Qualitative research in family medicine

In addition to this month’s clinical content, Canadian Family Physician features 2 qualitative family medicine research articles. One explores the referral practices of physicians providing obstetric care in remote locations, examining the reasons for referral to urban centres (page 185).¹ The other examines how early-career family physicians integrate social accountability into their practices, including the factors that both facilitate and hinder its adoption (page 192).²

Qualitative research as a concept is debated, especially in the scientific realm, and it is sometimes viewed as inferior, with the randomized controlled trial (RCT) considered the criterion standard. But is this hierarchy warranted?

First, let us define qualitative research. While quantitative research focuses on statistical analyses of numerical data, qualitative research “gathers participants’ experiences, perceptions, and behavior.”³ The methodology may include in-depth interviews, focus groups, surveys, and more. While quantitative research derives strength from factors such as sample size and statistics, qualitative research values richness in data. Rather than having participants selected randomly, sampling in qualitative studies is done purposively, so that appropriate, informative participants are selected to answer the research question.³

At the same time, given the clinical content we offer, journals such as ours have limited space to publish research. Medical publications as a whole often do not prioritize qualitative research. In 2016, a group of academics from around the world criticized the BMJ for the decision to halt publishing qualitative research.⁴ They argued that qualitative research provides critical insights into areas such as why certain interventions fail in practice, how health care professionals think, and the lived experiences of patients. One example cited was a qualitative study from 1996 exploring parental concerns when their children were acutely ill; currently, this paper has been cited more than 351 times.⁵

Qualitative research may be even more relevant for specific communities and populations. For example, there is a movement to decolonize Indigenous research, and qualitative methodologies are at the forefront of these efforts. In writing this editorial, I learned about an Indigenous research method called yarning, a form of conversation from Indigenous culture.⁶ As a white family physician, this topic was new to me, but the practice of yarning has existed for centuries.⁶ Other authors have gone so far as to argue that RCTs are inappropriate in certain groups, such as in the field of adolescent transgender health care.⁷

In a research landscape where space is at a premium, what is the best path forward for qualitative studies? The article in this issue by Martel et al¹ demonstrates the perspective a qualitative study may yield by including a quote from a physician participant:

If babies are no longer being born in the community or in the hospital, there will still be people dying. So there becomes an imbalance there where there is only grief associated with the hospital—with health care—and not the celebration. I think communities that lose rural obstetrics struggle with that. The hospital ends up becoming a place for the ill and dying.¹

Given the current strain on medical systems and high rates of physician burnout, should we place more emphasis on qualitative research to enhance our understanding of patient and physician experiences? Or, with limited journal space, should we prioritize quantitative research instead?

As the debate continues, the value of qualitative research cannot be overlooked. While RCTs and large data sets are invaluable for identifying important health outcomes, qualitative studies provide insights into the human elements of our work—insights that could ultimately lead us to practice more effectively and compassionately, keeping people at the forefront of what we do. In a time marked by immense pressures on the health care system, qualitative research is a key tool in fostering a more patient-centred approach to care. We hope the content in this month’s issue of Canadian Family Physician does just that.

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