Qualitative research methods: when to use them and how to judge them.
In March 2015, an impressive set of guidelines for best practice on how to incorporate psychosocial care in routine infertility care was published by the ESHRE Psychology and Counselling Guideline Development Group (ESHRE Psychology and Counselling Guideline Development Group, 2015) The authors report that the guidelines are based on a comprehensive review of the literature and we congratulate them on their meticulous compilation of evidence into a clinically useful document. However, when we read the methodology section, we were baffled and disappointed to find that evidence from research using qualitative methods was not included in the formulation of the guidelines. Despite stating that 'qualitative research has significant value to assess the lived experience of infertility and fertility treatment' the group excluded this body of evidence because qualitative research is 'not generally hypothesis driven and not objective/neutral, as the researcher puts him/herself in the position of the participant to understand how the world is from the person's perspective' Qualitative and quantitative research methods are often juxtaposed as representing two different world views. In quantitative circles, qualitative research is commonly viewed with suspicion and considered lightweight because it involves small samples which may not be representative of the broader population, it is seen as not objective, and the results are assessed as biased by the researchers' own experiences or opinions. In qualitative circles, quantitative research can be dismissed as oversimplifying individual experience in the cause of generalisation, failing to acknowledge researcher biases and expectations in research design, and requiring guesswork to understand the human meaning of aggregate data. As social scientists who investigate psychosocial aspects of human reproduction, we use qualitative and quantitative methods, separately or together, depending on the research question. The crucial part is to know when to use what method. The peer review process is a pillar of scientific publishing. One of the important roles of reviewers is to assess the scientific rigour of the studies from which authors draw their conclusions. If rigour is lacking, the paper should not be published. As with research using quantitative methods, research using qualitative methods is home to the good, the bad and the ugly. It is essential that reviewers know the difference. Rejection letters are hard to take but more often than not they are based on legitimate critique. However, from time to time it is obvious that the reviewer has little grasp of what constitutes rigour or quality in qualitative research. The first author (K.H. recently submitted a paper that reported findings from a qualitative study about fertility related knowledge and information seeking behaviour among people of reproductive age. In the rejection letter one of the reviewers (not from Human Reproduction) lamented, 'Even for a qualitative study, I would expect that some form of confidence interval and paired t tables analysis, etc. be used to analyse the significance of results' This comment reveals the reviewer's inappropriate application to qualitative research of criteria relevant only to quantitative research. In this commentary, we give illustrative examples of questions most appropriately answered using qualitative methods and provide general advice about how to appraise the scientific rigour of qualitative studies. We hope this will help the journal's reviewers and readers appreciate the legitimate place of qualitative research and ensure we do not throw the baby out with the bath water by excluding or rejecting papers simply because they report the results of qualitative studies.
Human reproduction