1. Prashanth N S Institute of Public Health, Bangalore
Questions as if methods matter Considerations for choice of methods in health equity research
Prashanth N S
Institute of Public Health, Bangalore

2. Objective of the session
describe worldviews underlying research questions and methods
Discuss the role of theory- driven inquiry in research on health inequalities and inequity

3. What is the truth?
The actual truth?
Many truths?
The real truth?
….consider these questions for research questions around health equity/inequity

4. Very scientific epistemological self-diagnosis
cartoonstock.com

5. Q1 What do you trust more? Hard science or soft science? Hard science
Both/either/it depends
Soft science
From Keystone HPSR course & CHEPSAA. See Open Access Teaching & Learning Resources on
Health Policy & Systems Research (HPSR) by KEYSTONE India initiative

6. Q2 Is there such a thing as truth? Can’t decide
No (no truth or many truths)
Yes
From Keystone HPSR course & CHEPSAA. See Open Access Teaching & Learning Resources on
Health Policy & Systems Research (HPSR) by KEYSTONE India initiative

7. Q3 Is knowledge discovered or created? Knowledge is created
Both/can’t decide
From Keystone HPSR course & CHEPSAA. See Open Access Teaching & Learning Resources on
Health Policy & Systems Research (HPSR) by KEYSTONE India initiative

8. Q4 Can we have a knowledge of a single reality that
is independent of the knower?
Yes No
Sometimes
From Keystone HPSR course & CHEPSAA. See Open Access Teaching & Learning Resources on
Health Policy & Systems Research (HPSR) by KEYSTONE India initiative

9. What is the role of the health systems researcher?
Truth gatherer
Interpreter
Meaning maker
From Keystone HPSR course & CHEPSAA. See Open Access Teaching & Learning Resources on
Health Policy & Systems Research (HPSR) by KEYSTONE India initiative

10. Self-scoring
Q1 A=1 B=2 C=3 Q2 A=2 B=3 C=1 Q3 A=1 B=2 C=3 Q4 A=1 B=3 C=2 Q5 A=1 B=2 C=3
From Keystone HPSR course & CHEPSAA. See Open Access Teaching & Learning Resources on
Health Policy & Systems Research (HPSR) by KEYSTONE India initiative

11. Results from our very scientific epi self-diagnosis
1- 6 -> Any guesses? > Any guesses? > Any guesses?

12. Questions are not in a vaccum…
Ontological questions – What is reality? What is the form and nature of reality?
Epistemological questions – What is knowledge? What can be known about reality?
Methodological questions – How can knowledge about reality be produced? How can the person seeking knowledge go about finding out whatever he or she believes can be known?
Lowenson PAR reader, quoting Guba & Lincoln (1994)

13. Positivism
Questions?

14. Constructivism
Questions

15. Post-positivism
Questions?

20. …neither are methods in a vacuum
Questions and methods closely interconnected, but both heavily derive from researcher worldviews
Questions and Methods are could range from being (mere) instruments of curiousity to being an agency for the exercise of power, politics and (often) privilege…..depending on where/how your own worldviews fall...

21. Illustration: Theory-driven/realist inquiry
Notion of a naïve or a blank/objective researcher for health equity research?
The elephant in the room: Underlying disadvantage/injustice. Cf. notion of power (Lowenson’s power over…, power to..., power with..., power within...)

22. Illustration: Theory-driven/realist inquiry
From Emilie Robert/CRCHUM

23. Illustration: Theory-driven/realist inquiry
Generative causality
Actors have a potential for change by their very nature
Agency : role of actors in change
Structural and institutional features exist independently of the actors (and researchers)
Actors and programmes are rooted in a stratified social reality
Result: interplay between individuals and institutions, each with their own interest and objectives, within a social context
Bruno Marchal/Keystone HPSR

24. Illustration: Theory-driven/realist inquiry
What works? How? For whom? Under what circumstances? Why?
“The basic task of social inquiry is to explain interesting, puzzling, socially significant regularities. Explanation takes the form of positing some underlying mechanism which generates the regularity and thus consists of propositions about how the interplay between structure and agency has constituted the regularity. Within realist investigation there is also investigation of how the workings of such mechanisms are contingent and conditional, and thus only fired in particular local, historical or institutional contexts.”
Pawson & Tilley

25. In summary…
Researchers and research approaches both have their particular history and worldview
Research on inequity requires a deeper understanding of the philosophical foundations of research approaches
Researchers need to be aware of the ontological-epistemological implications of their research questions and methodological approaches.
Depending on worldviews, participatory approaches and theory- driven approaches offer a rich insight into inequity research