Extending the epidemiological imagintion through qualitative research

Abstract

In this thesis I present four discrete yet methodologically congruent pieces of research. These works challenge traditional conceptualisations of epidemiology as a purely quantitative science by presenting insights derived from qualitative research. Collectively I use these studies as a basis from which to argue for greater recognition of the contribution of qualitative methods, highlighting the opportunity they provide to ‘extend our epidemiological imaginations’ by exploring and responding to population and public health issues in new and innovative ways. The first study addresses the epidemiological challenge of suboptimal bowel screening participation in New South Wales (NSW) by exploring the factors that influence decisions to screen. In this study the qualitative paradigm facilitated an understanding of how knowledge and awareness of bowel cancer and screening contributed to perceived risk and susceptibility, subsequently motivating intention to screen. The second study examines the role of General Practitioners (GPs) in promoting bowel screening participation to patients. The qualitative approach used here offered insight into how GPs conceptualise asymptomatic population screening, and the impact of these perceptions on their approach to recommending screening to patients. The third study is based on an evaluation of a policy directive mandating the delivery of smoking cessation brief interventions in public oral health services in NSW. In this study the use of qualitative methods helped elucidate the range of factors (from the personal to the contextual) that may affect the translation of health policy and health promotion activities in the clinical setting. The fourth study is drawn from an evaluation of the NSW influenza surveillance system, undertaken to inform system strengthening. Here, adopting a qualitative approach enabled mapping of the operation and function of the surveillance system and an assessment of its attributes from the perspective of key stakeholders. Together these studies provide illustrative examples of how qualitative research can contribute to, and extend our understanding of epidemiological issues. The findings provide important information about the ‘real world’ translation of policies and programs and have been used to inform a range of policy and practice strategies that ultimately seek to improve the health of the NSW population.