Response to commentary on: ‘Qualitative research: its practical contribution to physiotherapy’

Abstract

We welcome the commentary concerning our recent paper, both because it was gracious (which was encouraging in what can sometimes seem the rather ghoulish cut and thrust of academic life), and because the author reminded us that there are ‘risks’ associated with an increased emphasis on qualitative research. Although anonymized, the content suggests the author was Jan Ritchie, and we are grateful for her insightful thoughts over time, as well as those in response to our paper. Ritchie supports the majority of our arguments and appreciated our examples of the potential application of qualitative methods in physiotherapy. In particular, she welcomed our observation that on occasion, and in some contexts, proponents of qualitative or quantitative approaches seem to have been occupied with pointless debate over the merit of one methodology over another rather than focusing on the key task of research and healthcare — to answer questions of import. While on the whole, we too are encouraged that there has been a shift towards understanding the place of qualitative work, we continue to witness events that indicate not all are persuaded. At a recent international conference, the dominance of an apparent bias typifying all qualitative work as ‘soft’ was disappointing. And, in the past 12 months, we have heard people (including leading researchers) in various research contexts (too many to mention) argue that quality in research is necessarily and directly associated with the size of the sample. Such an argument would mean a study with n5800 is somehow always going to be better than a study with n520 regardless of appropriateness of the design, and key questions around quality and rigour. Despite the intuitive appeal that ‘more is better’, the argument is fallacious. Large population studies can at times be unethical either because they didn’t need to be that large, or because design flaws mean they still fail to answer the question despite the huge costs associated. Variants of the ‘more is better’ argument will probably continue to be heard in grant funding committees, international conferences, and reviews of curricula vitae for academic promotions the world over. It is a shame — but perhaps it is just too tempting to use ‘more’ and ‘bigger’ as a short hand for excellence. So what is the right sample size for a qualitative project? Like quantitative research, there is no magic number — it depends on the question and how variable the sample of interest is, or is required to answer that question. A particularly timely caution from Ritchie was that we should not allow an enthusiasm for the new knowledge that can be gained by qualitative approaches, to bring about a foolhardy ‘anyone can do it’ approach. There are specific technical skills required, and expertise comes both from education (informal and formal) as well as from working with experienced researchers, just as one would if learning the ropes of gait analysis or signal processing. Our own experience is that qualitative methods stretch researchers just as much as (and sometimes more than) quantitative work. Preparation is not only advisable but necessary. Partnership with people who have the required skills is a good place to start if you are new to qualitative research. It is far better than uninformed dabbling, which will do nothing to contribute to the development of knowledge, and risks providing substance to the negative stereotypes that many (including Ritchie) have worked hard to diminish. We agree robust randomized clinical trials (RCTs) rightly remain the gold standard for determining Correspondence to: K. McPherson, Private Bag 92006, Auckland, New Zealand. Email: kathryn.mcpherson@aut.ac.nz