Analyzing how innovative methods can succeed when evidence-based practice dominates the ways of thinking.

1. QUALITATIVE ANALYSIS IN
HEALTH RESEARCH:
HOW CAN INNOVATIVE METHODS SUCCEED WHEN EVIDENCE-BASED PRACTICE
DOMINATES THE WAYS OF THINKING?
DR. ASIFUL ISLAM
UNIVERSITY OF GUELPH – EDRD 6000

2. HISTORY & QUALITATIVE HEALTH
RESEARCH
- “History may seem to have some instrumental value for
health research: to learn about the efficacy and impacts of
interventions in the past; to avoid past mistakes or
reinventing the wheel; to be more influential advocates
(Bourgeault, Dingwall & De Vries, 2010).”
- Examples of historical changes affecting health:
This Photo by Unknown Author is licensed under
CC BY
This Photo by Unknown Author is
licensed under CC BY-SA

3. DISEASE AS A ‘FRAME’
• Some diseases can be captured by a moment in time
and stand out during a specific era.
• Examples: Small pox, HIV/AIDS and Zika virus
• Initially, the lack of knowledge of a disease can cause
widespread fear and panic.
• When HIV/AIDS was first discovered, it was thought
to be a death sentence. With the advancement in
medical treatment and better knowledge of the disease,
a patient can now live a much longer and healthier life.
• The stigma attached to HIV/AIDS patients on how the
disease can be transmitted is still present today
(touching, coughing and sharing saliva).
“It is often easier to be
critical of how health issues
in the past have been
framed and acted upon
(Bourgeault, 2010).”

4. EVIDENCE-BASED PRACTICE VS
CLINICAL AUTONOMY
EVIDENCE-BASED PRACTICE
• EBP is an interdisciplinary approach to
decision-making by combining the best
available research, clinical experience
and the patient’s best interests.
• This standardization can serve as a
guideline for safe practice and protect
the practitioner from making risky
decisions.
CLINICAL AUTONOMY
• “Based on in-depth interviews with GPs, one
study reveals that doctors who work among a
mostly elderly clientele are often reluctant to
act on the basis of well-known, and
abundantly documented risks associated with
the use of psychotropic medication in this
population (Bourgeault, 2010).”
• Even though there are guidelines in place,
these physicians trusted the experience of
their own clinical judgement over the
standard protocol.

5. UNCERTAINTY
• According to Renee Fox in a study published in 1959, there are “three types of
uncertainty: (1) Uncertainty stemming from gaps in their knowledge; (2) Uncertainty
created by the limits of medical knowledge per se; (3) Uncertainty resulting from the
difficulty of distinguishing the first from the second.”
• “The issue of clinical autonomy, EBP and uncertainty is therefore a fairly complex
one requiring qualitative methods to decipher, beyond the objective factors, the
norms and values that are challenged in clinical practice by the transformations in
health care systems (Bourgeault, 2010).”
• Uncertainty should breed further qualitative research and not be seen as a tool that
deters innovative methods.

6. - The hot topic in health right now is medical cannabis.
- “Canada legalized the use of cannabis for medical indications in 2001
and implemented updated regulations for medical use and production
in 2014 (Spithoff, Emerson & Spithoff, 2015).”
- Even after legalization, the stigma attached to prescribing cannabis is
still present as medical practitioners are either uncertain or not properly
educated on the proper indications, dosages, benefits and risks
associated with it.

7. CASE STUDY
• Mechoulam (researcher called the father of medical cannabis) says, “there are about
ten research groups in the field in Israel, working on cannabis as a treatment for
conditions such as post-traumatic stress disorder (PTSD), epilepsy, chronic pain,
rheumatoid arthritis, fibromyalgia and Crohn's disease (Sohn, 2015).”
• Israel has a national medical cannabis research programme with support from 75%
of the population for its medicinal purposes.
• In the states, “a mother whose 5-year-old daughter Charlotte was having 300
seizures a week and not responding to treatment. The family were desperate for
help. They had heard that medical marijuana was being used to treat epilepsy, but
had been turned away by doctors when they asked for the treatment for Charlotte
(Sohn, 2015).” They found a physician who prescribed cannabis to her and now she
has one seizure a month.

8. CONSIDERATIONS IN INNOVATIVE
HEALTH RESEARCH
OPPORTUNITIES
• “The breadth and depth capabilities of
qualitative health research are evident in
investigations of poorly understood clinical
conditions and contexts, patient
satisfaction, non-standard health
outcomes, developmental trajectories, and
aging.
• Qualitative research helps answer broader
health-related questions rooted in social
models of health, such as power
relationships and their dynamics, health
and health-care communications, complex
decision-making, stigmatization-
legitimization, and social
oppression/marginalization-acceptance
processes (Olson, Young & Schultz, 2016).”
LIMITATIONS
• Few practitioners are willing to take a chance
on the unknown.
• Policy change or a lack thereof can create a
lengthy or unsuccessful drug trial phase and
delay research.
• Stricter rules and norms are in place as
bureaucracies form in hospitals and health care
systems.

9. QUESTIONS/THOUGHTS
• How can qualitative research alter the rigid decision-making process of
physicians?
• What are the best practices to gather support from multiple stakeholders for
an innovative method?

10. REFERENCES
SLIDE 2:
Photos- “History of Medicine (Revised).” Poor MD, www.poormd.com/2015/03/history-of-medicine-measles.html.
http://rumconnection.com/wp-content/uploads/2012/12/image3.jpg
http://2.bp.blogspot.com/-t39ab-5hxEo/Tu90LI7oavI/AAAAAAAAASA/_I05vLoeVes/s1600/no_smoking.jpg
Quote- Bourgeault, I., Dingwall, R. & De Vries, R. (2010). The SAGE handbook of qualitative methods in health research London, UK: SAGE
Publications Ltd doi: 10.4135/9781446268247
SLIDE 5:
Fox, R. C. (1998). Experiment perilous: physicians and patients facing the unknown. New Brunswick, NJ, U.S.A.: Transaction.
SLIDE 6:
Spithoff, S., Emerson, B., & Spithoff, A. (2015). Cannabis legalization: adhering to public health best practice. Canadian Medical Association Journal,
187(16), 1211-1216. doi:10.1503/cmaj.150657
SLIDE 7:
Sohn, E. (2015). Research without prejudice: how one Mediterranean country is pushing the frontiers of medical cannabis knowledge. Nature,
525(7570), S12+. Retrieved from
http://link.galegroup.com.subzero.lib.uoguelph.ca/apps/doc/A429735804/AONE?u=guel77241&sid=AONE&xid=1393a663
SLIDE 8:
Olson, K., Young, R. A., & Schultz, I. Z. (2016). Handbook of qualitative health research for evidence-based practice. New York: Springer.