Response to Critically Appraised Paper, ‘Patient perspectives of hand osteoarthritis in relation to current measures of function’

Abstract

Dear Editor, Thank you for critically appraising our article and for your thoughtful comments and suggestions. We agree fully with what you write; however, we would like to raise the following issue. Several different theories, opinions and methodologies as well as differences in epistemology and ontology underpinning qualitative research exist. Choices and decisions have to be made by the researcher (Finlay & Ballinger, 2006). Qualitative research may benefit from this diversity and methodological discussion. In contrast with acknowledging such diversity in research methods, the dominant research paradigm in health and medicine in Austria, the country where we live and conduct our research, is rather one dimensional and follows a biomedical, positivist and natural science understanding of health and illness (Stamm, 2009). Editors (and reviewers) of international medical journals – which are ‘important’ in Austria in terms of their (medical) impact factor – may share this view. Our experience with raising money for qualitative projects as well as with publishing studies is thus ambivalent. As we feel that it is essential to bring qualitative projects to the knowledge of the (bio)medical audience, we had to argue for these projects and develop them within this existing context to get projects funded and studies accepted. Another example is that we included Kappa calculations for agreement between researchers in qualitative studies to make them more ‘attractive’ for a biomedical audience (Stamm et al., 2007), thus placing our study in a post-positivist research paradigm. However, firstly, we had to establish our position and research group within this predominantly positivist research culture (in terms of funding, impact factor and publications in top-medical journals); then secondly, we had the resources and self-reflection from our learning history within different research cultures to conduct and publish qualitative projects that acknowledged – for example – a textual and narrative approach to understand human experiences (Stamm et al., 2008a, 2008b). As this biomedical, positivist and natural science research tradition in our own learning history played an important part, we still feel that accepting a diversity of research methods in qualitative research that represents the continuum of methodology, including the context and environment in which the data have been ‘produced’, is essential.