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By O. Tuwas. Lubbock Christian University.

Deciding which methodology is right for you Don’t fall into the trap which many beginning (and ex- perienced) researchers do in thinking that quantitative re- search is ‘better’ than qualitative research quality lasix 100 mg. Neither is better than the other – they are just different and both have their strengths and weaknesses cheap lasix 40mg online. What you will find, however, is that your instincts probably lean you towards one rather than the other. Listen to these instincts as you will find it more productive to conduct the type of re- search with which you will feel comfortable, especially if you’re to keep your motivation levels high. Also, be aware of the fact that your tutor or boss might prefer one type of research over the other. If this is the case, you might have a harder time justifying your chosen methodology, if it goes against their preferences. EXAMPLES OF QUALITATIVE RESEARCH METHODOLGIES Action research Some researchers believe that action research is a re- search method, but in my opinion it is better under- stood as a methodology. In action research, the researcher works in close collaboration with a group of people to improve a situation in a particular setting. The researcher does not ‘do’ research ‘on’ people, but instead works with them, acting as a facilitator. There- fore, good group management skills and an under- standing of group dynamics are important skills for HOW TO DECIDE UPON A METHODOLOGY / 17 the researcher to acquire. This type of research is pop- ular in areas such as organisational management, com- munity development, education and agriculture. Action research begins with a process of communica- tion and agreement between people who want to change something together. Obviously, not all people within an organisation will be willing to become co-researchers, so action research tends to take place with a small group of dedicated people who are open to new ideas and willing to step back and reflect on these ideas. The group then moves through four stages of planning, acting, observing and reflecting. This process may hap- pen several times before everyone is happy that the changes have been implemented in the best possible way. In action research various types of research meth- od may be used, for example: the diagnosing and eval- uating stage questionnaires, interviews and focus groups may be used to gauge opinion on the proposed changes. Ethnography Ethnography has its roots in anthropology and was a popular form of inquiry at the turn of the century when anthropologists travelled the world in search of remote tribes. The emphasis in ethnography is on describing and interpreting cultural behaviour. Ethnographers im- merse themselves in the lives and culture of the group being studied, often living with that group for months on end. These researchers participate in a groups’ activ- ities whilst observing its behaviour, taking notes, con- ducting interviews, analysing, reflecting and writing 18 / PRACTICAL RESEARCH METHODS reports – this may be called fieldwork or participant ob- servation. Ethnographers highlight the importance of the written text because this is how they portray the cul- ture they are studying. Feminist research There is some argument about whether feminist inquiry should be considered a methodology or epistemology, but in my opinion it can be both. Epistemology, on the other hand, is the study of the nature of knowledge and justification. Often, in the past, research was conducted on male ‘subjects’ and the results generalised to the whole popu- lation. Feminist researchers critique both the research topics and the methods used; especially those which em- phasise objective, scientific ‘truth’. With its emphasis on participative, qualitative inquiry, feminist research has provided a valuable alternative framework for research- ers who have felt uncomfortable with treating people as research ‘objects’. Under the umbrella of feminist re- search are various different standpoints – these are dis- cussed in considerable depth in some of the texts listed at the end of this chapter. Grounded theory Grounded theory is a methodology which was first laid out in 1967 by two researchers named Glaser and HOW TO DECIDE UPON A METHODOLOGY / 19 Strauss. It tends to be a popular form of inquiry in the areas of education and health research.

The widespread acceptance of this outlook is all the more remarkable if you consider the extent to which it contradicts most people’s experience lasix 100 mg with mastercard. As Peele writes buy cheap lasix 40 mg online, ‘people regularly quit smoking, cut back drinking, lose weight, improve their health, create healthy love relationships, raise strong and happy children and contribute to communities and combat wrong—all without expert intervention’ (Peele 1995:29). I wonder whether expert intervention is in fact often counterproductive. This is most clearly apparent in relation to methadone maintenance where the goal of abstinence is replaced with that of indefinite dependence. But there is also a marked tendency for vulnerable people to develop 113 THE EXPANSION OF HEALTH an ongoing dependence on therapy, which is as likely to confirm their inadequacy as it is to enable them to overcome it. Counselling and Prozac Doctors of all sorts, notably psychiatrists and GPs, have helped to encourage the inflation of addiction and other psychological disorders and the demand for medical or psychological treatment that follows from it. Experts are continually advising us of the need to identify problem drinkers and others with ‘substance abuse’ problems so that they can be offered appropriate treatment. In 1992 the Health of the Nation white paper identified mental health as a key area and, for the first time, set targets on reducing the suicide rate. The neglect of any means of achieving this (or indeed its other targets) meant that this policy had little consequence, but this defect was remedied when the New Labour government after 1997 also established a target. It also sponsored a ‘Defeat Depression’ campaign, which sought to encourage GPs to increase their diagnosis of depression, in the hope that this would facilitate treatment and thus reduce the suicide rate. Treatments on offer in the surgery fall into two broad categories: counselling and medication. A BMJ editorial in 1993 noted that, even though ‘many attempts to evaluate its effectiveness have shown little or no benefit’, counselling had rapidly become established in general practice in Britain (Pringle, Laverty 1993). The authors noted that ‘as well as its general indications in anxiety and depression, and problems with relationships’, counselling had been advocated for ‘smoking cessation, modification of diet, alcohol misuse, postnatal depression, addiction to tranquillisers, and high risk sexual behaviour’. The government-imposed GP contract in 1990 had encouraged the provision of counselling in general practice by agreeing to reimburse up to 70 per cent of the cost. The later growth of fundholding practices gave a further boost to the employment of counsellors in the surgery. The theme of Pringle and Laverty’s editorial was ‘reasons for caution’ about the explosion of counselling in general practice, given the lack of evidence of effectiveness and uncertainties about confidentiality, qualifications and accreditation. There was a generally negative response to their editorial, and particularly to their suggestion that ‘the main reason for GPs’ enthusiasm for 114 THE EXPANSION OF HEALTH counselling may well be a desire to reduce contact with and responsibility for a very demanding group of patients’. One critic insisted that GPs ‘were not just avoiding “heartsink” patients, as the editorial suggests, but recognised the mutual benefit of bringing new skills and knowledge into the practice and extending the range of options within the primary care team’ (Jewell 1993). Counselling was one of those initiatives whose value was considered self-evident. Attempts to investigate its effectiveness were all very well, but should not be allowed to delay its implementa-tion. The provision of counselling in GPs’ surgeries was a radical departure with a number of significant features, not the least of which was the fact that it generally passed without much comment. It indicated that GPs were prepared to provide treatment, within the framework of the primary health care team, for a range of personal problems not previously considered to fall within the sphere of medical practice. Furthermore they were prepared to refer their own patients to unregistered practitioners in a way which, a few years earlier, would have led to a summons to appear before the General Medical Council. As GP Myles Harris, one of the few critics of this trend, pointed out, ‘the idea of the medical register was to protect the public against untested therapies and counselling has no substantial agreed body of scientific evidence to back its claims’ (Harris 1994:24). Harris was concerned that doctors were turning their backs on their traditions of scientific medicine and ‘in allowing counsellors into the NHS we may be deserting medicine for magic’. The fact that the government agreed to subsidise these counselling services indicated that it was ‘ready to treat ordinary human difficulties as illnesses’ (Harris 1994:6). Yet this also carried the danger of allowing the state, through the agency of counsellors, to define ‘what is “normal” in everyday behaviour’. The fact that coun-selling was already mandatory for HIV testing revealed the tendency towards compulsion that is often closely linked to the idea of normality.

Whatever the fate of Tony Blair’s subordination of the NHS to electoral expediency cheap lasix 100mg online, it is time to expose the deeper processes of the medicalisation of life and the corruption of medicine cheap 40 mg lasix fast delivery. In relation to my earlier dispute with the Department of Health, I would like to acknowledge the support of Diane Abbott, Mildred Blaxter, Gene Feder, Michael Neve, Peter Toon and Tony Stanton. In relation to this book, I am especially grateful to Mary Langan for assistance in many areas and to my medical colleagues Matthew Bench, Tricia Bohn, Gabriella Clouter, Chris Derrett, Janet Williams and Fayez Botros. Thanks are also due to Toby Andrew, Jennifer Cunningham, John Fitzpatrick, Liz Frayn, Heather Gibson, John Gillott, Sally Goble, James Heartfield, Brid Hehir, Gavin Poynter, Mark Wilks. I am particularly thankful to Mick Hume, the x PREFACE courageous editor of LM magazine, where many of the ideas developed here first appeared. I also pay tribute to all the staff and patients at Barton House Health Centre to whom this book is dedicated. Michael Fitzpatrick April 2000 xi GLOSSARY OF ACRONYMS ADHD Attention Deficit Hyperactivity Disorder Aids Acquired Immune Deficiency Syndrome ASH Action on Smoking and Health BMA British Medical Association BMJ British Medical Journal BSE Bovine Spongiform Encephalopathy (aka Mad Cow Disease) CHD Coronary Heart Disease CJD Creutzfeldt-Jakob Disease (also nvCJD: new variant CJD) CMO Chief Medical Officer DHSS Department of Health and Social Security DoH Department of Health ETS Environmental Tobacco Smoke (inhaled by passive smokers) GMC General Medical Council GP General Practitioner HIV Human Immunodeficiency Virus ME Myalgic Encephalomyelitis (aka Chronic Fatigue Syndrome) NHS National Health Service NICE National Institute of Clinical Excellence PHA Public Health Alliance RCGP Royal College of General Practitioners RCP Royal College of Physicians RCPsych Royal College of Psychiatrists UNICEF United Nations Children’s Fund WHO World Health Organisation xii 1 INTRODUCTION We live in strange times. People in Western society live longer and healthier lives than ever before. There is a widespread conviction that the modern Western diet and lifestyle are uniquely unhealthy and are the main causes of the contemporary epidemics of cancer, heart disease and strokes. The fears provoked and sustained by an apparently endless series of health scares, backed up by government and public health campaigns, tend to encourage a sense of individual responsibility for disease. In exploring these trends, this book seeks to advance what to many will seem a counter-intuitive proposition— that the government’s public health policy is really a programme of social control packaged as health promotion. In responding to, and even more by fomenting, increasing public anxiety, the government is seizing the opportunity to introduce a new framework within which people can more comfortably live, so long as they adhere to new rules and accept an unprecedented degree of supervision of their personal lives. In 1999 the New Labour government in Britain declared its commitment to the promotion of health and the prevention of disease in the White Paper Saving Lives: Our Healthier Nation (DoH 1999). The government set targets by which progress could be measured in reducing rates of heart disease and strokes, accidents, cancers and suicides. The public health White Paper put forward a strategy to link national targets to local initiatives, and it outlined plans to pursue health goals in schools, workplaces and neighbourhoods. It aimed to replace exhortations to behave virtuously (stop smoking, curtail drinking, take exercise, eat healthily, etc. In this way the government offered the prospect of a longer life—but at the cost of 1 INTRODUCTION an even more extensive and intrusive system of state regulation of individual behaviour. Working as a general practitioner, I am struck by the contrast between two types of patient. I see many young people, usually in professional occupations, who worry about their health, watch their diet and take regular exercise. They also seek regular check-ups and screening tests for various diseases. I also see many old people, often former manual workers, who have never been much concerned about their health and have rarely modified their lifestyles or consulted their doctors with a view to preserving it. If you congratulate them on their longevity, they often say that they only wish they had not lived so long. Sometimes they even request my help in assisting their escape from the misery of loneliness, infirmity and poverty. To the former, government health campaigns are a welcome response to a heightened sense of individual vulnerability to environmental dangers. The popular resonance for appeals for greater health awareness reflects the anxieties and insecurities that particularly afflict the younger and more prosperous sections of society. To an older and less affluent generation, these campaigns simply confirm the shift of the health service, as well as other institutions in society, away from any real concern for their needs. The positive response to official public health documents, such as Saving Lives and earlier health promotion initiatives, from the medical profession and the media in general, indicates the widespread acceptance of the basic assumptions of these programmes. But, aside from the specific proposals, some questions arise concerning the underlying principles. We can begin by noting a striking paradox: at a time when, by any objective criterion, people enjoy better health than at any time in human history, the government appears driven to ever greater levels of intervention to improve people’s health. Take life expectancy: the commitment to increase it is the first of the ‘aims’ proclaimed by the White Paper.