval- uating stage questionnaires, interviews and focus groups may be used to gauge opinion on the proposed changes. Ethnography Ethnography has its roots in anthropology and was a popular form of inquiry at the turn of the century when anthropologists travelled the world in search of remote tribes. The emphasis in ethnography is on describing and interpreting cultural behaviour. Ethnographers im- merse themselves in the lives and culture of the group being studied, often living with that group for months on end. These researchers participate in a groups’ activ- ities whilst observing its behaviour, taking notes, con- ducting interviews, analysing, reflecting and writing 18 / PRACTICAL RESEARCH METHODS reports – this may be called fieldwork or participant ob- servation. Ethnographers highlight the importance of the written text because this is how they portray the cul- ture they are studying. Feminist research There is some argument about whether feminist inquiry should be considered a methodology or epistemology, but in my opinion it can be both. Epistemology, on the other hand, is the study of the nature of knowledge and justification.