Evidence-Based Research: Dilemmas and Debates in Health Care

Evidence-Based Research: Dilemmas and Debates in Health Care

Evidence-Based Research: Dilemmas and Debates in Health Care

Evidence-Based Research: Dilemmas and Debates in Health Care


"A most valuable resource setting health care research into a contemporary philosophical setting" Dr Colin Thunhurst, Course Director, University College Cork

• Why is the philosophy of science important for health care research?

• What impact do world-views and paradigms have on the research process and the knowledge it generates?

• Why do some kinds of concepts get replaced by others?

This book covers the major perspectives in the philosophy of science and critically discusses their relevance to health care research, using examples of paradigms, concepts, theories and research findings in the health sciences. It makes sense of the bewildering variety of assumptions, world-views and epistemiological implications of the different research methods. It enables the reader to become an informed consumer of scholarship on health care issues.

The authors describe how health care research has been influenced by positivistic and interpretative approaches, and how it has recently been challenged by postmodernist philosophies. All of these approaches have research methods aligned with them which have taken their place in the panoply of tools at the disposal of the health scientist.

Written in a clear and accessible style, Evidence-Based Research demonstrates how the different philosophical bases to research impact in real-life health care work and research. It is key reading for the growing number of people involved in health care research in universities and health settings, and is particularly suitable for advanced undergraduate and masters students researching in the health care sciences.


At the start of the new millennium, health care is in a state of transition. in the English-speaking world, there are a number of strong political and scientific currents pulling practitioners and clients into new and unfamiliar territories where their skills, practices and even their identities will be challenged. Health care organizations, policies and funding arrangements are rapidly being restructured. New challenges are emerging from new health problems. hiv, Gulf War Syndrome, the proliferation of severe and life-threatening allergies, the resurgence of diseases such as leprosy in nations from which it was previously believed to have been eliminated, the problems presented by warfare, global migration, hunger and even iatrogenic problems originating in health care itself, all are being increasingly brought into focus for health professionals.

At the same time – and this is where we come in – in Europe and America there is an increasing emphasis on research in health care. There has been a massive shift in the policy arena towards evidence-based practice. Everyone in health care, from the consultant surgeon to the volunteer care assistant, is being urged to become research literate, to read research and apply it to their practice, and even to do research themselves.

A further development – and another on which we can help – is the change in focus in health care provision. More and more policy is emphasizing the needs of the patient. Indeed, they are increasingly seen not as patients but as 'clients', 'users', 'consumers' or even 'customers'. They are consulted, surveyed and assessed, via health needs surveys, user involvement in service planning and devolution of decision making to local level. This process of inclusion and consultation, in the uk at least, is built into the statutory framework for health care providers such as the newly formed 'trusts' which administer an increasingly large part of the UK's health care. This policy context has already been written about extensively. What interests us is the conceptual shifts that many of us will have to make to keep abreast of these changes. the shift from 'patient' to 'consumer' is, in some ways, just as profound as the change in thinking from 'demonic possession' to 'illness', or from an 'imbalance of the humours' to 'bacterial infection'. Thus, we would argue that there are lessons to be learned from previous revolutions in the way we think about health and illness. Like . . .

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