Qualitative Health Research

by Janice M. Morse

The leading figure in qualitative health research (QHR), Janice M. Morse, asserts that QHR is its own separate discipline―distinct from both traditional health research and other kinds of qualitative research―and examines the implications of this position for theory, research, and practice. She contends that the health care environments transform many of the traditional norms of qualitative research and shape a new and different kind of research tradition. Similarly, the humanizing ethos of qualitative health research has much to teach traditional researchers and practitioners in health disciplines. She explores how the discipline of QHR can play out in practice, both in the clinic and in the classroom, in North America and around the world. A challenging, thought-provoking call to rethink how to conduct qualitative research in health settings.

176 pages, Paperback

First published August 6, 1992

Reviews

[Miranda W. · Rating 5 out of 5]

Morse, Janice M., ed. Qualitative Health Research. Sage, Newbury Park, 1992

5 stars

Great collection! Compelling articles. Could have used a more direct explanation on what exactly qualitative methods are. But then again, it's a reader rather than an intro text on methods and is still very illustrative. Some of the introductory exposition papers (on the importance of context, holism) were highly theoretical and a bit dry, but the papers actually using qualitative methods were fantastic. I also appreciated that many of the selections were about women's health.

Contents

Part 1 - The Characteristics of Qualitative Research (5 articles illustrating foundational principles of the emic perspective, the holistic perspective, and an inductive and interactive process of inquiry - includes a foundational article about the disease of masturbation, a claim to the universal yet unique relevance of Shakespeare, a theoretical overview of the importance of context, a theoretical overview of the importance of holism, a study of values associated with breast-feeding).

Part 2 - The Qualitative Synthesis of Research (2 articles demonstrating process of synthesis in qualitative research - a satirical demonstration of folklore without end, an overview of theories of caring in nursing)

Part 3 - Phenomenology (3 articles that use a phenomenological approach to health research - phenomenology of birthing pain, a child's perspective of heart surgery, a girl and her mother's memory of childhood asthma)

Part 4 - Ethnography (4 articles demonstrating ethnographic approach - on the culturally specific meaning of menopause in a Newfoundland fishing village, the paranoia of surgeons, the rich activity in a passive-appearing nursing home, and the covert experiment in which healthy pseudopatients pretend to hear voices and are admitted to psychiatric hospitals)

Part 5- Ethnoscience (4 articles demonstrating ethnoscience approach - how men strategize to defeat charges of public drunkenness, strategies of gift-giving from patients to nurses)

Part 6 - Grounded Theory (3 articles demonstrating the grounded theory approach - on the process of becoming ordinary after leaving the psychiatric hospital, on the emotional experience of breast expression, on the negotiation of involvement between nurses and patients)

Part 7 - The Semi-Structured Interview (1 article using Semi-Structured interviews about the process of weaning from breast-feeding being a social process termed "social coercion")



D. L. Rosenhan's On Being Sane in Insane Places, 1973

Love it - CLASSIC status!

Topic: Pseudopatients get themselves admitted to mental hospitals and see if their sanity is detected - it's not, except by fellow patients. Research originally conducted in 1973.

Purpose: distinctions between sane and insane are suspect; the way these distinctions play out in psychiatric hospitals are distorting and countertherapeutic. Alludes to the idea that the environment of the psychiatric hospital creates illness.

Scope: sanity vs insanity, mental illness vs physical illness, power of diagnostic labels type i (false positive) vs type ii error (false negative), hierarchical organization of the hospitals resulting in segregation between staff and patients; patterns of depersonalization, invisibility, and powerlessness, Goffman "mortification" - socialization to settings characterized by high depersonalization, total institution

Illustrative Quote: "A a psychiatric label has a life and an influence of its own. Once the impression has been formed that the patient is schizophrenic, the expectation is that he will continue to be schizophrenic. When a sufficient amount of time has passed, during which the patient has done nothing bizarre, he is considered to be in remission and available for discharge. But the label endures Beyond discharge, with the unconfirmed expectation that he will behave as a schizophrenic again. Such labels, conferred by mental health professionals, are as influential on the patient as they are on his relatives and friends, and it should not surprise anyone that the diagnosis acts on all of them as a self-fulfilling prophecy. Eventually, the patient himself accepts the diagnosis, with all of its Surplus meanings and expectations, and behaves accordingly."

Reminds me of:
Labels have Agency, Latour's Actor Network Theory
Althusser's Interpellation - internalizing one's own subjectivity - putting outside labels on yourself - you're recognize yourself as insane, less human, invisible, powerless
Critiques of psychiatry, concept of madness

Methods - experiments, ethnography & covert participant observation, continuous monitoring/focal follows

Experiment: 8 healthy adults acted as pseudopatients, call a variety of hospitals for appointment and say they're hearing voices. After admission, they resume normal behavior. See what happens. Hospitals told in advance this would happen over a given time span - some detected pseudopatients when in fact none of the actual pseudopatients had checked in. The author had ways to keep tabs on the experimenters.

Other experiments: ask staff, "Pardon me, [Mr. Or Mrs. Or Dr. ] could you tell me when I will be eligible for grounds privileges?" (or "... When I will be presented at the staff meeting?" or... "when I am likely to be discharged?") always courteous, never more than once a day. Responsiveness measured (head averted, eye contact, whether they pause and chat or move on) - scale of depersonalization.

Covert Participant Observation: All pseudopatients took extensive notes describing their stay while participating and observing - this was dismissed as pathological "writing behavior" relayed to schizophrenia symptoms.

Focal follows: Time spent by staff outside the" staff cage" (the glasses quarters containing staff). 11.3 percent for attendants, less for nurses and physicians. For the latter measured in number of emergences.

Reflexivity - though the pseudopatients knew they were sane, they struggled to resist the depersonalization


Donna Lee Davis's The Meaning of Menopause in a Newfoundland Fishing Village

Topic: How women view menopause in Gray Rock Harbor in Newfoundland and how different types of instruments succeed in measuring this.

Purpose: Critiques barring of emic perspectives from scientific medical literature and instruments. Menopause inseparable from its context. Cites Trimble critiques of etic measures - does human cognition really work the way mathematical models of etic instruments propose (scales nominal ordering, questionnaire items with no context, etc)?

Scope:

Method - emic ethnography of local understandings of menopause. Then she uses more etic instruments to see if they hold up. She found that the women struggled to with the instruments. For instance, they were often viewed as IQ tests and tried to score higher numbers rather than neutrally reporting experience.

Anth of emotions - Gray Rock Harbor is a single-occupation community. Men are fishers, Women are seen as fishermen's wives and their worry keeps their husbands afloat. This is why concept of "nerves" takes center stage in discussions of menopause. If they're not doing a good job worrying, there's a problem.

Anth of disease - folk theory - menopause is a life stage not a disease so no cure. Women go through 7 year cycles. You just get through the cycle. Mentioned sick role - women must earn it through impression management of being a good woman - being stoic is valued but suffering must be communicated - things like "it's tough but I'm not giving in."

[Mills College Library]

610.721 M885 2012