Researching Complementary and Alternative Medicine

Jon Adams, Jon Adams

• Publisher: Routledge
• Year: 2007
• ISBN:
  9781134209125
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Researching Complementary and Alternative Medicine provides a valuable and timely resource for those looking to understand, initiate and expand CAM research.

This collection brings together leading international CAM researchers with backgrounds and expertise in a variety of areas including health social science, qualitative methodology, general practice, health services research and public health. Drawing upon their own research work and experience, the contributors explain and review core methods and research issues pertinent to contemporary CAM and its future development. Topics discussed include:

• the use and limitation of evidence in CAM research
• the issues facing practitioners (GPs, therapists, nurses, etc) who wish to conduct research
• how and why qualitative methods should be combined alongside quantitative methods to help explore CAM
• how the randomised control trial (RCT) method relates to CAM
• the future direction of CAM research in terms of public health and policy-related agendas.

Researching Complementary and Alternative Medicine is essential reading for students, academics and researchers in CAM, health studies, medicine, nursing, medical sociology and public health. It will also appeal to CAM and allied health practitioners.

Part I

Methods in practice

Chapter 1
Qualitative methods in CAM research
A focus upon narratives, prayer and spiritual healing

David Aldridge

Introduction

The daily life of a researcher and research supervisor is helping people make sense of what they do. Life is literally about making sense, with the activity on making–this is a constructivist approach to human knowledge that fits well with the broad spectrum of methods known as qualitative research (Denzin and Lincoln 1994). When we talk about what we do, this also includes health and sickness talk. We talk about falling ill and becoming well. How we regain health, and what that status of health is, is reflected in the ways in which we talk about it and how we explain this to others.

When we recall how sickness fell upon us and how we regained our health then we inevitably tell a story; these are the narrative approaches to life that we have. Narratives have characters, events and themes, and these are the very stuff of qualitative research (Williams et al. 2005). One of the difficulties of medical research is that while being increasingly proficient at refining concepts of disease and their treatment, there is little headway being made into those areas where health is defined and how that seemingly elusive status that we know as health can be achieved.

In response to such circumstances, this chapter explores the role of a narrative approach and aspects of the accompanying qualitative perspective necessary to help investigate and understand dimensions of health and CAM. To illustrate this qualitative research perspective, the chapter focuses upon the practices of spiritual healing and prayer, areas where the advantages of a qualitative approach can be clearly identified.

Qualitative research and definitions of health

Health care is invariably defined in positivist terms as an object, phenomenon or a delivery system (Aldridge 2004a). Knowledge gained through scientific and experimental research is deemed objective, quantifiable, stable and measurable (at best measurable by instrumentation reducing human error). In qualitative approaches, however, we have a shift in paradigm. Knowledge about health is considered to be a process, a lived experience, interpretative, changing and subjective (at best gleaned through human interaction as personal relationship). Indeed, from this qualitative perspective we may be encouraged to think of the gerund form of the word ‘health’ as ‘healthing’. In the same way, we can also consider what we do as professionals, and what our patients are involved in continually, as the relationship of healing (Aldridge 2000, Aldridge 2004a, Aldridge 2004b).

Qualitative research is not a testing mode of inquiry but a discerning form of inquiry requiring the collaborative involvement of those participating in that healing relationship. This emphasis on the verb ‘healing’ rather than on the noun ‘health’ goes some way to explain why qualitative approaches have found such resonance in nursing research, with its emphasis on nursing and caring as relational activities, rather than health-care research, which is by definition nominal and objective.

If healing is a relationship, then we have to ask ourselves how we evaluate relationships. Would we take friendship, for example, and rate it on a one to five Likert scale or would we value our friendships for their various qualities? It is possible to meaningfully explain to another person what the value of a relationship is without quantifying it if we wish to demonstrate the nature of that friendship. So too for the relationship that is healing. We need to discern those personal qualities that people use to explain healing. However, this is a major opposition between scientific paradigms and the first question often asked of qualitative research in medicine is, ‘Is it scientific?’ The short reply to which is, ‘Yes, it is social science’.

Medicine, being a social activity, is susceptible to being understood by a social-science paradigm as much as it is by a natural-science paradigm (Mechanic 1968, Kleinman 1973). To fulfil the functions of health-caring adequately, we need both quantitative and qualitative approaches. While medical science may concentrate on the external laws of the universe, qualitative research will concentrate on our internal understandings and their coherence with the way in which we live our lives.

Social psychology, ethnography and medical anthropology are acceptable scientific approaches for studying human behaviour, and qualitative research takes much of its methods from those fields. Indeed, suffering, distress, pain and death are experiences relevant to understanding health care but elusive to measurement. Similarly, well-being, hope, faith, living a full life and satisfaction are experiences central to health care but not immediately amenable to quantification. But they can be apprehended by understanding (Lewinsohn 1998) and these understandings are gleaned in relationship, the central activities of which are listening and telling stories. As stories are central to the therapeutic relationship and a vital part of qualitative research, then I shall develop below the concept of narrative (Aldridge 2000).

Health-care narratives: context and meaning

Spiritual meanings are linked to actions and those actions have consequences that are performed as prayer, meditation, worship and healing. What patients think about the causes of their illnesses influences what they do in terms of health-care treatment and to whom they turn for the resolution of distress. What we have to ask, as health-care practitioners, is does the inclusion of spirituality bring advantages to understanding the people who come to us in distress? As soon as we talk about life being something which we can cherish and preserve, that compassion for others plays an important role in the way in which we choose to live with each other, that service to our communities is a vital activity for maintaining well-being, that hope is an important factor in recovery, then we have the basis for an argument that is spiritual as well as scientific. Essentially I am arguing for a plurality of research understanding in healing. How do we make meaningful connections that form the narratives we make as patients and practitioners, and how do those narratives inform each other?

Anecdotes, the applied language of healing

CAM approaches are often dismissed as relying upon anecdotal material, as if stories are unreliable. My argument is that stories are reliable and rich in information. While we as medical scientists may try and dismiss the anecdote, we rely upon it when we wish to explain particular cases to our colleagues away from the conference podium (Aldridge 1991a, Aldridge 1991b).

Anecdotes may be considered bad science but they are the everyday stuff of clinical practice. People tell us their stories and expect to be heard. Stories have a structure and are told in a style that informs us too. It is not solely the content of a story, it is how it is told that convinces us of its validity. While questionnaires gather information about populations and view the world from the perspective of the researcher, it is the interview that provides the condition for patients to generate their meaningful story. The relationship is the context for the story and patients’ stories may change according to the conditions in which they are related. This raises significant validity problems for questionnaire research. Anecdotes are the very stuff of social life and the fabric of communication in the healing encounter. Miller writes that every time the experimental psychologist writes a research report in which anecdotal evidence has been assiduously avoided, the experimental scientist is generating anecdotal evidence for the consumption of his or her colleagues (Miller 1998). The research report itself is an anecdotal report.

Stories play an important role in the healing process, and testimony is an important consideration. Indeed, we have to trust each other in what we say. This is the basis of human communication in the human endeavour of understanding; it is the central plank of qualitative research. When it comes to questions of validity, then we have the concepts of trustworthiness in qualitative research. Testimonies are heard within groups that challenge veracity.

Multiple perspectives

We need a multiple perspective for understanding health-care delivery that is not solely based upon a positivist approach but also upon an interpretative approach. To take such a position is political in that it challenges the major paradigm of scientific research in medicine, a paradigm that is often transparent to those involved. Quite rightly, the qualitative paradigm is also seen as being critical; it challenges both the power and privilege of a dominant scientific ideology (Aldridge 1991a, Aldridge 1991b, Aldridge 1991c, Aldridge 1992, Trethewey 1997).

An advantage of qualitative research is that it allows us to see how particular practices are being used. We can discover the meanings attached to activities as they are embedded in day-to-day living. The terms ‘healing’, ‘spirituality’, ‘intentional’ and ‘energy’ are subject to dictionary definition but also defined by their practice. Qualitative research helps us to understand how such terms are understood in practice (Aldridge 2004a) and that is a political activity, as the feminist movement has reminded us (Aldridge 2004a). We have the right to call our experiences by what terms we wish without a dominant group telling us how that term ‘should’ be used. While many of us may question the use of the term ‘energy’ in healing, the word is used by both patients and healers alike, and we might be better directed to discovering its use in practice if we wish to understand it better. When we come to discuss the meaning of healing itself, what role spirituality has in health care, the nature of intentionality, then we are discussing the role of meaning in people’s lives. One way to discover those meanings is to ask the participants. The rigour of the asking and the way those meanings are interpreted is the scientific method–methodology –of qualitative research.

To understand the health implications of prayer, for example, we can discern the effect of prayer by experiment. However, the impact of prayer from a spiritual perspective is better understood in its subjective interpretation as a qualitative study; both complement each other. If we successfully argue for complementary medicine, that is increasingly being called an integrative medicine, then surely we can have a congruent paradigm for health-care research that is also complementary and integrative.

A way of seeing how these differing perspectives can be applied to a common problem would be to study those patients who fail to complete a course of treatment, what is sometimes referred to as ‘non-compliance’. A positivist paradigm may hypothesise that compliance with the prescribed treatment regime is a matter of patient education. By designing a patient education programme to raise an understanding of the treatment, compliance would be improved according to specific criteria for evaluation. We could design an experiment that would randomise identified non-complying patients to a taught education programme, a leaflet education programme and to no education. Their compliance with medication could then be measured by an assessor blind to the education programme itself.

A qualitative approach would not initially set up an experiment, nor would it try to measure anything. In this instance we would be interested in the experience of patients consulting a practitioner, listening to what the practitioners say, prescribe and advise, and then ask whether patients have complied with that advice. We would be asking where, when, with whom and on what grounds is the decision made not to comply with medical advice. In this case it is the perspective of the non-complier that is as important as the practitioner. Similarly, we may ask patients who also complete a course of treatment and compare them with those who fail to complete. This includes interviews, observations in various settings such as the consulting room and the home, and maybe written material such as diaries. Once we knew the circumstances of non-complying, then we could design suitable initiatives to investigate experimentally. Non-compliance may be located in the patient; it may be a located in the practitioner; or it may be an artefact of their relationship. Unless we discern with whom and when, then our experimental work will be inevitably limited.

From a critical research perspective, we would be interested in how a clinic is so organised that some groups fail to have their treatment needs met and where some patterns of treatment response are endemic. This may mean a collaborative inquiry with a self-help patient group and entail some form of advocacy between the clinic and the group (Aldridge 1987d, Reason and Rowan 1981). This latter approach reflects the strong participatory action component of early social-science research.

In order to further illustrate the role of a qualitative perspective for CAM research it is first necessary to provide a brief (and potted) overview of the broad field. Qualitative research is an umbrella term. Some qualitative approaches lean towards an emphasis on analysing texts and interviews (such as content analysis and discourse analysis), while others rely upon descriptions of interaction, that may use a variety of media, and are based upon, ethnography, ethnomethodology, symbolic interactionism and phenomenology. Some qualitative approaches set out to build theories while others aim to discover a particular historical background and locate this within an ideological or political perspective–the assimilation of acupuncture within modern Western medicine, for example, contrasting its acceptance in various European states.

Qualitative research as constructed meanings in context

Qualitative research covers a variety of approaches, and a selection of these is outlined in the following section. What characterises these approaches is an emphasis on understanding the meaning of social activities as they occur in their natural contexts. These are interchangeably called field studies, ethnographies, naturalistic inquiries and case studies. A central plank of these approaches is that we can discern the meaning of social behaviour such as healing and prayer from the experiences that people have in particular contexts, and that these meanings themselves are constructed. Constructed, in the sense that people make sense of what they do. The difficulty these approaches face, ...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Illustrations
• Notes On Contributors
• Acknowledgements
• Abbreviations
• Introduction
• Part I: Methods In Practice
• Part II: Issues from the Field