Theoretical and methodological positions and the choice to use qualitative methods

Joanna Coast and Louise Jackson

It is assumed that the main audience for this book comprises (health) economists with an interest in using qualitative methods in their own research; this chapter therefore begins the book with a relatively accessible discussion of issues around ontology, epistemology and methodology. The nature of training in economics (Lawson 1997; Lee, Pham, et al. 2013) means that many economists reading this book may be unaware of these terms and will not have thought about these issues previously (Coast 1999). Indeed, when publishing her first article exploring these issues in a health economics journal in the late 1990s, Coast was asked to include a glossary detailing these terms, as they were deemed to be terms that health economists would generally be unfamiliar with (Coast 1999). It has been noted that economists' training does not tend to provide an understanding of data collection processes or the role of qualitative methods in complementing quantitative research, with Berik stating that 'such training would be an eye-opening and humbling experience – an essential antidote for arrogance – for economists who do not question their data' (Berik 1997, p. 124). Those with an existing sophisticated understanding (e.g., qualitative researchers reading the book because they are working with economists) may want to read this chapter not so much for its content but to become aware of the different understandings of ontology and epistemology that the economists they are working with may have.

This chapter begins by considering theories of knowledge and their application in economics, drawing on Coast's earlier paper (Coast 1999). There is much work of an explanatory nature examining issues relating to the nature of health care systems as well as health more generally. The vast majority of this work is conducted within the neoclassical framework (indeed Murphy and colleagues have noted the 'narrowness of the range of economic thought that is currently being deployed on the problems of health technology and health services' [Murphy, Dingwall, et al. 1998, p. viii]) although explanatory work can also be conducted within alternative frameworks. Normative (welfare or extra-welfare), institutional, behavioural and feminist economics are all briefly considered, as is the potential for approaches based on critical realism. The chapter then details the nature of qualitative research methods as well as the constructivist philosophy with which they are most frequently associated. From this discussion it is apparent that such a philosophy is very different from that usually associated with the discipline of economics. The nature of enquiry associated with qualitative research is briefly examined, covering details of specific data collection methods, sampling, analysis of data and ensuring rigour. Despite differences in philosophy from mainstream economics, it is apparent that qualitative methods are useful to economists, and the use of qualitative methods in health economics is then examined. It is argued that robust qualitative research can provide scientifically valuable contributions to health economic knowledge both through improving quantitative data collection, such as when generating attributes for discrete choice attributes, and through contributing directly to economic theory, particularly in complex areas such as priority setting or developing financial incentives.

UNDERSTANDING RELEVANT TERMINOLOGY

Health economists embarking on qualitative research first need some understanding about the ways in which different types of researchers understand the world. Many are likely to have a view similar to that of Coast when she started work as a junior health economist in 1990. She had completed a first degree in economics and a master's degree in health economics, and throughout these degrees, theories had been largely presented either as self-evident, and thus without the need for any supporting evidence, or in terms of economists developing hypotheses...