Appropriate Research Methods
6. Appropriate Methods
Towards More Appropriate Methods and Measures
The prevailing paradigm, with its inherent assumptions and orientation, results in a disproportionate emphasis on downstream, individually-oriented activities which have limited effectiveness for whole-population public health. This concern can be extended to the research methods currently employed to quantitatively measure these downstream activities. Upstream analysis requires the use of different research methods that are appropriate to this emerging new focus.
As defined by the Oxford Dictionary, the term "appropriate" denotes something that is "specifically fitting or suitable," or, phenomena that are "proper." With respect to the kit which was used to successfully combat neonatal tetanus, the term "appropriate technology" supersedes the high-low continuum. Depending on the problem of concern, so-called "low technology" may be appropriate or inappropriate – likewise with so-called "high technology."
"Appropriate" health technology does not conform to some idealized national or international standard, nor is it necessarily optimal or even "simple" (Newell, 1977). Instead, it serves as a suitable approach for that purpose at a particular point in time, taking into account the nature and magnitude of the problem and the available resources.
The neonatal tetanus kit described previously was appropriate in at least three ways:
- It was appropriate to the problem;
- It was appropriate in terms of community resources and skills (i.e., it was cost efficient); and
- It was socioculturally appropriate (i.e., it was compatible with local community values and the indigenous health system).
In other words, the term "appropriate" encompasses effectiveness, cost efficiency, and sociocultural acceptability at whatever level.
Some observers appear to conceive of research methods in terms of a hierarchy, or along some continuum – from so-called gold standard approaches (like experimentation) to some lower level types of research. Thinking of some methods as intrinsically better than others, despite the nature of the research task, is absurd. It is akin to asking: “what’s better, a banana or a wristwatch?” One obviously cannot tell the time with a banana, nor are wristwatches edible. Everything depends on the research task – if the job is to estimate the prevalence and risk factors associated with some problem, then a social survey fits the bill. If, however, the task is to determine whether something works (i.e., is effective), then a well-designed experiment is required.
These concepts have been described elsewhere and their utility for policies designed to ensure equitable resource allocation demonstrated (McKinlay, 1979; 1980). They all appear to be applicable to behavioral and social science research methods:
- What is the task or problem?
- Are there resources and people with adequate training to conduct the study?
- Will the group affected agree to being investigated?
Obviously, what is appropriate in one cultural setting may be quite inappropriate in another setting. Moreover, even within a particular setting there are often differences over time in what is deemed appropriate.
Appropriateness is a Heraclitan notion: it connotes fluidity. It is not a state that is achieved, with progress easily measured against some gold standard.