Where history meets qualitative health research

1. Where history meets qualitative health research Dr Claire Hooker Public Health Sciences

2. Aims • To reflect on the differences (if any) between historical research in the history of health and medicine, and qualitative research in health and medicine • To discuss the utility and consequences of formalising research procedures • To identify what we could do better

3. Aims …purpose?? • Reinventing the wheel • Conversation and pleasure • Intuition, nuance, experience, perception

4. My ‘narrative’ • Honours, PhD in history • History and material culture of public health in Australia • History and Philosophy (& a lot of sociology) of science • Political history of tobacco control in Australia • Public health sciences

5. Disciplinary Shock • ‘obfuscate, confuse, elude, obscure, mislead, betray, lie …’ • A ‘methods’ section • ‘qualitative research’ … software, textbooks, a whole journal • chronologies …. What would this have looked like if I’d done it in history/ HPS?

6. The historian approaches … Principles: • to make things strange • Symmetry • To scrutinise power/ knowledge relations, expertise, hegemonies • To understand: which means, to identify the wider context and its interaction at a local level, and especially to celebrate complexity, ambivalence, confoundings All of this is probably inimical to actually achieving tobacco control!

7. … and goes to work • What did smoking mean to people? • what discourses were used to support tobacco control? • How did it feel to be a company executive or a premier? • Why did company practices develop as they did? • How was thinking about tobacco control shaped by thinking about concepts like ‘risk’ or ‘drugs’? • What insights can the history of tobacco control offer into a late modern therapeutic consumer culture? • NB - these are *not* the same questions that older generations of historians might have asked

8. How? • Gathering material • Oral history • Listening to the material Versus: ‘document research’ ‘semi structured or open ended interviews’ Coded / thematic analysis

9. Outcomes For the tobacco control group: • Chronologies • A few criticisms of ‘magicked quotations’ • recommendations to Senate committees For me: • Notion of deliberation • A discourse about drugs • A new moralism • relations between politicians were complicated by adherence to particular political cultures that had changed over the period of tobacco control

10. History v Qual Health Research • History looks at change - qual looks at the present • History has more of a focus on ‘meta’ issues – qual more focused on specifics • Qual health research is fundamentally instrumental – history is not • Qual health research is formalised – history is not Major implication: in comparison to history, qual makes claims on objectivity and predictability that history does not (indeed, is opposed to in some sense)

11. Evidence! • ‘theory and method’ 1992: Ranke; structuralism; Annales school; Marx and historical materialism; Gramsci and hegemony; (political history) social history; cultural history; feminist history; postmodern history • 2003: ideas about evidence; history wars; audio; visual; material; memory; biography; movies; public • What is not included: statistics, history of ideas, political history, military history, archiving, and paradigm shift, inter alia

12. But wait! Not so fast! History IS a form of qualitative research! I could start by telling you who uses them: philosophers, psychologists, sociologists, anthropologists, students of literature, historians, biologists...anyone, in fact, who finds the methods of the physical sciences somehow inappropriate for understanding human (and, occasionally, even animal) realities.’ C. George Boeree http://www.ship.edu/~cgboeree/qualmethone.html

13. Current Philosophical Similarities Both stand in critical relation to quantitative research: ‘qualitative research exchanges the tyranny of numbers for the enigma of words’ ‘… rooted in a non tangible domain, fundamentally experiential and intuitive’ ‘… polyvocal attempts at interfacing with cultural / linguistic/ relational accounts of the real. They are therefore interpretations, not truths in the positivist sense’ www.nova.edu/ssss/QR/QR9-1/jones.pdf

14. Hence, similarities in analytical methods • Narrative • Storytelling • Identity • Frames • Reflexive • Differences between history of public health and qualitative studies in public health would seem to lie in scope, focus, interest, language (best described qualitatively!)

15. Grappling with validity • both feel that their accounts capture some aspect of ‘truth’ • Both try to generalise from multiple instances • Both try to explain river systems as well eddies: both generate macro and micro levels of theory • Both make claims to influence future actions

16. Process similarities • oral history and interview are concerned with memory, context, how the interviewer’s relation with the subject alters things, how the subject constructs their narrative. • both grapple with issues of authenticity, reliability and truth • both require their practitioners to go through an informal process of trying to get themselves out of the picture • Coding turned out to be the same! I just didn’t count

17. …I’ll be better next time? • The IMRD format can really help crystallise the purpose of your research, and whether the method is adequate for that purpose • A ‘methods section’ can help ensure your research is sufficiently complete, and invites readers/reviewers to scrutinise whether your conclusions are justified • To historians I should think this would help in the interpretive questions they claim to be interested in: what can we learn from each piece of evidence? • ie formalising one’s methods in advance and at the conclusion of research, like peer review, can aid in ‘objectivity’, the strength of research

18. I’ll also always be an historian • A narrative piece invites playfulness, new kinds of coherence, intuitive and experiential facets for the audience • Making strange, attention to change, and attention to a variety of evidence are good ways of keeping macro and micro engaged with each other, and of being constructively critical and reflexive

19. Conclusions and Implications • Method should be thought of as dynamic until the paper is published: it is a kind of grappling • Private research audits are probably a good idea • Dialogue and deliberation are even better ones • Living in someone else’s discipline once every 15 years is really good for you