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and social care practitioners engage in similar practices when we could argue that although the first group may be excused through lack of exposure to health-promoting messages, the second group should really know better, through exposure to specific health education – some of which they may actually teach! Of course, this is to oversimplify what is occurring, as we know there are many factors influencing individual health behaviour. For researchers in health and social care, interested in exploring these phenomena or manifestations of behaviour, we need to know something about research philosophy if we are to understand the fundamental problems for practitioners and users of health and social care services and to ask the right questions in the right ways. Until recently, it was generally accepted that there are two main ways of coming to know the social world, by which we mean the world inhabited by social beings or communities as opposed to the world of the individual. These distinct philosophies gave rise to two paradigms (patterns of thought) referred to as the positivist and interpretivist paradigms. However, researchers now recognise the place of mixed methods research (in particular the notion of pragmatism within mixed methods) as offering an alternative but legitimate paradigm within research (we will return to this later). Before we look at the characteristics of positivism, interpretivism and mixed methods, we need to consider exactly what we mean by a paradigm and how we have arrived at a position whereby researchers generally associate themselves, rightly or wrongly, with one or another paradigm. This is important, as we need to be able to articulate how our ch_01.indd 4 13/09/2013 16:24 Understanding the language of research 5 view has informed our subsequent decisions about research design to those who share our interests and are, in turn, interested in our research findings. Research paradigms A paradigm is a set of assumptions, concepts, values and practices constituting a view of reality. In terms of research a paradigm represents a view shared by a scientific community about how we can come to know the essence of things (ontology) and how we can come to know what is true, and what is false (epistemology). Over time, scientific communities have come to hold a common set of assumptions and values and to follow certain rules in pursuit of solutions to problems in the real world. The EQUANS study The writing that follows will draw on an example of research to provide some context to what might otherwise be a quite abstract discussion. Research undertaken for the National Sickle Cell and Thalassaemia Screening Programme (a scientific community) sought to establish whether the costly processes of antenatal screening of women for sickle cell and thalassaemia genes could be targeted by focusing on women who answered an ethnicity question and placed themselves into a group at higher risk of carrying such genes (economically but potentially inequitable), or whether all women, irrespective of an answer to an ethnicity question, should be offered such screening (equitable but economically expensive), comparing different population groups undergoing different treatments across different periods (Dyson et al., 2006). The assumption underpinning the first phase of the Ethnicity and Antenatal Screening Study (EQUANS) was that it would be possible to answer the research question by undertaking a randomised controlled trial (a positivistic paradigm: more of this later). In the EQUANS study a category-based ethnicity screening question was shown to be more effective than a binary plus open-ended question. Study data were analysed using statistical tests to understand whether an ethnicity question would be sufficiently valid and reliable as a screening question to ascertain risk status for sickle cell/thalassaemia in an antenatal screening programme. ch_01.indd 5 13/09/2013 16:24 Research skills for nurses and midwives 6 The paradigm underpinning this research is positivism, because the researchers do not intend to ask the participants (in this phase of the EQUANS study) about their experiences, feelings or views regarding screening, but rather have chosen to gather numerical data, which can be subjected to statistical tests to measure the error rate between midwife and participant (pregnant women) assignment of ethnicity. In utilising an essentially positivistic approach the EQUANs study was able to show that using the more effective question, 5.74% (CI 2.34–11.46%) of significant haemoglobinopathies will be missed in a selective screening programme, and 4.33% (CI 2.63–6.68%) of replies to an ethnicity screening question will be unreliable when compared to information given upon re-interview (Dyson et al., 2006). Positivism Positivists believe the goal of science is to uncover the truth. Consequently, a positivist would view science as a means of getting at the truth in order to understand the world well enough to predict and control it. Stereotypically, scientists are depicted wearing white coats and based in laboratories. This image was certainly true in the past, supported by popular imagery such as television and film. Positivistic scientists are interested in observing what can be seen (phenomena), describing what is seen and measuring what is seen. Knowledge of
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