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Sym posium : Cl in ical Epidemiology and Research Methods- I I

Quantitative Vs Qualitative Research MethodsM . L a k s h m a n , L e e n a S i n h a , M o u m i t a B i s w a s , M a r y a n n C h a r l e s a n d N . K . A r o r aD e p a r t m e n t o f P e d i a tr i c s , A l l In d i a In s t i t u t e o f M e d i c a l S c i e n c e s , N ew D e l h iAbst rac t. Quantitative methods have been widely used because of the fact that things that can be measured or counted gainscientific credibility over the unmeasurable. But the extent of biological abnormality, severity, consequences and the im pact ofillness cannot be satisfactorily captured a nd answ ered by the quantitative research alone. In such situations qualitative methodstake a holistic perspective preserving the complexities of human behavior by addressing the "why" and "how" questions. In thispaper an attempt has been made to highlight the strengths and weaknesses of both the methods and also that a balanced mixof both qualitative as well as quantitative methods yield the most valid and reliable results. [In dian J ourna l of P edi atr ics ,2000; 67 (5) : 369-377]Key words Quali tat ive research; Q uanti tat ive research; Strength; Limitat ionsTh e almost sole recognition given t ~ quantitative m ethod shas t ra ined s tudents inadequa te ly , es tab l ished f lawedstandards of prac t ice and research , and delayed thed ev e lo p men t o f e s sen t ia l med ica l k n o w led g e. W h enqualitative metho ds are clearly established in ou r researchrepertoire, the advance of medical knowledge will be greadyaccelerated1.

Aetiological and he alth services research is dom inat edby quanti tat ive m ethods. Research tends to be consideredreal and serious only whe n it uses these approaches som uc hso that quantificat ion has acquired a bogus value - i fsom ething can be meas ured or coun ted, it gains a scientificcredibil i ty often not applicable to the unmeasured orunmea surable. Because of this, a fin ding is mo re likely tobe accep ted as a fact if it has been q uantif ied th an if it hasnot . O n occasions, our affini ty with numb ers goes evenfurther. Sometimes, we may suspend our critical facultieswhen facedwith quantitat ive information, whether derivedfrom routine or ad hoc sources. As a result, many wellknown , widely accepted "facts" of dou btful accuracy havebecom e entrenched in our supposed knowledge of health,disease, and health care, such as that one couple in ten isinfertile, one hospital bed in ten in the USA is for intensivecare, and the prevalence of co rona ry heart disease initiallyrose and is now declining. Th e scientific bases for all theseclaims are doubtfuP.

Objective results were defined as those which werereproducible in the experience of others a nd which couldpredict futur e events unde r similar circumstances. BecauseReprint requests: Narendra K. Arora, Additional Professor,Department of Pediatrics, All India Institute of Medical Sciences,New Delhi-110 029

of the complexity of natural events (e.g. chemical andphysical reactions, inheritance of characteristics, growthand development) a dominant method in the quest forobjectivi ty was reductionism 3. Reductionism seeks, byreducing the num ber of reactants of variables in a stud y tothe min imum to ob ta in incont rovert ib le in format ionabout a given material or interact ion, and he nce achieveobjectivi ty. These approaches have com e to be kn own asquanti tat ive research. As scientific inquiry becam e m orewidely valued, it was applied outside natural science toimportant social, cultural, psychological and economicissues 1.

Quanti tat ive methods examine the effects of specifiedcircumstances (independent variable) on an ou tcom e ofinterest (de pen den t variable) in ways that can be expressednumerically. In these settings, causal inferences are drawneither from direct observation, as in true experiments, orfrom associations established th rou gh statistical analysis.Th ey are most effect ive when the conte nt is so constrainedor controlled that the study events are free of any undefinedinfluence. Unde r those circumstances, reproducibil i ty ishigh and the results are likely to predict, reliably, theoutc om e of the same event in future.

Th e re sh o u ld b e n o d o u b t ab o u t t h e en o rmo u saccomplishm ents of reductionist strategies and meth odsp e n e t r a t i n g i n f o r m a t i o n a b o u t t h e f u n d a m e n t a lcomponents of biological systems and their functionalpotentials. They have also yielded important diagnosticand therapeutic tools. But i t is also undeniable thatconventional biomedical research has not provided decisiveinformat ion about the or ig ins or m anagement of the mostp rev a l en t co n t emp o ra ry med ica l p ro b l ems , n ame ly ,

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M . L a k s h m a n e t a L

c h r o n i c i l ln e ss es . C h r o n i c i l ln e s s , w h i c h c o n s i s t s O f t h ec h r o n i c b i o l o g i c a l a b n o r m a l i t y ( t h e d i s e a s e ) a n d i t sc o n s e q u e n c e s ( d i s c o m f o r t , d i s a b i l i t y , e m o t i o n a l d i s t r e s s ,l i m i t e d s o c ia l f u n c t i o n ) u n f o l d s o v e r ti m e . T h e e x t e n t o ft h e b i o l o g ic a l a b n o r m a l i t y a n d o f t h e v a r i o u s c o n s e q u e n c e sd e t e r m i n e s t h e s e v e r it y a n d i m p a c t o f th e i ll n e ss w h i c hq u a n t i t a t i v e r e s e a rc h a l o n e c a n n o t s a t i s fa c t o r il y c a p t u r eand a n s w e r 1.

S u r v e y r es ea rc h n o w d o m i n a t e s s o c i o e c o n o m i ci n v e s t i g a t io n s f o r n a t i o n a l p l a n n i n g a n d p r o g r a me v a l u a t io n i n th e d e v e l o p i n g c o u n t r ie s . D a t a c a n b eq u a n t i f i e d a n d a g g r e g a t e r e s u l t s p r e s e n t e d c o n c i s e l y .S o p h i s t i c a t e d s t a t i s t i c a l m e t h o d s c a n b e u s e d t o a s s e s sr e l a ti o n s h i p s b e t w e e n t h e v a r ia b l es m e a s u r e d . I n a d d i t i o n ,s u r v e y s a re f a ir ly e as y t o d e s i g n a n d q u i c k t o i m p l e m e n t .Q u e s t i o n n a i r e f o r m s ar e o f t e n s t a n d a r d i z e d , t h e r e b yi n c r e a s i n g t h e r el ia b il it y, c o m p a r a b i l i t y , a n d p r e c i s i o n o fd a t a f r o m o n e r e g i o n o r t i m e f r a m e t o a n o t h e r 4"s.

N e v e r t h e le s s , s o m e o f t h e s c h o l a r s ar e q u i t e o p e n i nt h e i r c r i t ic i s m o f t h e u s e o f s u rv e y s i n t h e t h i r d w o r l d .C h e n a n d Murray6h a v e d e v i s e d t h e f o l l o w i n g d e s c r i p ti v ed e f i n i t i o n " A r u r a l t h i r d w o r l d s u r v e y i s t h e c a r e f u lc o l l e c t i o n , t a b u l a t i o n , a n d a n a l y s i s o f w i l d g u e s s e s , h a l f -t r u t h s , a n d o u t r i g h t l ie s m e t i c u l o u s l y r e c o r d e d b y g u l l ib l eo u t s i d e r s d u r i n g i n t e rv i e w s w i t h s u s p i c i o u s , i n t i m i d a t e d ,b u t o u t w a r d l y c o m p l i a n t v i ll a g er s" .Q u a n t i t a t iv e R e s e a r c h C a n n o t A n s w e r A l lP r o b l e m s !I n r e l a t i o n t o m e d i c i n e , t h e r e s u l t s p e r t a i n i n g t o a ni n d i v i d u a l i n e v e n t h e b e s t c o n t r o l l e d t h e r a p e u t i c t ri a l m a yb e q u i t e d i f f e r e n t f r o m t h e a v e r a g e r e s u l t s p e r t a i n i n g t ot h e g r o u p . T h i s t r u i s m s i m p l y r ef le c ts t h e c o m m o n l yr e c o g n i z e d e r ro r o f a t t r i b u t i n g t o a n i n d i v i d u a l , t h o s ep r o p e r t i e s w h i c h a p p l y c o l le c t i v e ly t o a g r o u p , a n d i tsr e l e v a n c e i s p e rv a s i v e i n m e d i c a l r e s e a r c h . Y e t t h e t r u i s md o e s n o t a c c u r a te l y c h a ra c t e ri z e t h e c o m p l e x i t y o f e i th e rm e d i c a l r e s e a r c h o r p r a c t i c e . M e d i c i n e i s a l s o c o n c e r n e dw i t h g r o u p r e s u lt s. C l i n i c ia n s k n o w t h a t o n e c a n n o tu n d e r s t a n d a p a t i e n t w i t h o u t k n o w i n g b o t h t h e g e n er a la t t r i b u t e s o f t h e d i s e a s e s t a t e ( e. g. c a n c e r , o b s t r u c t i v e l u n gd i s e a s e ) a n d t h e p a r t i c u l a r s o f t h e p a t i e n t ' s d i s e a s e a n di ll n es s . T h e c r it ic a l n e e d i s t o u n d e r s t a n d w h e r e g e n e r a l it ye n d s a n d i n d i v i d u a l i t y b e g i n s , a n d t h a t r e q u i r e s m e r g i n gt h e t w o t y p e s o f k n o w l e d g e . H o w e v e r , o n l y g e n e r alk n o w l e d g e i s r e ve a le d b y r a n d o m i z e d c l in i c a l t ri a ls , a n dt h e n a l s o i n a g g r e g a t e f o r m , d e v o i d o f t h e i n f o r m a t i v ec l in i c a l r i c h n e ss o f a m o s a i c o f i n d i v i d u a l p a t t e r n s k

A n o t h e r i n s t a n c e i s c h r o n i c i l l n e s s c r e a t i n g d i s a b i l i t i e s ,d i s c o m f o r t s a n d a c c u m u l a t i n g c o st s. B e c a u se i t c a n n o t b ec u r e d , it m u s t be m a n a g e d , a n d m o s t m a n a g e m e n tp r a ct ic e s h a v e b o t h b e n e f it s a n d f l a w s .T h e s t u d y o f c h r o n i cd i se a s e is r e p l e t e w i t h i ss u e s f o r w h i c h q u a l i t a t iv e m e t h o d sa r e p e r t i n e n t . I n c h r o n i c i l l n e s s p a t i e n t ' s u n d e r s t a n d i n go f t h e i ll n e ss c an b e a c r u c i a l d e t e r m i n a n t t o t h e d e s i g n i n go f a t r e a t m e n t p r o g r a m a n d i ts su c c e ss7 . I n t h e s e d i v e r s es e t ti n g s , a n e x p l a n a t i o n o f e v e n t s c a n a l m o s t c e r t a i n l y n o tb e o b t a i n e d w i t h o u t i n q u i r y i n t o t h e p e r c e p t io n s , a t t it u d e sa n d b e h a v i o r s o f t h o s e w h o a r e i n v o l v e d .L i m i t a t io n s o f Q u a n t i ta t i v e R e s e a r c hQ u a n t i t a t i v e d a t a , n o m a t t e r h o w r i g o r o u s l y c o l l e c t e d , i ss ti ll v u l n e ra b l e . E v e n r o u t i n e m o r t a l i t y d a t a c a n b em i s l e ad i n g . T h e i n t e rn a t i o n a ll y r e p o r t e d i n f a n t m o r t a l i tyr a te f o r F r a n c e i s a n u n d e r e s t i m a t e a s it e x c l u d e s n e o n t a ld e a t h s i n b a b i e s w e i g h i n g l es s t h a n 5 0 0 g a t b i r t h a s t h e s ea re d e f i n e d a s s t il l b ir t h s. I m p r e c i s i o n i n d e f i n i n g t h e c a u s eo f d e a t h h a s r e n d e r e d m u c h o b s e r v a ti o n a l q u a n t i t a t iv er e se a r ch o n c o r o n a r y h e a r t d i s e a se s u s p e c t s'9 . T h e c u r r e n tb e l i e f t h a t m o r t a l i t y f r o m c o r o n a r y h e a r t d i s e a se h a sd e c l i n e d b y a b o u t 3 0 % i n se ve ra l d e v e l o p e d c o u n t r i e s m a ys i m p l y r e fl e c t se c u l a r c h a n g e s i n d i a g n o s t i c c h o i c e s j u s t a st h e e a r l i e r s u p p o s e d r i s e i n i n c i d e n c e m a y h a v e b e e n a na r te f a c t. M e a n w h i l e , b o t h s u p p o s e d "f ac ts " h a v e i n f l u e n c e dt h e d i r e c t i o n o f r e s e a rc h o n t h e p r e v e n t i o n o f t h e d i s e a s e 2.

N o m a t t e r h o w w e l l a q u e s t io n n a i r e h a s b e e n d e v e l o p e d ,p r e t e s te d a n d r ev i se d , so m e r e s p o n d e n t s m a y h a v ep r o b l e m s o f re ca ll; s o m e m a y m i s u n d e r s t a n d a q u e s t i o n ; aq u e s t i o n n a i r e t o p i c m a y b e t o o s e n s i t i v e ; a r e s p o n d e n tm i g h t k n o w i n g l y li e t o p r o j e c t a d e s i r e d i m a g e o r b e c a u s eh e o r s h e f e ar s a n e g a t i v e c o n s e q u e n c e o f a t r u t h f u lr e s p o n s e . A p e r v a s i v e p r o b l e m , p a r t i c u l a r l y i n r u r a l a r e a so f d e v e l o p i n g c o u n t r ie s , i s th a t r e s p o n d e n t s a n s w e r w h a tt h a t t h e y p r e s u m e t h e i n t e rv i e w e r w i s h e s t o h e a r , a p r o b l e ms o m e t i m e s r e f e r r e d t o a s " c o u r t e s y b i a s '1 ~

C a m p b e l l a n d h i s c o l l e g u e s 11 w e r e i n v o l v e d i n a ni n t e n s i v e c r o s s- c h e c k i n g o f d a t a o b t a i n e d f r o m a f e r ti l it ya n d K A P f a m i l y p l a n n i n g s u rv e y in N e p a l a n d r e p o r t e dt h a t t h e s u r v e y er ro r s o n m a n y t o p i c s w e r e q u i t e h i g h t h u sq u e s t i o n i n g t h e a n a l y t ic a l a n d p o l i c y c o n c l u s i o n s t h a t h a v eb e e n b a s e d o n s u c h s t u d i es . H o w e v e r , t h e e r r o rs u n c o v e r e df o r s o m e o t h e r t o p i c s w e r e n o m i n a l o r i n s i g n i f ic a n t . T h ep l a u s i b l e e x p l a n a t i o n s , a s h a v e e m e r g e d f r o m c a s u a lc o n v e r s a t i o n s a n d u n s t r u c t u r e d i n t e r v i e w s , a r e p r e s e n t e db e l o w .

T h e i r s u r v e y r e c o r d e d f a r h i g h e r l e v e l s q f a w a r e n e s s

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Q u a n t i t a t i v e V s Q u a l i t a t i v e R e s e a r c h M e t h o d s

o f c o n t r a c e p t i v e me a su r e s in c l u d i n g a b o r t i o n a n d f a mi l yp lann ing serv ices than w ere recorded in th e N epal Fer t i li t yS u r ve y o r i n t h e c o m p a ra b l e F P / M C H s u rv e y12. T hi s wa sf o u n d t o b e d u e t o t h e u s e o f h i g h s o u n d i n g w o r d s w h i c hw e r e n o t f a mi l i a r t o t h e r u r a l f o l k . T h e s e l i n g u i s t i cp rob lems remain in a ques t ionnai re even a f t e r p re t es t ingand "back t rans l a tions" in to Eng l i sh .

S o m e q u e s t o i n n a i r e i t e m s w e r e n o t m e r e l ymi s u n d e r s t o o d , b u t w e r e c o n s i s t e n t l y r e i n t e r p r e t e d i nt e rms o f responden t s ' soc ia l and cu l tu ra l va lues , a p rob leminheren t in su rvey research i t s e l f . Th i s p rob lem and i t sma n i f e s t a t i o n is r e f e r r e d a s " c o n t e x t u a l b i a s" . P e o p l er e s p o n d n o t t o t h e f o r ma l c o n t e n t o f a q u e s ti o n b u t t o t h emean ing ( the conno ta t ions and as soc ia t ions ) . A case inpo in t f rom the i r s tudy concerns the in i t i a l ques t ion onabor t ion . S ince abor t ion i s cons idered by the NepaleseH ind u a nd B uddh i s t t rad i t ions to be a rel igious s in , m an yr e s p o n d e n t s f e l t a w k w a r d o r i n s u l t e d b y t h e q u e s t i o n" H a v e y o u h e a r d o f a b or t io n ? " a n d f e n d e d i t o f f w i t h anega t ive response . To pub l i c ly admi t t o knowing mucha b o u t a b o r t i o n w o u l d s ug g e st t h a t o n e m a y h a v e o n e s e l fpart ic ipated in this s inful beha vior 12.

A s a g e n e r a l r u le t h e y f o u n d t h a t r e s p o n d e n t s t e n d e dto in t e rp re t m os t ques t ions persona l ly and as sum ed tha tthe ques t ion w as des igned to e l i c i t de ta i l s o f the i r persona le x p e r i e n c e . Fo r e x a mp l e , t h e q u e s t i o n " D o y o u k n o wwh ere to go fo r fam i ly p lann ing serv ices?" was in t e rp re t edas "Do you go there?" o r in a more genera l sense , " Jus th o w mu c h d o y o u p e r s o n a l ly k n o w a b o u t s e xu a l ma t t e r sa n y w a y ? " A b e t t e r w a y o f p u t t i n g t h e s a me q u e r y w o u l dhave been "Where do o ther peop le who t ake p i l l s , u sec o n d o m s o r u n d e r g o o p e r a ti o n s g o f o r f a mi l y p la n n in g ? "

W o m e n w h o r e p o r t e d li tt le k n o w l e d g e o f f a m i l yp l a n n i n g w e r e n o t a b l e t o r e s p o n d t o t h e s e q u e s t i o n sbecause the in t e rv iewers were e i ther males , s t rangers o ro ther re l a t ives and ne ighbours were p resen t a t t he t ime.M an y ru ra l peop le wi ll fend o f f in t e rv iew ques t ions abou tfam ily plan ning because, regardless of thei r actual beha viorin p r iva te , i t i s cu l tu ra l ly unaccep tab le fo r them. Thereare a num be r o f norm s , va lues and soc ia l i n s t i t u t ions tha treward abu nda n t fe r t il i ty and pun i sh ch i ld l es sness o r lowfert i l i ty13,14.W h a t i s Q u a l i t a ti v e R e s e a r c h ?Qual i t a t ive inqu i ry app l i es to s i tua t ions where re l evan tvari ab les p ro ducin g an ou tco m e are no t apparen t o r wheret h e n u m b e r o f su b je c ts o r o u t c o m e s u n d e r s t u d y a r einsu ffic ien t for statistical analysis 15'Is. Sub jects m ay var yin s ize f rom an ind iv idua l to l a rge g roups , an d the focus

o f s t u d y m a y v a r y f r o m a p a r t ic u l a r b e h a v i o r t o t h ef u n c t i o n o f a c o m p l e x i n s t i t u t i o n . I n v e s t i g a t o r s a r econ cern ed wi th th e be li efs, m ot iva t ions and ac t ions o fpeople, organizat ions or ins t i tu t ions . Invest igative m eth odsi n c l u d e s t r u c t u r e d o r o p e n e n d e d i n t e r v i e w s , e x t e r n a lo b s e r v a t i o n o r o b s e r v a t io n b y p a r t i c i p a t i o n , a n din te rp re t a t ion o f wr i t t e n m ater i a l. Class ica l exam ples a rean th ropo log ica l s tud ies o f a cu l tu re , soc io log ica l s tud ieso f an ins t i tu t ion and psycho log ica l s tud ies o f a behav io r ;i n m a n y w a y s , t h e c l i n ic a l p r a ct ic e o f m e d i c i n e i s a n o t h e rexample . As a genera l ru l e , p rac t i t ioners o f quan t i t a t iveinvest igat ions , part icularly natural scient is ts have lookedup on ~lual itative inq uiry as less r igorous o r objec t ive, lessgenera li zab le , an d henc e l es s m er i to r ious 1.

Q u a l i t a t iv e m e t h o d s a r e m o s t r e v e al in g w h e nc o n t e x t u a l f o r c e s a r e i l l - d e f in e d , u n c o n t r o l l e d o rs i tua t iona l .Th i s d i s t inc t ion emphas izes tha t un ders t and ingi s no t s yno nym ous wi th un iversa l ity o r p red ic t ab i l i ty ; t het h r e e ma y a c c o r d , b u t o f t e n a n a c c u r a t e u n d e r s t a n d i n g o fa n e v e n t o r a n o u t c o me is i d io s y n c r at i c a n d t i me b o u n d * .The focus may range f rom a s ing le ind iv idua l o r smal lg roup , such as the in t e rac t ion be tween a hea l th p ro fess iona land a pa t i en t , t o the func t ion ing o f a l a rge o rgan iza t ion ,such as a hospi tal . In essence i t is research tha t helps u s tou n d e r s t a n d t h e n a t u r e , s t r e n g t h s , a n d i n t e r a c t i o n s o fvariables . Like quant i tat ive research, qual i tat ive researchc a n a d d r e s s * c a u s a t i o n a n d i n v o l v e s o b s e r v a t i o n a n din te rp re t a t ion o f even t s . Un l ike quan t i t a t ive research , its eeks to answer "what " and no t the " how of t en" que s t ion .Thu s , ra the r than ad op t ing a s impl i f ied , reduc t ion i s t v i ewof the sub jec t in o rder to m easure and c oun t the occur ren ceo f s t a te o r e v e n t s , q u a l it a t iv e me t h o d s t a k e a h o l i s t i cperspec t ive which p reserves the complex i t i es o f humanbehav io r 9 .S y n t h e s i s o f Q u a n t i t a t i v e a n d Q u a l i t a t i v eR e s e a r c h M e t h o d sW e c a n b e n e f it e n o r m o u s l y f r o m t h e q u a n t if i c a t io n o fmany aspec t s o f the phys ica l , soc ia l and psycho log ica lw o r l d s . I n d e e d , i t i s t h e u n d e n i a b l e i m p o r t a n c e o fquan t i ta t ive enqu i ry tha t makes the need fo r improv eme nt sin i t s conduct so c ruc ia l . Th i s can be ach ieved in th reeways . F ir st , by the deve lopm ent o f more soph i s t i ca t edstat is tical m eth od s for han dl ing quan t i tat ive data. Seco nd,b y u s i n g q u a n t i t a t i v e a n d q u a l i t a t iv e m e t h o d s i nc o mb i n a t i o n . A n d t h i r d , b y a c k n o w l e d g i n g t h a t s o mes i tua tions a re inev i t ab ly bey ond the scope o f quan t i t a t iveme t h o d s b u t c o u l d b e i n v e s ti g a te d mo r e a p p r o p r i a t e l y b yqual i t a tive m ethod s 2.

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M . L a k s h m a n e t a l .

I n t h e l a s t f e w y e ar s th e r e h a s b e e n c o n s i d e r a b l e i n t e r e s ti n e n c o u r a g i n g d o c t o r s t o a u d i t t h e i r w o rk . T o p r o m o t et h i s , m a n y q u a n t i t a t i v e s u r v e y s w e r e c a r r i e d o u t t o f i n do u t t h e v i e w s o f d o c t o r s . N e e d le s s to s a y, w h e n c o n f r o n t e dw i t h c lo s e e n d e d q u e s t i o n s o n a u d i t , m o s t r e s p o n d e d i nt h e p o l i t i c a l ly c o r re c t w a y a n d s t a t e d t h a t t h e y w e r e i nf a v o u r o f p e e r r ev i e w a n d o t h e r s u c h n o b l e i d e a ls .M e a n w h i l e , o b s e r v a ti o n a l r e p o r t s s h o w e d t h a t l i t tl e o r n oa u d i t w as ta k i n g p l ac e . T h e a p p a r e n t c o n t r a d i c t i o nb e t w e e n i n t e n t a n d a c t i o n w a s e x p l a i n e d b y a q u a l i t a ti v ee n q u i r y i n v o l v i n g d e t a i l e d i n t e r v ie w s w i t h d o c t o r s o f a llg r a d e s a n d o b s e r v a t i o n s o f c l in i c a l m e e t i n g s ~ T h i s r e v e a l e d1 9 r e as o n s w h y d o c t o r s w e re u n c e r t a i n o r u n s u p p o r t i v eo f a u d it , m o s t o f w h i c h h a d n o t b e e n a d d r e s se d i n t h ep r e v i o u s q u a n t i t a t i v e s t u d i e s . I t s u g g e s t e d t h a t u n l e s s th eu n d e r l y i n g a n x i e t i e s a n d c o n c e r n s w e r e a d d r e s s e d , t h ei n t r o d u c t i o n a n d a c c e p t an c e o f a u d i t w o u l d c o n t i n u e t ob e u n s u c c e s s f u l2.

Q u a n t i t a t i v e m e t h o d s w o r k b e s t w h e n t h e r e i s am i n i m u m o f d e p e n d e n t va ri ab le s, a ll u n d e r t h e c o n t r o l o ft h e i n v e s t i g a t o r , a n d w h e n t h e s u b j e c t s a re b o t hh o m o g e n o u s a n d p as siv e. T h e p r o b l e m s w e h a v e b e e nd i s c u s s i n g i n m e d i c i n e a r i s e w h e n c i r c u m s t a n c e s a r ed i f f e r e n t e . g . v a r ia b l e s a r e d i v e r s e , o n l y s o m e v a r i a b l e s a r ek n o w n t o t h e i n v e s t i g a t o r o r a r e m e a s u r a b l e , a n dh e t e r o g e n o u s s u b j e c t s a re a c t iv e l y p u r s u i n g t h e i r l i v es i n ac h a n g i n g e n v i r o n m e n t w h i l e t h e s t u d y p r o c e e d s . H e r e ,u n d e r s t a n d i n g t h e n a t u r e , s t r e n g t h s a n d i n t e r a c t i o n s o ft h e v a r i a b l e s i s u s u a l l y e s s e n t ia l . Q u a l i t a t i v e r e s e a r c hm e t h o d s , b y p r o v i d i n g a c ce ss to p o t e n t i a l l y c r u c i a li n f o r m a t i o n w h i c h o t h e r w i s e m u s t b e s u r m i s e d b y t h ei n v e s ti g a to r , c a n y i e l d t h e e s s e n ti a l u n d e r s t a n d i n g . T h e ya re , th e r ef o re , c e n tr a l a n d c o m p l e m e n t a r y c o m p o n e n t s i nt h e i n v e s t i g a t o r ' s a rs e n a l o f t o o l s k

Q u a n t i t a ti v e a n d q u a l it a ti v e m e t h o d s c a n b e e m p l o y e ds e q u e n t i a l l y o r s i m u l t a n e o u s l y i n a s i n g l e s t u d y . A s a ne x a m p l e o f s e q u e n t i a l u s e - w h e n a n u n e x p l a i n e dq u a n t i t a t i v e o u t c o m e is o b t a i n e d f r o m a s t u d y , t h ep a r t i c i p a n t s c a n b e a p p r o a c h e d t o e l i c i t a n e x p l a n a t i o na n d a n i n s t r u m e n t d e s i g n e d t o t e s t t h e s t a t e d r e a s o n s .A p p l i c a t io n o f th e i n s t r u m e n t y i e ld s a n o t h e r s et o fq u a n t i t a t i v e d a t a w h i c h m a y a ff i rm o r r e f u te t h e a c c u r a c yo f t h e r e a so n s f o r t h e g r o u p a s a w h o l e .

C u r r e n t t r e n d s i n c li n i c a l s o c i al s c i e n c e a n d i n m e d i c a la n t h r o p o l g y a r g u e f or t h e r e le v a n ce o f e t h n o g r a p h i cr e se a rc h m e t h o d s i n t h e s t u d y o f p ro b l e m s p r e s e n t e d inp r i m a r y c a r e s e t t i n g s . G r o u n d e d i n t h e e x p e r i e n c e o fe v e r y d a y l if e , q u a l i t a t i v e m e t h o d s ar e s u i t e d t o i n t e r p r e t i n g

t h e s e m a n t i c s o f h u m a n e x p e r i e n c e 2 ''2 2, t h e s o c i a ld e t e r m i n a n t s o f c u l t u ra l m e a n i n g s 7 , a n d t h e p r o c e ss e s o fi n d i v i d u a l a n d s o c ia l c h a n g e ~3. I n a d d i t i o n , t h e q u a l i t a t i v em e t h o d s a l s o p e r m i t t h e r e s e a r c h t o b e d a t a b a c k e d ,p a r t i c u l a r l y w i t h r e g a r d t o b o d i l y a n d h e a l t h r e l a t e de x p e r i e n c e s a n d t o t h e n a t u r a l h i s t o r y o f i ll n e ss , h e a l t ha n d d i s ea s e e x p e r i e n c e s24.

Q u a n t i t a t i v e r e su l ts c a n b e m i s l e a d i n g b e c a u s ei n s u f f ic i e n t a t t e n t i o n m i g h t b e p a i d t o t h e w a y" t h e d a t aw e r e c r e a t e d e .g . h o w v a r ia b l e s w e r e d e f i n e d , t h e e x t e n t o fa d h e r e n c e t o t h o s e d e f i n i t i o n s , a n d h o w t h e d a t a w e r ec o ll e ct e d. U s e d i n c o m b i n a t i o n , q u a l it a ti v e m e t h o d s c a nh e l p t o i m p r o v e t h e a c c u r a c y a n d r e le v a n c e o f q u a n t i t a t i v es t ud i e s b y i n c re a s in g o u r u n d e r s t a n d i n g o f t h e c r e a t i o n o fq u a n t i t a t iv e d a t a , a n a c t i v i ty k n o w n a s e t h n o s t a t i s ti c s 2 .

Q u a li ta t iv e m e t h o d s s u p p l e m e n t a n d c o m p l e m e n t t h eu n d e r s t a n d i n g s r e v e al e d b y q u a n t i t a t iv e m e t h o d s a n d a r ea ls o a f e r t il e s o u r c e o f h y p o t h e s e s f o r f u t u r e i n q u i r i e s o fb o t h t y p e s . D e s p i t e t h e d i s t i n c t i o n s b e t w e e n t h e t w om e t h o d o l o g i c a l a p p ro a c h e s , b o t h p o s se s s s t ru c t u r e s a n dm e a n s o f e v a l u a ti n g r e s u lt s w h i c h , w h e n a p p l i e d c o r r e c tl y ,a r e r ig or o us 15'25~6. I n r ece nt y ea r s , the d i sc ip l in e o f c l in ica le p i d e m i o l o g y h a s e s t a b l is h e d t h e d e c is iv e i m p o r t a n c e o fa n a l y z i n g a n d e v a l u a t i n g c l i n i c a l p r a c t i c e . A p p r o p r i a t ei n c l u s i o n o f q u a l i t a ti v e m o d e s o f e n q u i r y w i l l g re a t lye n h a n c e t h e p r o c e s s . T r u e u n d e r s t a n d i n g i n m e d i c i n ec a n n o t b e a c h i e v e d w i t h o u t a d d i n g q u a l i t a t i v e m e t h o d st o t h e r e se a r ch a r s e n al . A n d i t re i te r a te s a c a n o n o f s o u n di n v e s t i g a ti o n , i.e . t h e m e t h o d s e m p l o y e d s h o u l d b e f i t t h eq u e s t i o n a s k e d a n d n o t v i c e v e rs a .

F o l l o w i n g a d e c l i n e i n t h e p r e v a l en c e o f b r e a st f e e d i n gi n t h e 1 9 5 0 s a n d 1 9 6 0 s ( t o 5 0 - 6 0 % o f m o t h e r s ) , A u s t r a l i ae x p e r i e n c e d a n i n c re a s e in t h e 1 9 7 0 s a n d 1 9 8 0 s , s o t h a tr e c e n t s tu d i e s c l a i m p r e v a l e n c e o f 8 0 % o r m o r e o f b r e a s tf e e d in g a m o n g s t m o t h e r s l e a v in g h o s p i t a l s .T h e i n c i d e n c ea n d d u r a t i o n o f b r ea s t f e ed i n g i n A u s tr a li a a re a m o n g s tt h e h i g h e s t f o r w e s t e r n i n d u s t r i a l i z e d n a t i o n s a n d h i g h e rt h a n m a n y d e v e l o p i n g c o u n t r ie s . H o w e v e r , t h e r e i s c o n c e r na t c u r r e n t l e ve ls o f c e s sa t i o n o f b r e a s t f e e d i n g ; o n l y a b o u t5 0 % o f A u s t r a l ia n w o m e n a re s ti ll b r e a s t f e e d i n g a t 3m o n t h s . T h i s p a t t e r n o f h i g h i n c i d e n c e o f b r e as t f e e d i n gi n h o s p i t a l s, f o l l o w e d b y a r a t h e r d r a m a t i c d e c l i n e i n t h ef i rs t t h r e e m o n t h s o f t h e b a b i e s ' l iv e s, h a s b e e n r e v e a l e db y a s e ri es o f q u a n t i t a t i v e s t u d i e s ~7.

H o w e v e r , e t h n o g r a p h i c s t u d ie s w e r e c o n d u c t e ds u b s e q u e n t l y , l o o k i n g a t t h e i s s u e f r o m a c u l t u r a lp e r s p e c t i v e . T h e s e r e v e a l e d t h a t t h e e x p e r i e n c e o f

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Q u a n t i t a t i v e V s Q u a l i t a t i v e R e s e a r c h M e t h o d s

' i n s u f f i c i e n t m i l k ' w a s r e l a t ed t o th e m o t h e r ' sm i s i n t e r p r e t a ti o n o f t h e n o r m a l p h y s i o l o g ic a l c h an g e s i nt h e b r e a s t s , o r c h a n g e s i n t h e b a b y ' s b e h a v i o r t o ad i m i n u t i o n i n m i l k s u pp l y. T h e p r o d u c t i o n i s t m o d e ls u g g e s ts t h a t t h e y f ee l a n x i o u s a b o u t t h e i r a b i li t y to m e e tp r o d u c t i o n t a r g e ts . W o m e n ' s b r e a st s ar e a p o w e r f u l s y m b o lo f f e m a l e se x u a li ty ; w o m e n h a v e a m b i g u o u s f e e l in g s a b o u tt h e i r u s e f o r a n i n s t r u m e n t a l i s t p u r p o c , . T h e y f e el s u b j e c t e dt o p r e s s u r e f r o m t h e i r h u s b a n d s w h o a r e j e a l o u s o f t h eb a b y ' s c l a i m s o n t h e i r b o d y . I n a so c i e t y ; w h i c h s t r es s e sp e rs o n al a u t o n o m y a n d i n d iv i d u al is m , t h e d e m a n d s o ft h e n u r s i n g i n f a n t ar e a t o d d s w i t h a w o m e n ' s q u e s t f o ra u t o n o m y . I t m a y b e " i n s u f l q d e n t m i l k ' , d r a w i n g a s it d o e so n t h e p r o d u c t i o n i s t a n d m e c h a n i c a l m e t a p h o r s o f th eb o d y p r e v a l e n t i n m e d i c a l d i sc o u r s e , p r o v i d i n g a s o c ia l lya c c e p ta b l e re s p o n se b y w o m e n w h o w i s h t o d i s c o n t i n u eb r e a s t f e e d i n g f o r o t h e r r e a s o n s .L a stl y, m o r e i n t e n s i v e q u a l it a t iv e f i e l d w o r k m e t h o d sc o u l d b e o f a s si s t a n c e t o a s u r v e y , p r e c i s e l y b e c a u s e t h e s em e t h o d s a r e a d a p t e d t o c r o s s -c u l t u ra l r e se a r c h a n d t o t h ep o s it iv e u s e o f c o n t e x t i n t h e s t u d y o f h u m a n b e h a vi o r.T h e s e q u a l i t a t i v e m e t h o d s c o u l d b e u s e d t o p r o v i d eg u i d e l i n e s f o r s u r v e y d e s i g n s , t o p r o v i d e a m e a n s o fc h e c k i n g a n d m e a s u r i n g n o n s a m p l i n g e r ro r s, a n d t o o b t a i nd a t a o n t o p i c s f or w h i c h t h e su r v e y m e t h o d isi n a p p r o p r i a t e .M e t h o d s o f Q u a l i ta t iv e R e s e a r c hQ u a l i t a t i v e s o c i o c u l t u r a l f ie l d m e t h o d s p r o v i d e t h e " e m i c 'o b s e r v a t i o n s ( a n i n s i d e r 's v i e w ) b e c a u s e o f t h e s u s t a i n e di n t e r a c t i o n o f th e r e s e a rc h e r w i t h t h e p e o p l e b e i n g s t u d i e di n t h e i r o w n l a n g u a g e a n d i n t h e i r o w n t e rr it o r y . O b j e c t i v ed e s c r i p t io n s a r e d r a w n t h r o u g h m e t h o d s s u c h asp a r t i c i p a n t o b s e r v a t i o n , l if e h i s t o r i e s, c o n t e n t a n a l y s is a n do p e n - e n d e d i n t e r v i e w s . Q u a l i t a t i v e m e t h o d s a l s o o f f e rs t r o n g v a l i d i t y c h e c k s r e g a r d i n g t h e k n o w l e d g e , b e l i e f s ,p r ac ti c es a n d l if e e v e n ts o f p e o p le . S o m e c o m m o n l y u s e dq u a l i t a ti v e m e t h o d s a r e li s te d i n T a b le 1 a lo n g w i t h t h e i rc h a r a c t e r i s t i c f e a t u re s .E n s u r i n g Q u a l i ty i n Q u a l i t a t iv e R e s e a r c hQ u a l i t a t i v e o r q u a n t i t a t i v e r e s e a r c h m e t h o d s a r e n o tc o m p l e t e i n t h e m s e lv e s a n d c a n n o t a n s w e r t h e q u e s t i o n sf ul ly . H o w e v e r , t h e re s h o u l d b e q u a l i t y c h e c k s w h i c h w o u l dm a k e t h e d a t a v a l i d a s w e ll a s re l ia b l e . T h e f o l l o w i n g q u a l i t yc h e c k s m u s t b e i n c o r p o r a t e d i n q u a l i ta t i v e s tu d i e s .

R e a s o n f o r t h e r e s e a r c h a n d c l e a r l y f o r m u l a t e dq u e s t i o n s s h o u l d b e s t a t e d b e f o r e s ta r t i n g a s t u d y : T h i sn e e d s t o b e t a k e n c a r e o f i n q u a l i t a t i v e s t u d i e s a s w e l l

b e c a u s e t h e r e i s n o s c i e n ti f ic v a lu e i n i n t e r v i e w i n g o ro b s e r v i n g p e o p l e j u s t f o r t h e s a k e o f it . T h e r e i s n e e dt o u n d e r s t a n d t h e a p p r o p ri a te n e s s o f a n a p p r o a c h a n du t il iz e t h e a p p r o p r i a t e r e s ea r c h m e t h o d s u i t e d t o t h er e se a r ch q u e s t i o n .T h e r e is a lw a y s a n e e d f o r t r a i n i n g b e f o r e i n i t i a t i n gt h e s t u d y so as to b r i n g a b o u t a c o m m o nu n d e r s t a n d i n g a m o n g t h e i n v e s t i g a t o r s b y t a k i n gc o l l e c t i v e d e c i s i o n s . T h i s d e f i n i t e l y h e l p s t o r e s o lv et h e d i f fe r e n c e s i n o p i n i o n w h i c h i n e v i t a b l y e m e r g e i ft h e p r o c e d u r e s a r e u n f a m i l i a r . I n l a r g e s c a l e s t u d i e sc o v e r i n g a r e a s w i t h d i f f e r e n t l a n g u a g e s , d i f f e r e n tt r a n s l a t io n p r o c e d u r e s a re a m a j o r s o u r c e o fi n t r o d u c i n g e r ro r i n t h e st ud )~ T h e r e f o r e , a c o m m o np r o c e d u r e m a y b e a d o p t e d . S i m i l ar p r o c e d u r e sa d o p t e d f o r fi e ld w o r k a n d d a t a p r o c e s s in g r e d u c e t h ec h a n c e o f v a r ia b i l it y d u e t o i n d i v i d u a l b i as . G r e a t e ri n v o l v e m e n t o f p r in c i p a l i n v e s ti g a to r s i n t h e f ie l da c t i v i t i e s a c t s a s a q u a l i t y c h e c k . T h e s t u d y d e s i g n ,s p e c i f i c t o p i c s a n d t h e m o d e r a t o r g u i d e l i n e s f o rc o n d u c t i n g t h e s e s s i o n o r i n t e r v i e w s m a x i m i z ec o m m o n f e a t u r e s w h i l e r e m a i n i n g s e n s i t i v e t o t h ec u l t u r e s o f t h e s p e c i f i c so c i e t ie s .T h e r e i s a c o n t r a s t i n s e l e c t i o n o f s t u d y s e t t i n g a n ds t a ti s ti c a l s a m p l i n g o f q u a n t i t a t i v e a n d q u a l i t a t i v er e s ea r c h . A tr u l y r a n d o m s a m p l e i s v i ta l f o rq u a n t i t a t iv e s t u d i e s t o e n s u r e t h a t t h e r e su l ts r e fl e c t,o n a v e r ag e , th e c o n d i t i o n o f t h e p o p u l a t i o n f r o mw h i c h t h e s a m p l e w a s d r a w n . B u t i n q u a l it a t iv er e se a r c h t h e p r e f e r e n c e is to w a r d s d e v e l o p i n g a nu n d e r s t a n d i n g o f t h e e x p e r ie n c e s o f t h e i n d i v i d u a l o rg r o u p t h e re b y g a i n i n g i n - d e p t h k n o w l e d g e o f ap a r t i c u l a r i s s u e b y d e l i b e r a t e l y s e l e c t i n g i n d i v i d u a l s .I t is i m p o r t a n t t o r e c o g n i z e t h e r e s e a rc h e r 's p e r s p e c t iv e .I n q u a l i t a t i v e r e s ea r c h , t h e re i s n o w a y o f a v o i d i n g o rf u ll y c o n t r o l l i n g t h e o b s e r v e r b i a s 2 s. T h u s , i n - d e p t hi n t e r v i e w s o r f o c u s g r o u p d i s c u s s i o n s s h o u l dp r e f e r a b l y b e t a p e r e c o r d e d , f u l l y t r a n s c r i b e d , a n da c c u r a t e l y t r a n s l a t e d . T h i s b i a s c a l l b e f u r t h e rm i n i m i z e d i f t h e r e s e a rc h e r d e t a i l s w h e r e t h er e se a rc h e rs a re c o m i n g f r o m s o t h a t t h e r e su l ts c a n b ei n t e r p r e t e d a c c o r d in g l y .M e t h o d o l o g y f o r c o ll e c ti o n o f d a t a a n d a d e t ai l edd e s c r i p t i o n o f th e s e m e t h o d s n e e d s t o b e g i v e n fo rb o t h t y p es o f s t u d y d e s i g n s. T h e q u a n t i t a t i v em e t h o d o l o g y , a lt h o u g h e x t e n si v e, m a y b e s u m m e d u pi n t o a s i n g le s e n t e n c e g i v i n g r e fe r e n c e t o a s t a n d a r dt e x t b u t t h e q u a l i ta t iv e m e t h o d s c a n n o t b o w r i t t e n i n

Indian Jou ma l of Pediatrics, 2000; 67 (5) 373

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M . L a k s h m a n e t a l .

TA BLE 1 . C o m m o n Q u a l i t a ti v e R e s e a r c h M e t h o d s w i t h t h e i r C h a r a c t e r is t i c F e a t u r e sP a r t i c i p a n t 9o b s e r v a t i o n

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S t r u c t u r e d , o p e n -e n d e d i n t e r v i e w

F o c u s g r o u pd i s c u s s i o n ( F G D )

Q u a l i t a t i v e c a s e -c o n t r o l r e s e a r c hd e s i g n

Q u a l i t a t i v ec o n t r a s t i n g g r o u p s

Q u a l i t a t i v el o n g i t u d i n a l d e s i g n

Q u a l i t a t i v e c r o s s -s e c t i o n a l d e s i g n

M e t h o d w h e r e i n v e s t i g a t o r i s n o t m e r e l y a d e t a c h e d o b s e r v e r o f t h e l iv e s a n d a c t i v it i e s o f t h ep e o p l e u n d e r s t u d y b u t i s a l s o a p a r t ic i p a n t i n t h e i r ro u n d o f d a i l y a c t iv i ti e s .I t i s a k e y m e t h o d b y w h i c h t h e r e s e a r c h e r c a n d i s c o v e r t h e r e l a t io n s h i p b e t w e e n k n o w l e d g e ,a t t i t ude an d p r ac t i c e s ( K A P ) . I n te r vi ew s and s e l f ad n t n i s t e~ d ~ on l y p r ov i de t he r es ea r c he rw i t h i n fo r m a ti on abou t w ha t pes p l e s ay t hey do , w h i c h has a v a r i ab l e r s 4al Jom h ip t o w h a t t hey m ayactua l ly do.

9 T h e r e s e a rc h e r m a y a l s o h a v e a s m a l l n u m b e r o f i n d i v id u a l s f ro m w h o m h e / s h e c a n o b t a i na l a r g e a m o u n t o f d e t a i l e d i n f o r m a t i o n a b o u t p a r t i c u la r to p i c s o r t h e g e n e r a l l if e o f t h e c o m m u n i t y .

9 I t i s u s e d t o b e s t a d v a n t a g e w h e n i t i s c l o s e l y li n k e d w i t h p a r t i c ip a n t o b s e r v a t i o n o r o t h e r m e t h o d s .T h e r e s e a r c h e r n e e d s t o b e a b l e t o a s s e s s t h e i n f o r m a n t ' s s t a t u s w i t h i n t h e g r o u p u n d e r s t u d y .

9 I t r e v e a l s w h a t p e o p l e t h i n k a n d f e e l, h o w t h e y s e e e v e n t s a n d t h e w o r l d a r o u n d t h e m . I n t e r v i e w sa r e t y p e o f c o n v e r s a t i o n s t h a t a r e u s e d t o c h e c k d a t a o b t a i n e d f r o m p a r t i c i p a n t o b s e r v a t i o n ,t o g a t h e r i n f o r m a t i o n a b o u t a c o m m u n i t y , a n d t o o b t a i n s p e c i f i c i n f o r m a t i o n a b o u t b e l i e f s a n dbehav i o r .

9 D u r i n g i n f o r m a l i n t e r v ie w s , t h e q u e s t i o n s a r e u s u a l l y o p e n - e n d e d , a l l o w i n g th e r e s p o n d e n t t os p e a k h i s i h e r m i n d o n t h e s u b j e c t u n d e r d i s c u s s i o n .

9 A d v a n t a g e o f i n f o r m a l i n t e r v i e w t e c h n i q u e s a r e w h e n w e a r e i n i t ia t i n g a s t u d y a n d t r y i n g tol e a r n a b o u t t h e b e h a v i o r , b e l i e f s a n d a t t i t u d e s o f p e o p l e i n a c o m m u n i t y .9 T h e d i s a d v a n t a g e o f i n f o r m a l i n t e r v i e w is th a t i f t h e i n f o r m a n t i s n o t r e s p o n d i n g t o s e t q u e s t i o n s ,

i t i s d if f ic u l t t o c o m p a r e a n d e v a l u a t e a n s w e r s g i v e n b y o t h e r i n f o r m a n t s .9 T h e q u e s t io n s s h o u l d b e c a r e fu l ly te s t e d a n d s c r e e n e d i n a d v a n c e f o l l o w e d b y r e w o r d i n g o r

d r o p p i n g t h e q u e s t i o n s t h a t b r in g a m b i g u o u s r e s p o n s e s .9 W i t h c o n s t r a i n t s o n t i m e a n d b u d g e t r e s o u r c e s fo r d e v e l o p i n g c o m m u n i t y p r o g r a m s i t i s n e c e s s a r y

t o g a t h e r q u a l i t a t iv e d a t a i n a r e l a t iv e l y ra p i d m a n n e r .9 It m a y n o t p r o v i d e a t h o r o u g h a n a l y s i s o f l o c a l s o c i o ~ u l t u r a l s y s t e m s b u t g i v e s th e b a s i c

i n f o r m a t i o n a b o u t a t t i t u d e s a n d a p p r o a c h e s t o h e a l t h c a r e s e r v i c e s .9 F o c u s g r o u p d i s c u s s i o n i s o n e o f t h e m e t h o d s w h e r e t h e p a r t ic i p a n t s t a lk w i t h e a c h o t h e r u n d e r

t h e g u i d a n c e o f a f a c i li ta t o r . T h e p u r p o s e i s t o o b t a i n i n - d e p t h i n f o r m a t i o n o n c o n c e p t s , p e r c e p t i o n sa n d i d e a s o f t h e g r o u p o n s p e c i f i c t o p i c s .

9 T h e c o n f i d e n c e , c r e d i b il it y , g e n e r a l i s a b i l it y a n d d e g r e e o f c a u s a l i n f e r e n c e a s s o c i a t e d w i t h f in d i n g sf r o m q u a l i t a t iv e m e t h o d s c a n b e i n c r e a s e d , a n d a t t h e s a m e t i m e t h e v a l i d i ty a n d u n d e r s t a n d i n go f e x p e r im e n t a l m e t h o d s c a n b e e n h a n c e d i f b e t h a p p r o a c h e s a r e c o m b i n e d i n t h e s a m e s tu d y .

9 e . g . i n t e g r a t i n g t h e s u b j e c t s e l e c t i o n c r i t e r i a o f a c a s e - c o n t r o l d e s i g n w i t h q u a l i t a t i v e i n q u i r yt ec hn i ques f o r i l l um i na t i ng r i s k f ac t o r s i s r e f e r r ed t o as " qua l i t a t i v e c as e - c on t r o l " .I n t h i s d e s i g n t h e r e s e a r c h e r s e l e c t s s u b j e c t s f r o m o p p o s i n g a n d e x t r e m e g r o u p s b a s e d o nt h e i r s c o r e s o n a b e h a v i o r a l c o n t i n u u m h e a v y d r in k e r s o f a lc o h o l a n d t h o s e w h o a b s t a i n f ro md r i n k in g . T h i s e x t r e m e o r d e v i a n t c a s e s a m p l i n g t e c h n i q u e c o n s t r u c t s t w o g r o u p s q u a n t i t a t iv e l yt o r e p r e s e n t c o n t r a s t i n g c h a r a c t e r i s t i c s o n t h e o u t c o m e v a r i a b l e .

9 T h e r e h a v e b e e n c a l l s f o r s tu d i e s to e x p a n d e x i s t i n g u n d e r s t a n d i n g b y i d e n t i fy i n g t h e u n d e r l y i n gs o c i a l a n d c u l t u r a l d e t e r m i n a n t s o f t h e m a i n t e n a n c e o f d i f f e r e n t s o c i a l b e h a v i o r s .

9 A n u n d e r s t a n d i n g o f t h e s o c i a l ly a n d c u l t u r a ll y d e t e r m i n e d a s s u m p t i o n s a n d e x p e c t a t io n s s u r r o u n d i n gs u c h i s s u e s w o u l d s e e m t o h a v e t h e p o t e n t i a l t o f u r th e r o u r u n d e r s t a n d i n g o n t h e m , i n t h e c o n t e x to f c h a n g i n g s o c i a l , e c o n o m i c a n d t e c h n o l o g i c a l e n v i r o n m e n t .

9 A c r o s s s e c t io n a l s t u d y i s u s u a l ly a s im p l e d e s c r i p t io n o f t h e p r e v a l e n c e o f d e m o g r a p h i cc h a r a c t e r i s t i c s a s w e l l a s h e a l t h b e h a v i o m a n d a t t i t u d e s o r e x p e r i e n c e s w i t h h e a l t h s e r v i c e s .S u c h s t u d i e s a r e a l s o k n o w n a s p r e v a l e n c e s t u d i e s o r s u r v e y s .

9 T h e o b j e c t iv e i s u s u a l l y t o e s t i m a t e t h e m a g n i t u d e o f a p r o b l e m i n a d e f in e d " ta r g e t' p o p u l a t i o n .9 C r o s s s e c t i o n a l s tu d i e s m a y p r o v i d e e t i o lo g i c c lu e s ' o r g e n e r a t e e t i o l o g i c h y p o t h e s i s , a n d m o r e

c o m p l e x s t u d i e s w il l h a v e t o b e p e d o r m e d t o t e s t s u c h h y p o t h e s i s . T h u s t h e s u r v e y m a y b eu s e d t o o b t a i n c a s e s a n d c o n t r o l s f o r c a s e c o n t r o l s t u d i e s .

9 C r o s s s e c t i o n a l s t u d i e s h a v e t h e a d v a n t a g e o f b e i n g c a r r i e d o u t i n r e l a t iv e l y s h n r t d u r a t io n .

374 Ind ian Journa l o f Ped ia tr ics , 2000; 67 (5)

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Q u a n t i t a ti v e V s Q u a l it a t iv e R e s e a r c h M e t h o d s

s h o r t h a n d o r b e r e f e r r e d t o s o m e o n e e l s e ' s r e s e a r c ht e c h n i q u e . I t i s u s u a l l y l e n g t h y a n d d i s c u rs i v e a n d i ni t s a b s e n c e t h e r e s u l t s c a n n o t b e i n t e r p r e t e d . T os ta n d a r di z e t h e m e t h o d o l o g y a p r a ct ic a l m a n u a l m a yb e d e v e l o pe d . T h i s m i n i m i z e s t h e c h a n c e s o f s o m ef i e ld w o r k e r s r e s o r ti n g t o s h o r t c u t s i n s o m e o f t h er e c o m m e n d e d f ie ld w o r k p r o c e d u r e s l ik e r e c r u it i n gt h e s u b j e c ts . It i s e s s en t ia l t o u n d e r s t a n d w h a t m e t h o d sw e r e u s e d b y t h e r e se a r c h er t o a n a l y z e t h e d a t a a n dt h e q u a l i t y a s s u r a n c e m e a s u r e s a p p l i e d . T h e d a t aa n a l y s is s e c t i o n o f q u a l i t a t i v e r e s e a rc h r e a d i lyd i s t i n g u i s h e s se n s e f ro m n o n - s e n s e S . I t is n o t e n o u g ht o p r e s e n t s o m e q u o t e s b u t t h e r e s ea r c h e r m u s t f i n d as y s t em a t i c w a y o f a n a l y zi n g t h e d a t a a n d s e e k e x a m p l eso f c as e s w h i c h a p p e a r t o c o n t r a d i c t o r c h a l l e n g e t h et h e o r i e s d e r iv e d f r o m m a j o r it y . I n t h e o r y , d a t a n e e d st o b e a n a l y z e d b y m o r e t h a n o n e r e se a r ch e r to c o n f i r mt h a t t h e y a r e a ss i g n in g t h e s a m e m e a n i n g t o t h e d a ta .T o i n c r e a s e t h e r e l i a b i l i ty o f t h e a n a l y s i s a n d t o e n s u r ea c c o u n t a b il i ty o f t h e d a t a, c o m m o n p r o c e d u re s a ret o b e f o l l o w e d d u r i n g a n a l y s is a s d u r i n g f i e ld w o r k .F o r i n t e r p r e t i n g t r a n s c r ip t s a n d c o m p a r i n g r e s u l ts w i t he x t e r n a l e v i d e n c e , t e a m a p p r o a c h i s b e t t e r t h a n u s i n gs o m e s p e ci a l c o m p u t e r s o f rw a r e . T h e t r a n s c ri p t s n e e dt o b e m o n i t o r e d f o r c o m p l e t e n e s s f r o m t h e t a p er e c o r d e d v e r s io n f o r m i n i m i z i n g t h e l o s s o f v a l u a b led a t a .T h e c r e d i b i li ty a n d t h e c l in i c al i m p o r t a n c e o f th er e su l ts n e e d s t o b e e s t a b l i s h e d . C r e d i b i l i t y c a n n o t b ea s se s se d t h r o u g h p r e c i s io n a n d a c c u r a c y o f m e a s u r i n gd e v i c e s , n o r c a n t h e s i g n i f i c a n c e o f r e su l t s v i ac o n f i d e n c e i n t e rv a l s a n d n u m b e r s n e e d e d t o t re a t, b u ta l i t t l e m o r e t h a n c o m m o n s e n s e i s r e q u i r e d t ou n d e r s t a n d t h a t t h e r e s u l t s a r e s e n s i b l e a n d b e l i e v a b l e ,a n d t h e y a c t u a l l y m a t t e r i n p r a c t i c e . A n o t h e r a s p e c to f s u c h r e su l ts i s t o c h e c k w h e t h e r a u t h o r s c i t e a c t u ald a t a o r n o t . T o i m p r o v e t h e c r e d ib i l it ~ v e r b a t i m q u o t e sa re r e p r o d u c e d w h i c h a r e i n d e x e d a n d c a n b e t ra c e db a c k t o a n i d e n t if i a b le s o u r c e . T h e v e r i fi c a t io n p r o c es si s g r e a t l y f a c i l i t a t e d b y c o d e m a p p i n g a n d r e t r i e v a l .'Code ma pping ' i s t h e p r o c e s s o f r e a d i n g t h r o u g h t h et r a n s c r i p t s a n d m a r k i n g s e g m e n t s o f t e x tc o r r e s p o n d i n g t o t h e i ss u es o f in t e r e s t a n d a n y r e la t e dc o n c e p t s . T h e r e li a b il it y o f a n a ly s is c a n b e i m p r o v e db y t w o o r m o r e r e s e a r c h e r s g o i n g t h r o u g h t h e s a m et r a n s c r i p t a n d r e s o l v i n g t h e d i f f e r e n c e s , i f a n y .M o s t t e a m m e m b e r s m a y u n d e r e s t i m a t e h o wd e m a n d i n g t h e d a t a a n al y si s w o u l d b e i n t e r m s o f t im ea n d a l so b e c a u s e o f u n f a m i l i a r i t y w i t h t h e p r o c e d u r e s .

Indian Journal of Pediatrics, 2000; 6 7 (5)

S o t h e y s h o u l d i d e a l ly b e i n v o l v e d at t h e d a t a a n a l y s i ss t a g e as w e l l. T h e c o n c l u s i o n s d r a w n f r o m t h e d a t aa n d t h e i n t e r p r e t a t i o n o f r e s u l t s d i f f e r a c c o r d i n g t ot h e r e s e ar c h a p p r o a c h a d o p t e d . Q u a n t i t a t i v e r e s e a rc hc l e a r ly d i s t i n g u i s h e s t h e s t u d y r e s u l t s s o t h a t t h e r e a d e rc a n e a s il y d i f f e re n t i a t e b e t w e e n w h a t t h e r e s ea r c h erf o u n d a n d w h a t t h e y t h i n k i t m e a n s w h i l e s u c h ad i s t i n c t i o n i s r a r e l y p o s s i b l e i n q u a l i t a t i v e r e s e a r c hw h e r e r e s u l t s a r e , b y d e f i n i t i o n a n i n t e r p r e t a t i o n o ft h e d a ta . T h u s , w h e n a s se s si n g t h e v a l i d i t y o fq u a l i t a t i v e r e s e a r c h i t i s n e c e s s a r y t o u n d e r s t a n dw h e t h e r t h e i n t e r p r e ta t i o n o f d a ta a c c o r d s w i t h t h ec o m m o n s e n s e a n d p e r s o n a l o r c u l t u r a l p e r s p e c t i v ea l t h o u g h i t is d i ff i c u l t b e c a u s e t h e l a n g u a g e w e u s e t od e s c r i b e t h i n g s s o m e t i m e s t e n d s t o a s s i g n m e a n i n g sa n d m o t i v e s w h i c h t h e s u b je c ts m a y n o t s h ar e.T o p r o v e t h a t r e s u l t s o f t h e r e s e a rc h a r e "grounded ine v / d e n c e " t h e f o l l o w i n g q u e s t i o n s m a y b e u s e f u l:H ow wel l does this analys is explain wh y people behavein the way the y do?H ow comprehensible wo uld this explanation be to athough~eul par ticipa nt in the setting?Ho w wel l does the exp lana tion cohere wi th wh at w ealready know?

F u t u r e S t r a t e g i e sA s h e a l t h c a p e p r o v i d e r s a r e i n c r e a s i n g l y e x p e c t e d t op r o v i d e h e a l t h p r o m o t i o n a d v i c e , n o t s i m p l y d i s ea sep r e v e n t i o n c o u n s e l 29, i t w i ll b e n e c e s s a r y f o r t h e m t ou n d e r s t a n d t h e m e a n i n g a n d s o ci al s ig n i fi c a n ce o f t h e i rp a t i e n t s ' l i fe s ty l es . F r e q u e n t u s e o f q u a l i t a ti v e m e t h o d sw i l l g re a t ly e n h a n c e b o t h a e t io l o g i c al a n d h e a l t h s e rv i ce sr e se a rc h . F a i lu r e t o u s e h as c u r b e d t h e a d v a n c e i n m e d i c a lk n o w l e d g e a n d a t t i m e s l e d t o f al se t ra i ls b e i n g f o l l o w e dp a r t l y b e c a u s e o f s c e p t i c is m o n t h e p a r t o f q u a n t i t a t i v es c i e n t is t s a b o u t t h e o b j e c t i v i t y a n d r i g o r o f q u a l i ta t i v em e t h o d s . W h i l e t h i s v i e w m a y b e j u s t if i e d o c c a s io n a l l y it si s n o t a v a l i d r e a s o n f o r i g n o r i n g t h e p o t e n t i a l u s e o fq u a l i t a t i v e m e t h o d s . A s t h e s t a ti s ti c ia n T u r k e y~~ p o i n t e do u t , " f a r b e t te r a n a p p r o x i m a t e a n s w e r t o t h e r i g h t q u e s t i o nt h a n a n e x a c t a n s w e r t o t h e w r o n g q u e s t i o n " . I f s u c h a d v i c ei s i g n o r e d w e r u n t h e r i s k o f p u r s u i n g t h e m e a s u r a b l e r a th e rt h a n t h e r e l ev a n t. T h i s w o u l d h a v e c o n s e q u e n c e s o n o u ru n d e r s t a n d i n g o f b o t h t h e c a u se s o f d is ea se s a n d h o w t oi m p r o v e h e a l t h s er v ic e s.

G o o d c l in i ca l t h o u g h t r e q u ir es r e c o g n i t i o n o f t h e c o -e x i s t e n c e o f g e n e r a l i t y a n d i n d i v i d u a l i t y . S i m i l a rl y , g o o dm e d i c a l r e s ea rc h r e q u i re s r e c o g n i z i n g th e c o m p l e m e n t a r i t y

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a n d i n t e r - p e n e t r a t i o n o f q u a n t i t a t i v e a n d q u a l i t a t iv emethods o f inqu i ry . W he n qua l i t a tive m ethod s a re c l ear lye s t a b l i s h e d i n o u r r e s e a r c h r e p e r t o i r e , t h e a d v a n c e o fmed ica l kn owledge wi l l be g rea t ly acce le ra t edL

H u ma n b e i n g s l i v e i n c o mp l e x s o c i o - c u l t u r a l a n dre l ig ious env i ronment s . The in t en t ions and behav io r o fi n d i v i d u a l s a r e f u r t h e r i n f l u e n c e d b y t h e e c o n o m i cconsequences o f the behav io r . Hen ce hea l th care p rac ti ces,com pl i ance to shor t o r long t e rm therap ies and to ex i s t ingand new t echn o logy wi l l a ll be com plex dec i s ions wh ichcan no t be as sessed th rou gh quan t i t a t ive que s t ionnai re o rsu rvey metho do log y a lone . Th e key ques t ions in a ll t heses i tua tions a re "why" an d " how " . Th us i f we a re in t e res t edt o k n o w w h y a m o t h e r d o e s n o t s t a rt w e a n i n g h e r c h i ldby 6 m onth s o f age , how fam i ly p lann in g serv ices can bema d e mo r e a c c e p t a b l e , a n d w h y a t u b e r c u l o s i s p a t i e n tbecom es ir regu lar wi th h i s t rea tm en t in 6 -12 week s t ime,then the answer qua l i t a t ive methodo log~ Simi la r l )~ thed e t e r m i n a n t s o f c l i e n t U t i li z at io n b e h a v i o r f o r v a r i o u spub l i c hea l th p rogram s shou ld p referab ly be inves t iga tedin dep th th roug h qua l i t a t ive appra i sal t echn iques . In th isway , worka b le hypo theses tha t exp la in the c l i en t behav io ra r e g e n e r a t e d . T h e s e c a n b e f i e l d t e s t e d t h r o u g hquan t i ta t ive method s wi th adequate sample o f responden t s .

I t i s deplorable that poor qual i ty qual i tat ive papersn o w a p p e a r r e g u l a r l y i n s o me me d i c a l j o u r n a l s w h o s eed i to rs have c l imbed on the qua l it a tive bandwa gon w i thou tgainin g an a bi l i ty to a ppraise su ch papers 2s. M eth ods l ikefocus g roups shou ld no t be ad ded as a me re s ide l ine to acom para t ive bas ic research p ro jec t s imply because i t hasb e c o m e a la m o d e t o inc lude a qua l i t a t ive da ta co l l ec t ionc o m p o n e n t3].

R E F E R E N C E S1. Holm an HR. Qualitative inquiry in medical research.J C/inEpidemiol 1993; 46(1) : 29-36.2. BlackN. Why we need qualitative research.J EpidemiolComm unity Health 1994; 18 : 125-126.3. KoestlerA, Sm ythies JR (eds). Beyond Reductionism, Ne wPerspectives n the L ife Sciences.Ne w York: Hutchinson 1969.4 . Bla lock HM . Social Statistics. Second Edition Tokyo:McG raw-Hill, Kogakusha 1972.5. Johnson AW. Quan tification in Cultural Anthropology: AnIn troduction to Research Design . Stanfo rd : S tan fo rdUniversity Press 1978.6. Ch en K, Murray GE Truths and untruths in village Haiti:An experiment in third world survey research. In: John FM arshal & Steven Polgar eels. Culture, Natality an d F amilyPlanning. Carolina Population Centre, University of N orth

Carolina at Chapel Hill 1976; pp 241-262.7. KleinmanA. The lUnest Narratives: Healing an d the H um an

Condition. New York; Basic Books 1988.8. Stehbens W E. Im precision of the clinical diagnosis ofcoron ary hear t d i sease in ep idem io logy stud ies and

atherogenesis.J Clin Epidemio11991; 41 : 999-1006.9 . Bu r n a u d B , Fe i n s te i n A R. T h e r 0 1 e o f d i a g n o s t icinconsistency in changing rates of occurrence for corona ryheart disease.J Clin Epidemio11992; 4 2 : 9 2 9 - 9 4 0 .10. M itchel l R. Survey materials col lected in dev elopingcoun t r i es : Sampl ing , measurement and in t e rv iewingobstacles in intro and international comparisons. Intern

Social Science JournaL i965; 17 : 665-685.11. Cam pbell GJ, Shrestha R, Stone L. The ~lsea n d M i s u s e o fSocial Science Research in N ep al Cen tre for Nepal and AsianStudies. Kathm andu: H is Majesty's Govern ment P ress 1979.12. Stone L, Campbell GH . T he use and misuse of surveys ininternational development: An experiment from Nepal.H u m a n O rg a n iza tio n 1984; 43(1) : 27-37.13. Stone L. Cultural Repercussions o f C hildlessness an d Lo wFerti li ty in N epa l Contributions to Nepalese Studies 1978;

5 : 7-36.14. Benne tt L. Sex a n d Mo th erh o o d Am o n g th e Bra h m a ns a n d

Chetries o f East Centra l Nepal Contributions to NepaleseStudies. 1976; 3 : 1 -52. (Speical issue:An~thropology,Healthand Development)15. SmelserNJ, T he methodology o f comparative analysis. In:Wa rwick DP, O shermn S (eels) Com parativeResearch Methods.Ne w Jersy: Prentice-Hall. 19 73; 42-86.16. Patton M Q. Qua~ tative Evaluation a nd R esearch Methods.New bury Park: Sage Publications 1990.17. StraussA, Corbin J. Basicso f Qua litative Research.NewburyPark: Sage Publications, 1 990.18. Crabtree BJ, Miller WL. D o in g Q u a l i ta t ive Resea rch .New bury P ark: Sage Publications 1992.19. Strong PM . Th e case for qualitative research. International

Journal o f Pharmacy Practice 1992; 1 185-486.20. BlackNA, Thom pson E. Attitudes to medical audit: British

doctors speak. Soc Sci Me d 1993; 36: 849-856.21 . Good BJ, Good MD .The mean ingofsymptoms :Aculturalherm eneutic model for clinical practice. In: Leon Eisenbergand A rthur Kleinman eds The Relevance o f Socia l Science orMedicine Dordrecht: Rediel, 198!; 165-196.

22. Nic hter M. Idiom s of distress: Alternatives n the expressionof psychological distress. A case study from South India.Cu l tu re M ed Po vh ia t 1981;5(4): 379-408.23. Wicker AW. Getting out o f our conceptual ruts. AmericanPsychologist 1985; 40(10) : 1094-1103.

376 Indian Journa l of Pediatrics, 2000; 67 (5)

7/30/2019 10.1007-BF02820690

9/9

Q u a n t i t a t iv e V s Q u a l i t a ti v e R e s e a r c h M e t h o d s

24 . W i l l ms D G, Best JA , T ay l o r DW . A sys t ema t ic appr oa chf o r u si n g q u a l it a t iv e m e t h o d s i n p r i m a r y p r e v e n t i o nresearch. MedAnthropol Quart 1990; 4 : 4 ( NS ) , 391- 409 .

25 . S teckl er A , M cL er oy K , Goo dm an R , B i r d S , M cCo r mi c kL .T owar d i n t egr a t ing qua l i t a ti ve and quan t i t a ti ve m e t hods :A n I n t r o d u c t i o n . Health Educ Quart 1992; 19 : 1-8.26 . I nu i T S , F r anke l R M . E va l ua t i ng the qua l i t y o f qua l i ta t iveresearch: A proposal pro tern. J Gen Intern Med 1991; 6 :4 8 5 - 4 8 6 .

2 7 . L a k s h m a n M . Q u a l i t a t i v e r e s e a r c h m e t h o d s i n c l i n i c a lresearch. In: Hand book of Clinical EpidemiologyChris t ianMedical Col lege & Ho spi ta l , Vel lore , 1995; 11 0-118.

28 . Gr eenha l gh T , T ay l o r R . H ow t o r ead a paper :. P ape rs t ha tgo beyo nd nu mb er s ( qua l i ta t i ve re sea r ch) BMJ 1997; 315 :7 4 0 - 7 4 3 .

2 9 . W i l l ia m s A , B o u l to n M . T h i n k i n g p r e v e n t i o n : C o n c e p t sand const ructs in general pract ice . In: Margaret Lock andDeborah R Gordon ed~Bio-medicine Exaraine~A. Do r dr ech t:K l uwer Academ i c P ub li she rs , 1988 ; 2 27- 25 5 .

30. Turk ey JW~.T h e f u tu r e o f d a ta analyisAnn Math Stat 1962;33 : 1-67.

31 . Kno de l J . Cond uc t i ng com par a t i ve f ocus g r oup r e sea rch :C a u t i o n a r y c o m m e n t s f r o m a c o o r d in a t or . Health TransitionRev/ew. 1994; 4(1) : 9%104.

T H E M I I I F N N I U M A N D M E D I C I N E : T H E 1 0 M O S T I N F L U E N T I A L P E RSONSNo. 10: S igmund Freud ( 1 8 5 6 - 1 9 3 9 ) - c o n s id e r e d t h e f o u n d e r o f p sy c h o a na l ys is h e b e li e ve d t h a t a c o m p l e x o fr epr es sed and f o r go t t en expr es s i ons unde r l i e s a l l abnor mal ment a l s t a t e s and t ha t i n f an t i l e ment a l p r oces ses a r ei mpor t an t i n l a t e r deve l opment .N o . 9 : W i l h el m R o n t g e n ( 1 8 4 5 - 1 9 2 3 ) - d i s c o v er e r o f X - r a y s in 1 8 9 5 a n d N o b e l P ri ze w i n n e r in p h y s ic s i n 1 9 0 1 .T he va l ue o f X- r ays i n t he d i agnos i s and t r ea t ment was r ecogn i sed and accep t ed a l mos t f r om t he ou t se t o f t he i rdiscovery.N o . 8 : K a r l L a n d s t e i n e r ( 1 8 6 8 - 1 9 4 3 ) - c alle d th e " f a t he r o f b l o od g ro u p i ng " - a c o n c e p t w it h ou t w h i c h b l o odt r ans fus i on woul d no t be poss i b l e . In 1 901 , he show ed t ha t t he r e a r e a t I Gas t 3 m a j or t ypes o f b l ood . L an ds t e i ne r wasawar ded t he Nobl e P r i ze fo r h i s wor k i n 1 930 .N o . 7 : E d w a r d J e n n e r ( 1 7 4 9 - 1 8 2 3 ) - i n tr o d u ce d th e i no c u la t io n f o r s m a l l p o x a t t h e e n d o f t h e 1 8 t h c e n tu r ywhi ch i s cons i de r ed o ne o f t he g r ea t e s t t ri umph s i n the h i s t o ry o f medi c i ne .N o . 6 : M a r ie C u r i e ( 1 8 6 7 - 1 9 3 4 ) - d i s c o v e r e d r a d io a c ti v it y a n d w a s g i v en t h e N o b e l P r iz e i n 1 9 0 3 . T h e d i sc o v e r yf or m ed t he bas i s o f r ad ia t i on t he r apy . I n 1 911 , she was aga i n co nf e r r ed t he N obe l P r ize in chemi s t r y f o r he r d i s cove r yof r ad i um and po l on i um.N o . 5 : F r a n c is C r i ck ( 1 9 1 6 - ) a n d J a m e s W a t so n ( 1 9 2 8 - ) - a c c re d i te d w it h d e t e r m i n i n g th e m o l e c u la rs t r u c tu r e o f D N A , t h e c h e m i c a l s u b s t r a t e o f h e r e d it y , w h i c h i s r e g a r d e d a s t h e m o s t i m p o r t a n t d i s c o v e r y o ft h e 2 0 t h c e n t u r y i n M e d i c i n e a n d S c i e n c e . T h e y w e r e a w a r d e d t h e N o b e l P r iz e in 1 9 6 2 s h a ri n g it w i th M a u r ic eWilkins (19 16- ) . Curren t ly, Cr ick i s associa ted wi th the Salk Ins t itute for Biological S tudies in San D iego whi leW at son i s t he d i r ec t o r o f the Col d S pr i ng H ar bo r lab in sou t hea s t e r n New Yor k .N o . 4 : G r e g o r M e n d e l ( 1 8 2 2 - 1 8 4 4 ) - f o r m u l a t ed t h e l aw s o f h e r ed i ty . M e n d e l 's w o r k l ai d t h e m a t h e m a t i c a lf ounda t i on o f t he s c i ence o f gene t ic s .N o . 3 : R u d o l f V i r c h o w ( 1 8 2 1 - 1 9 0 2 ) - f o u n d e d C el lu la r p a t h o l o g y . H i s c o n c e p t t h a t t h e b a si s o f d is e a s e is th ecell , the essen t ia l funct ional and s t ructural uni t of the body , was of mon um enta l impo r tan ce as a bas i s for unders tan dingt he cause , t he p r o ces s and t he r e su l t s o f t he d i sease .N o . 2 : R o b e r t K o c h ( 1 8 4 3 - 1 9 1 0 ) - t h e fir st t o is o la t e t h e a n th r a x ba cil lu s ( 1 8 7 6 ). I n 1 8 8 3 , h e p u b l is h e d ame t hod o f p r even t i ve inocu l a t ion aga i ns t t h i s d i s ease , i n 18 82 he an nou nced t he d i scove r y o f t ube r c l e bac il lus an d i n1883 , he d i scove r ed t he cause o f cho le r a . He was awar de d t he No be l P ri ze in phys i o l ogy o r medi c i ne i n 19 05 .N o . 1 : L o u i s P a s t e u r ( 1 8 2 2 - 1 8 9 5 ) - p r o p o s e d t h e " g e r m t h e o r y " . H e f ir st a s s o c ia t e d a s p ec i fi c m i c r o o r g a n i s m(baci llus) wi th a speci f ic di sease (anthrax) . He d eve loped the m eth od o f pas teur i sat ion - a heat ing p roc ess tha t ki ll sbac t e r i a i n mil k, w i ne a nd o t he r l iqu ids . He was a l so a p i onee r i n s t e r eochemi s t r y .

A b s t r a c t e d f r o m : M a y o C l i n P r o c 2 0 0 0 ; V o l . 7 5 : 1 1 9 - 1 2 1

Indian Journal of Pediatrics, 2000; 67 (5) 377