Health Psychology. Michael Murray
We would not know where to start without theories, models and hypotheses to guide us. Using sound methodology and analysis is of equal importance in testing theories and models, putting theory into practice, and evaluating the consequences of doing so. In interventions and actions to produce change, we need to know what works and doesn’t work, and why. The process is as important as the outcome. In an ideal situation we understand both, and can repeat the process and achieve the same outcome on multiple occasions.
Many traditional methods and research designs are quantitative, placing an emphasis on reliable and valid measurement in controlled investigations with experiments, trials and surveys. Multiple sources of such evidence are integrated or synthesized using systematic reviews and meta-analysis. Case studies are more suited to unique, one-off situations that merit investigation. Qualitative methods use interviews, focus groups, narratives or texts to explore health and illness concepts and experiences. Action research enables change processes to feed back into plans for improvement, empowerment and emancipation. Interest in qualitative methods and action research has been increasing. These different kinds of method complement each other, and are necessary if we want a complete picture of psychology and health. Which method is appropriate in any given situation depends entirely upon the question being asked and the context.
The sections below present an A–Z of the most commonly used research methods and issues that arise in health psychology.
Action Research
Action research is about the process of change and what stimulates it. The investigator acts as a facilitator, collaborator or change-agent who works with the stakeholders in a community or organization to help develop a situation or make a change of direction happen. Action research is particularly suited to organizational and consultancy work when a system or service requires improvements. In a community it aims to be emancipatory, helping to empower members to take more control over the way things work in their local community.
Action research can be traced back to the Gestalt psychology of Kurt Lewin (1936: 12): ‘Every psychological event depends upon the state of the person and at the same time the state of the environment. … One can hope to understand the forces that govern behaviour only if one includes in the representation the whole psychological situation.’ Lewin later wrote about what he called ‘Feedback problems of social diagnosis and action’ (1947) and presented a diagram of his method (see Figure 7.1). A series of action steps with feedback loops allows each action step to be ‘reconnoitred’ before further action steps.
Participant action research (PAR) is a prominent method in community health psychology (Campbell and Cornish, 2014). In PAR, researchers share power and control with participants and need to tolerate the uncertainty that rolls out of power-sharing. PAR is a suitable research approach in direct social actions that are organized to create change in entrenched scenarios where power imbalances are disadvantaging many of the actors. For example, Yeich (1996) described how housing campaigns with groups for homeless people involved assisting in the organization of demonstrations and working with the media to raise awareness of people’s housing needs.
Action research takes time, resources, creativity and courage. It requires collaboration with different agencies. It is an approach that does not follow a straight line but proceeds in a halting, zig-zag format. Often there are personal challenges and disappointments for the researcher, who must devote substantial emotional and intellectual energy to the project (Brydon-Miller, 2004). Cornish et al. (2014) proposed the Occupy movement as a paradigm example of community action that they labelled ‘trusting the process’ (see Chapter 16).
PAR researchers also use the arts and performance as vehicles for envisioning and promoting change. Two examples are the photo novella (Wang et al., 1996; Lykes, 2001) and PhotoVoice (Haaken and O’Neill, 2014; Vaughan, 2014). Research participants in PhotoVoice take and display photographs with the aim of becoming more reflectively aware and are able to mobilize around personal and local issues. Tucker and Smith (2014) developed a Lewinian approach to the investigation of life situations and a specific example of self-care in a service user’s home. A study of accidents in a fishing community used the PAR approach (Murray and Tilley, 2004), as did Gray and his colleagues when they transformed interviews with cancer patients into plays performed to support groups (Gray et al., 2001; Gray and Sinding, 2002).
Figure 7.1 Planning, fact-finding and execution, as described by Kurt Lewin (1947)
Between Groups Designs
A between groups design allocates matched groups to different treatments. If the measures are taken at one time, this is called a cross-sectional design, in contrast to a longitudinal design where the groups are tested at two or more time points. When we are comparing only treatment groups, a failure to find a difference between them on the outcome measure(s) might be for one of three reasons: they are equally effective; they are equally ineffective; they are equally harmful. For this reason, one of the groups should be a control group that will enable us to discover whether the treatment(s) show a different effect from no treatment.
Ethical issues arise over the use of control groups. Not treating someone in need of treatment is unacceptable. However, if there is genuine uncertainty about what works best, it is better to compare the treatments with a control condition than to continue forever applying a treatment that may be less effective than another. Once it has been determined which therapy is the most effective, this can be offered to the control group and to all future patients (Clark-Carter and Marks, 2004).
The choice of the control condition is important. The group should receive the same amount of attention as those in the treatment condition(s). This type of control is known as a placebo control (see below) as treatment itself could have a non-specific effect to ‘please’ the client and enhance his/her well-being.
If all of the various groups’ responses are measured only after an intervention, then we haven’t really measured change. All groups, including the control group, could have changed, but from different starting positions, and failing to find a difference between the groups after the treatment could miss this. We can help to deal with this problem by using a mixed design when we measure all groups before and after the treatment. However, we would be introducing some of the difficulties mentioned above for a cross-over or within-subjects design (Clark-Carter, 1997).
Bonferroni Correction
It is common in research to make multiple statistical comparisons. At the .05 or 5% significance (α) level with 20 tests there is a 64% chance of observing at least one significant result, even if none is actually significant (a Type I error). In a research project, numerous simultaneous tests may be required and the probability of getting a significant result simply by chance may be very high. The α level must be adjusted in some way, so that the probability of observing at least one significant result due to chance remains below the desired significance level. The Bonferroni correction places the significance cut-off at α/n. For example, with 20 tests and α at .05, you would only reject a null hypothesis if the p-value were less than .05/20 = 0.0025.
Case Studies
The term ‘case study’ is used to describe a detailed descriptive account of an individual, group or collective. The purpose of case studies is to provide a ‘thick description’ (Geertz, 1973) of a phenomenon that would not be obtained by the usual quantitative or qualitative approaches. It requires the researcher to be expansive in the types of data collected, with a deliberate aim to link the person with the context, e.g., the sick person in the family. The researcher usually attempts to provide a chronological account of the evolution of the phenomenon from the perspective of the central character.
A challenge for the researcher is in establishing the boundaries of the case. These need to be flexible to ensure that all information relevant to the case under investigation is collected. The major strength