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Archive for May, 2007

Qualitative-based Evidence

Brophy, P. Narrative-Based Practice. EBLIP. 2007. 2:(1):149-158.

Given, L. Evidence-Based Practice and Qualitative Research: A Primer for Library and Information Professionals. EBLIP. 2007. 2:(1):15-21

In the movement promoting evidence-based library and information practice — defined as use of formalized strategies for including evidence in daily practice – the definition of the body of knowledge constituting “best evidence” continues to evolve. In the two articles cited above, which share the same issue of EBLIP, authors Brophy and Given argue for the inclusion of qualitative studies in that body of knowledge. While quantitative randomized-controlled trial (RCT) studies have long been considered the gold standard for producing evidence in the disciplines embracing evidence-based practice, Brophy and Given both argue that social fields like librarianship must look to qualitative studies to answer questions of “why” and “in what context.” They also argue that we cannot fully understand social context without methods that emphasize listening to people, observing behavior and reviewing textual and pictorial documents.

Brophy’s article, a commentary, promotes use of a database of high quality narratives (or stories) to inform practice – something he calls “narrative-based practice.” He writes “We are more likely to find meaning in the telling of how things have been experienced by others than in the formality of arid statistics and measures.” (p.156) Thus, he believes that narratives must be presented along with statistics to help managers with their “evidence-based” decision making.

Given’s article presents a more informative treatment of qualitative research with examples of its three primary methodologies: interviews; observation; and analysis of textual data (e.g., participant-created documents like journals or existing texts like policy manuals or meeting minutes). She also discusses some standard criteria for assessing qualitative research – which differs considerably from criteria for judging quantitative research.

Any number of articles have been published that argue for the legitimacy of qualitative research, but Brophy and Given go a step further. They believe that qualitative studies are essential to the development of a complete body of knowledge for informing practice.

The Joint Commission’s Strategies for Addressing Patient Diversity and Low Health Literacy

The Joint Commission (the health care organizations’ accrediting agency formerly known as JCAHO), has launched a public policy initiative to address broad issues that may undermine patient safety and quality of health care. It has published two papers that address important concerns related to patient safety and quality of care: linguistic and cultural diversity of patients; and low health literacy. A recent publication titled Hospitals, Language, and Culture: Snapshot of a Nation. A Report of Findings presents findings from a qualitative study of how 60 hospitals dealt with linguistic and cultural diversity. A white paper, “What did the Doctor Say? Improving Health Literacy to Improve Patient Safety” addresses the problem of health literacy and strategies for meeting patients’ communication needs.

The Joint Commission recognizes that the problems rising from diversity and low health literacy must be resolved through engagement of “multiple publics.” And medical librarians represent one “public” that should be engaged. Yet neither publication specifically mentions librarians, who could play a key role in providing access to information needed to support the strategies suggested in the publication. It appears that librarians may have to advocate for their role.

Fortunately, the MLA’s 2006-2007 priorities include a broad media effort to inform health care administrators of “librarians’ value (ROI) in providing consumer health information and patient education that improves patient safety, welfare and empowerment.” Another MLA priority — research defining the relationship between consumer health information and health information literacy on patient outcomes, safety and health care costs — will provide an “evidence-based” foundation for advocacy. The Joint Commission’s public policy initiative (and the accreditation standards that result from it) could pave the way for collaboration between health care organizations facing the challenges of caring for a diverse patient population and medical librarians who can support their efforts through access to much-needed information.