How Will We Know "Good" Qualitative Research When We See It? Beginning the Dialogue in Health Services Research

Health Services Research, Dec, 1999 by Kelly J. Devers

This article is organized in four sections. The first shows how the criteria traditionally used to evaluate qualitative research in health services research, and the social and clinical sciences on which they rest, stem from a philosophical perspective (i.e., positivism) most closely associated with quantitative research and methods. Although the theoretical perspectives traditionally associated with qualitative methods were often based on different paradigmatic assumptions, separate criteria were often not used to assess them historically, even by qualitative researchers themselves. In the second section, I delineate two forces that have stimulated other disciplines to reconsider the use of these criteria. Specifically, I show how the reassertion of an alternative paradigm in the social sciences (i.e., post-positivism) and the goal of putting research results into practice challenge the use of traditional criteria. Third, through a comparison of three sets of criteria proposed in primary care and medicine, I illustrate how the positivist and post-positivist paradigms are shaping the evaluation criteria proposed and used in health services research. Although these different paradigms, as well as the criteria derived from them, have much in common, there are advantages and limitations to adopting either set, or some combination of the two, in the future. The article concludes with a discussion of possible next steps for the field to take.

TRADITIONAL CRITERIA AND THEIR PHILOSOPHICAL ORIGINS

The criteria traditionally used to evaluate both qualitative and quantitative research in the basic and applied social sciences, clinical sciences, and (by extension) health services research are very familiar to researchers. They are:

* Internal validity. The degree to which findings correctly map the phenomenon in question;

* External validity. The degree to which findings can be generalized to other settings similar to the one in which the study occurred;

* Reliability. The extent to which findings can be replicated or reproduced by another investigator; and

* Objectivity. The extent to which findings are free from bias.

The philosophical origins of these criteria (including the assumptions about the social world that accompany their adoption and use) and the relationship between the philosophical perspective and methods are somewhat less familiar.

The philosophical perspective, or paradigm, that primarily underlies these criteria is positivism. Although the meaning of positivism is complex, essentially it is a philosophy that proclaims the suitability of the scientific method to all forms of knowledge (natural and social) and gives an account of what that method ideally entails. [6] The adoption of this philosophical perspective is also accompanied by a broad commitment to the idea that the social sciences should emulate the natural sciences. Of what does the positivist paradigm consist? Five frequently cited elements of this paradigm include a belief that:

1. The methods and procedures of the natural sciences are appropriate to the social sciences. This view stems from positivist ontology, that a stable, objective reality exists independent of an individual's perception.