Description:

Methodological discussions within healthcare research have traditionally described a methodological dichotomy between qualitative and quantitative methods. The aim of this article is to demonstrate that such a dichotomy presents unnecessary obstacles for good research design and is methodologically and philosophically unsustainable. The issue of incommensurability is not a question of method but rather a question of the philosophical premises underpinning a given method. Thus, transparency on the philosophical level is important for validity and consistency as well as for attempts to integrate or establish an interface to other research. I argue that it is necessary to make a distinction between methodology and philosophical assumptions and to ensure consistency in these correlations. Furthermore, I argue that the question of incommensurability is best answered at this basic philosophical level. The complexity of health care calls for methodological pluralism and creativity that utilises the strength of both qualitative and quantitative approaches. Transparency and consistency on the philosophical level can facilitate new mixed methods research designs that may be promising methodological assets for healthcare research. I believe we are ill-served by fortified positions that continue to uphold old battle lines. Empirical research begins in the field of practice and requires a certain amount of pragmatism. However, this pragmatism must be philosophically informed. A global shift in the setting of healthcare from hospitals and long-term care institutions to homes and communities has been accompanied by the growth of interest in the home as a site of healthcare research. Home care researchers have identified the recruitment of research subjects as a significant concern. The present descriptive, exploratory study used qualitative, semi-structured interviews with home care researchers (n = 9) to illuminate the challenges related to recruitment.

The results suggest that while home care research shares recruitment issues common to other forms of health research, it has unique concerns. Factors affecting recruitment in home care studies include non-dedicated recruiters, the current context of healthcare restructuring, and gatekeeper and participant feelings about the home as a setting for care and research. Reasons for refusal to participate may be more complex in home care research given the meanings care recipients attribute to their ‘homes’. Home care researchers may also face unique ethical and/or moral dilemmas. This paper recommends the routine reporting of recruitment problems, increased inclusion of minority subjects to ensure sample representativeness and further studies of the subjective meanings of ‘home’ as it is associated with healthcare treatment. Carolyn M. Clancy, MD, serves as Director of the Agency for Healthcare Research and Quality (AHRQ) in the U.S. Department of Health and Human Services (DHHS). Prior to her appointment as director on February 5, 2003, Dr. Clancy served as AHRQ's acting director (since March 2002) and before that as director of AHRQ's Center for Outcomes and Effectiveness Research (COER). Dr. Clancy is a general internist and health services researcher and a graduate of Boston College and the University of Massachusetts Medical Schools. Following clinical training in internal medicine, Dr. Clancy was a Henry Kaiser Family Foundation Fellow at the University of Pennsylvania. She was also an assistant professor in the Department of Internal Medicine at the Medical College of Virginia in Richmond prior to joining AHRQ in 1990. Her major research interests include women's health, primary care, access to care, and the effect of financial incentives on physicians' decisions. She holds an academic appointment at The George Washington University School of Medicine (Clinical Associate Professor, Department of Medicine) and serves as Senior Associate Editor, Health Services Research. Dr. Clancy is a member of the editorial boards of several journals (American Journal of Public Health; Journal of Evaluation in Clinical Practice; Annals of Family Medicine, and Medical Care Research and Review), has published widely in peer-reviewed journals, and has edited or contributed to seven books.

With Regards
Willson
Journal Coordinator
Global Journal of Research and Review