Health Psychology. Michael Murray
Traditionally, the method has been applied to quantitative data. Recently, researchers have begun to investigate ways and means to synthesize qualitative studies also.
Knowing how to carry out and to critically interpret an SR report are essential skills in all fields of health research. They enable researchers and clinicians to integrate research findings and make improvements in health care.
Systematic reviews act like a sieve, selecting some evidence but rejecting other evidence. To retain the metaphor, the reviewers act as a filter; what they see and report depends on how the selection process is operated. Whenever there is ambiguity, the process may well tend to operate in confirmatory mode, seeking positive support for a position, model or theory rather than disconfirmation. It is essential to be critical and cautious in interpreting and analysing SRs of biomedical and related topics. If we want to implement new practice as a direct consequence of such reviews, we had better make certain that the findings are solid and not a mirage. This is why the study of the method itself is so important. Systematic reviews of the same topic can produce significantly different results, indicating that bias is difficult to control. Like all forms of knowledge, the results of an SR are the consequences of a process of negotiation about rules and criteria, and cannot be accepted without criticism and debate. There are many examples of SRs causing controversy, for example Law et al. (1991), Swales (2000), Marks (2002c), Dixon-Woods et al. (2006), Roseman et al. (2011) and Coyne and Kok (2014).
Taxonomy for Intervention Studies
This section describes an idea for a taxonomy designed to help solve a variety of issues mentioned elsewhere in this A–Z, namely, the description of interventions, replication and transparency. As noted, lack of replication has been a major issue in psychology. One reason for the failure to replicate is the sheer complexity of different interventions that are available. A vast array of interventions and techniques can be delivered in multitudinous combinations, enabling literally millions of different interventions designed to change behaviour (Marks, 2009).
If interventions are incompletely described, it is not possible to: (1) determine all the necessary attributes of the intervention; (2) classify the intervention into a category or type; (3) compare and contrast interventions across studies; (4) identify which specific intervention component was responsible for efficacy; (5) replicate the intervention in other settings; or (6) advance the science of illness prevention by enabling theory testing in the practice of health care.
One way to put order into the chaos is to use a taxonomic system similar to those used to classify organisms or substances. Taxonomies for living things have been constructed since the time of Aristotle, with the periodic table in chemistry being the best-known example. Some researchers approached this issue by generating ‘shopping lists’ of interventions used in different studies. For example, Abraham and Michie (2008) described 26 behaviour change interventions, which they claimed provided a ‘taxonomy’ of generally applicable behaviour change techniques. Michie et al. (2008: Appendix A) also produced a list of 137 heterogeneous techniques. However, these lists are not useful as taxonomies because they do not demonstrate any systematic structure or organization of classification. A list of techniques is no more useful than a list of chemicals. Only when there is an organization like the periodic table do we gain an understanding of the underlying structure and the relationship between the various elements that lie in the table.
Psychology lacks a system for classifying interventions into a single system consisting of all known techniques and sub-techniques. In an effort to fill this gap, one of the authors has described a taxonomic system which includes six nested levels:
1 Paradigms, e.g., individual, community, public health, critical.
2 Domains, e.g., stress, diabetes, hypertension, smoking, weight, exercise, etc.
3 Programmes, e.g., smoking cessation, obesity management, stress management and assertiveness training.
4 Intervention types, e.g., relaxation induction, imagery, planning, cognitive restructuring, imagery, buddy system monitoring.
5 Techniques, e.g., within imagery there are a large number of techniques, such as mental rehearsal, guided imagery, flooding in imagination and systematic sensitization.
6 Sub-techniques, e.g., within guided imagery there exist a variety of sensory modalities (sight, sound, smell, taste, touch, warmth/coldness), scenarios (e.g., beach, forest, garden, air balloon), delivery methods (e.g., spoken instruction, self-administered by reading, listening to audio tapes), settings (e.g., individual, group) and participant positions (e.g., supine, sitting on floor, sitting on chair).
This taxonomic system is capable of including all health psychology paradigms, domains, programmes, intervention types, techniques and sub-techniques, as defined with universal reference in the form of a tree diagram. Any research design that is sufficiently specific can be placed within this taxonomic system to enable any imaginable intervention to be constructed, delivered, evaluated, labelled, reported and replicated in an unambiguous fashion. This system, or something similar, is needed to remove some basic problems that hold back progress in psychology as a discipline.
Top-down versus Bottom-up Research Approaches
A ‘top-down’ research approach is where an executive decision-maker, who may be a theorist, a research director or other influential person within an organization, makes decisions about the nature of a research programme that should be carried out, the objectives of the research, and the methodology, with or without the consultation of an advisory board. This executive decision requires the existence of suitable funding, for example from governmental and/or commercial sources. A hierarchical system with different levels of research personnel responds according to the requirements of the programme. In many instances, the research programme will be carried out across multiple institutions, which compete for the resources by demonstrating their excellence in their commitment to the research question and in their competence to carry it forward.
The top-down research approach mirrors the social hierarchy found in ancient Egypt, wherein the Pharaoh ruled over a hierarchy of social and occupational classes residing at various levels below (Figure 7.4).
A top-down research approach has been the predominant approach across universities, institutes and research organizations. The ‘Pharaoh’ is normally a leading theoretician, funding body, institute director or professor who sets the goals for the research, organizes the funding and appoints the principal investigators (PIs) who are responsible for implementing the research programme, including the methodology, defining the specific research questions, and selecting personnel qualified to organize recruitment of the participants (or ‘subjects’) and the data collection. In turn, the PIs are responsible for recruiting assistants to collect data and statisticians to analyse the data from participants, who are normally patients or college students, at the bottom of the research hierarchy. Expert paper writers may consist of the PIs themselves or be especially hired for their ability to write up the study in the most favourable light to the study hypotheses. The ‘Pharaoh’ rarely, if ever, interacts or communicates with anybody lower in the hierarchy than the PIs, especially the research participants. Typically, ‘Pharaohs’ prefer quantitative variables that are believed by him/her to be less prone to error and bias, but they may also opt for subjective, self-report measures, which are more prone to confirmation bias in a non-blinded trial (e.g., see White et al., 2011)
Figure 7.4 Top-down research approach
Some health psychologists, especially those who prefer qualitative methods, disagree with the top-down approach, which imposes a particular theoretical framework or mould on the research and the research participants. They argue that a formulaic, top-down approach tends to produce confirmation biases and group-thinking, which constrain creativity and innovation. Researchers who prefer the reverse approach, the so-called ‘bottom-up approach’ (please note that it is ‘bottom-up’ and NOT ‘bottoms up’, which is the kind of thing people say before downing a stiff drink!) tend to use an open-ended