Using focus groups in general practice research

Recent years have seen a growing recognition of the appropriatenessof qualitative methods in family practice. This has been paralleledby an upsurge of interest in focus group discussions as a method.Drawing on the experience of using focus groups with generalpractice teams as one component of a multi-method study thispaper explores emergent orthodoxies regarding the use of focusgroups and reviews the contribution which this method can maketo research in general practice.     

Doing qualitative research in general practice: methodological utility and engagement

General practice uses an eclectic range of research methodology. This includes increasing reliance upon qualitative research methods. There seem to be two distinct treatments of qualitative research within primary care and, in particular, within general practice research. The first is characterized by a purely utilitarian and technical focus, using a qualitative method because it is the most appropriate means of realizing the aims of the research, while the second is characterized by in-depth engagement with the philosophical and paradigmatic aspects of qualitative methodology. In-depth engagement with methodology and theory, and theory building, is an important aspect of masterate and doctoral research within social sciences such as education and anthropology, and in the discipline of nursing, but has not been a feature of qualitative research in medicine. A practical difficulty encountered within postgraduate programmes such as the one in which the author teaches is that when innovative qualitative techniques are used by GPs in their postgraduate research dissertations and theses, it is often beyond GP examiners' own knowledge and experience, yet it fails to measure up to standards established in social sciences, particularly in sociology and anthropology where in-depth reflexive engagement with the theory and philosophy of qualitative methodology is expected. This paper suggests that the value of in-depth engagement with methodology when conducting qualitative research results in creative and innovative ways of conducting research that are consonant with the nature of general practice itself, and strengthens research findings. Therefore, as teachers of research methods and supervisors of research theses, it is important to encourage students conducting qualitative research to engage fully with theoretical and methodological issues.     

Building family/general practice research capacity

To promote the range of interventions for building family/general practice (family medicine) research capacity, we describe successful international examples. Such examples of interventions that build research capacity focus on diseases and illness research, as well as process research; monitor the output of research in family/general practice (family medicine); increase the number of family medicine research journals; encourage and enable research skills acquisition (including making it part of professional training); strengthen the academic base; and promote research networks and collaborations. The responsibility for these interventions lies with the government, colleges and academies, and universities. There are exciting and varied methods of building research capacity in family medicine.     

Qualitative methods in general practice research: experience from the Oceanpoint Study

BACKGROUND: The Oceanpoint Study is a collaborative study between generalpractice and medical anthropology. METHOD: The study involved a qualitative ethnographic approach includinglong-term participant observation, in-depth interviews, healthdiaries and focus group discussions. Qualitative methods aresuited to describing the phenomenological perspectives of peoplethrough the generation of rich detailed accounts which leaveparticipants' perspectives intact. RESULTS: The use of these methods in this study has enabled the researchersto explore a range of community beliefs and practices concerninghealth and illness. The underlying concerns and approach ofgeneral practice medicine are similar to those of the qualitativeresearch tradition. CONCLUSIONS: The experience of being a general practitioner parallels theexperience of an ethnographer conducting qualitative researchand the paper explores the similarities and differences betweenthem and discusses the usefulness of such collaborative research. Keywords. Qualitative methods, ethnography, general practice research.     

The use of standardized patients in research in general practice

Standardized patients (SPs) are simulated patients or actual patients who have been carefully coached to present their illness in a standardized way. Much is known about the use of standardized patients in medical education. This article reviews advantages and disadvantages, reliability and validity of the use of standardized patients in general practice and primary care research. Performance in general practice can be measured with direct or indirect methods. With direct methods the physician-patient contact is directly observed or heard. Indirect methods are seldom complete and seldom accurate and therefore often invalid. Direct methods (observation, video, audiotapes, etc.) have face validity, but nevertheless have shortcomings. The SP method can mainly avoid the disadvantages of the other methods. The presentation of the case by the SP is accurate. The judgement of physician's behaviour during the consultation by the SP is accurate and reliable. SPs are generally believable. Less than one in five SPs is detected by the physicians, so the method has face validity. To obtain sufficient reliability and validity, a thorough selection and training of SPs is required, as is careful organization with an eye for detail. The SP method also has some important shortcomings. The method is time and work demanding, limiting the number of physicians that can be measured. In addition, measurement is usually limited to one consultation. In reality, however, diagnostic and therapeutic interventions are often spread over several consultations. This 'first-visit-bias' hampers conclusive answering of some research questions.