Where history meets qualitative health research

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Where history meets qualitative health research

• Dr Claire Hooker
• Public Health Sciences

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Aims

• To reflect on the differences (if any) between
  historical research in the history of health and
  medicine, and qualitative research in health and
  medicine
• To discuss the utility and consequences of
  formalising research procedures
• To identify what we could do better

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Aims

• purpose??

• Reinventing the wheel
• Conversation and pleasure
• Intuition, nuance, experience, perception

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My narrative

• Honours, PhD in history
• History and material culture of public health in
  Australia
• History and Philosophy ( a lot of sociology) of
  science
• Political history of tobacco control in Australia
• Public health sciences

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Disciplinary Shock

• obfuscate, confuse, elude, obscure, mislead,
  betray, lie
• A methods section
• qualitative research software, textbooks, a
  whole journal
• chronologies
• . What would this have looked like if Id done
  it in history/ HPS?

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The historian approaches

• Principles
• to make things strange
• Symmetry
• To scrutinise power/ knowledge relations,
  expertise, hegemonies
• To understand which means, to identify the wider
  context and its interaction at a local level, and
  especially to celebrate complexity, ambivalence,
  confoundings
• All of this is probably inimical to actually
  achieving tobacco control!

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and goes to work

• What did smoking mean to people?
• what discourses were used to support tobacco
  control?
• How did it feel to be a company executive or a
  premier?
• Why did company practices develop as they did?
• How was thinking about tobacco control shaped by
  thinking about concepts like risk or drugs?
• What insights can the history of tobacco control
  offer into a late modern therapeutic consumer
  culture?
• NB - these are not the same questions that
  older generations of historians might have asked

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How?

• Gathering material
• Oral history
• Listening to the material
• Versus
• document research
• semi structured or open ended interviews
• Coded / thematic analysis

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Outcomes

• For the tobacco control group
• Chronologies
• A few criticisms of magicked quotations
• recommendations to Senate committees
• For me
• Notion of deliberation
• A discourse about drugs
• A new moralism
• relations between politicians were complicated by
  adherence to particular political cultures that
  had changed over the period of tobacco control

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History v Qual Health Research

• History looks at change - qual looks at the
  present
• History has more of a focus on meta issues
  qual more focused on specifics
• Qual health research is fundamentally
  instrumental history is not
• Qual health research is formalised history is
  not
• Major implication in comparison to history, qual
  makes claims on objectivity and predictability
  that history does not (indeed, is opposed to in
  some sense)

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Evidence!

• theory and method 1992 Ranke structuralism
  Annales school Marx and historical materialism
  Gramsci and hegemony (political history) social
  history cultural history feminist history
  postmodern history
• 2003 ideas about evidence history wars audio
  visual material memory biography movies
  public
• What is not included statistics, history of
  ideas, political history, military history,
  archiving, and paradigm shift, inter alia

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But wait! Not so fast!

• History IS a form of qualitative research!
• I could start by telling you who uses them
  philosophers, psychologists, sociologists,
  anthropologists, students of literature,
  historians, biologists...anyone, in fact, who
  finds the methods of the physical sciences
  somehow inappropriate for understanding human
  (and, occasionally, even animal) realities. C.
  George Boeree
• http//www.ship.edu/cgboeree/qualmethone.html

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Current Philosophical Similarities

• Both stand in critical relation to quantitative
  research qualitative research exchanges the
  tyranny of numbers for the enigma of words
• rooted in a non tangible domain, fundamentally
  experiential and intuitive
• polyvocal attempts at interfacing with
  cultural / linguistic/ relational accounts of the
  real. They are therefore interpretations, not
  truths in the positivist sense
• www.nova.edu/ssss/QR/QR9-1/jones.pdf

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Hence, similarities in analytical methods

• Narrative
• Storytelling
• Identity
• Frames
• Reflexive
• Differences between history of public health and
  qualitative studies in public health would seem
  to lie in scope, focus, interest, language (best
  described qualitatively!)

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Grappling with validity

• both feel that their accounts capture some aspect
  of truth
• Both try to generalise from multiple instances
• Both try to explain river systems as well eddies
  both generate macro and micro levels of theory
• Both make claims to influence future actions

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Process similarities

• oral history and interview are concerned with
  memory, context, how the interviewers relation
  with the subject alters things, how the subject
  constructs their narrative.
• both grapple with issues of authenticity,
  reliability and truth
• both require their practitioners to go through an
  informal process of trying to get themselves out
  of the picture
• Coding turned out to be the same! I just didnt
  count

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Ill be better next time?

• The IMRD format can really help crystallise the
  purpose of your research, and whether the method
  is adequate for that purpose
• A methods section can help ensure your research
  is sufficiently complete, and invites
  readers/reviewers to scrutinise whether your
  conclusions are justified
• To historians I should think this would help in
  the interpretive questions they claim to be
  interested in what can we learn from each piece
  of evidence?
• ie formalising ones methods in advance and at
  the conclusion of research, like peer review, can
  aid in objectivity, the strength of research

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Ill also always be an historian

• A narrative piece invites playfulness, new kinds
  of coherence, intuitive and experiential facets
  for the audience
• Making strange, attention to change, and
  attention to a variety of evidence are good ways
  of keeping macro and micro engaged with each
  other, and of being constructively critical and
  reflexive

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Conclusions and Implications

• Method should be thought of as dynamic until the
  paper is published it is a kind of grappling
• Private research audits are probably a good idea
• Dialogue and deliberation are even better ones
• Living in someone elses discipline once every 15
  years is really good for you