Evidence-based medicine favors quantitative research over qualitative research. How do you, on the other hand, feel about the latter?
My answer will be biased. As early as my dissertation days, this predilection of mine for qualitative research was born.
I remember being fascinated by the richness of the narratives, the uniqueness and variety of meanings provided by the people interviewed, and the challenge posed by the botton-up approach, typical of qualitative research, coming to formulate an interpretation of the observed phenomenon from the very words of the research participants.
The process is similar to a quantitative analysis of data through inferential statistics: I share the same fascination with colleagues capable of making “numbers speak,” only with qualitative research it is the very words spoken by people that communicate and guide us toward a particular direction or interpretation of the phenomenon. Here, in recent years, I have witnessed an effort, in terms of openness and acceptance, on the part of evidence-based medicine to take into account the results obtained from qualitative research, although the bias of weak or unhelpful research due to the fact that its results cannot be generalized always remains, and this has always hindered its dissemination in the evidence-based field. A bias that, more often than not, stems from a lack of knowledge of the methods and tools of qualitative research, its purpose and what it enables it to bring to research in general.
What do you think of Narrative Medicine as qualitative research?
Narrative Medicine itself is not qualitative research but, as we know, a methodology of clinical care intervention that draws methods and tools from qualitative research, as well as quantitative of course. It comes closest to the methods and tools made available by qualitative research because it has in common with narrative medicine the descriptive and exploratory intent of a phenomenon, which in the case of narrative medicine concerns the patient’s illness story and its narrative.
In this regard, as the Consensus Conference summary document reminds us, “Narrative is the fundamental tool for capturing, understanding, and integrating the different points of view of those involved in the disease and the treatment process. The goal is the shared construction of a personalized care pathway (care story).” For the acquisition and understanding of these different points of view, qualitative research with its tools and methods can certainly intervene, dialoguing, if the researcher deems it necessary, also with the tools made available by quantitative research.
How do you feel about mixed methods using quantitative and qualitative research?
I am a strong advocate of mixed methods. Where it is possible-qualitative research may require a greater commitment in terms of cost and time to carry out-a study that comes about by integrating the two methods will be able to communicate more complete results of the phenomenon being investigated and return a richer, more detailed and multifaceted picture of the phenomenon itself.
This is because research that adopts a mixed approach interfaces with the research process in circular terms. The interesting thing, in fact, is that in mixed methods there is an ongoing reflection on the research process itself, with the possibility of rethinking the methodological choices made and adapting them according to the results obtained in the process.
There is less linearity and rigidity. In the literature we can find numerous research contributions that adopt the mixed approach; if the phenomenon being investigated is little known, there is a tendency to favor in the initial phase the conduct of a qualitative study, which is then followed by a quantitative study. There is no shortage, however, of research contributions that started with a quantitative investigation that, based on the results obtained, then veered into deepening some significant elements with a qualitative study. I recommend their reading. So in general, whenever possible, I think it is the most comprehensive form of conducting research.
How to abolish biases about qualitative research and Narrative Medicine in such a quantitative society?
To abolish these biases I believe we can act on two fronts. First, by not giving up conducting qualitative research despite the obvious difficulties in publishing qualitative research studies in some clearly “quantitative” journals. Second, by stimulating the training of health professionals not only with regard to the typical acts of narrative medicine, but also with regard to the research activity that should revolve around it. The latter encourages participation in moments of communication, through seminars or conferences, with respect to its training and research activities, with the result of bringing members of the scientific community closer and closer to narrative medicine. Therefore, my suggestion is to encourage the sharing and knowledge, including through the organization of training events, of qualitative research applied to narrative medicine. Without this sharing, the study of common practices or the testing of narrative based interventions is not possible.
Prof. Covelli is an expert in Narrative Medicine and Research and in 2017 published the book «Medicina Narrativa e Ricerca. Prospettive teorico-metodologiche multidisciplinari per la raccolta e l’analisi delle narrazioni dei pazienti» Lybellula University Press.