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Any parents of a child with an allergic disorder would have no hesitation in declaring that their expectation is to be able to access a high‐quality pediatric allergy service. Clinicians providing the service hope to be able to deliver high‐quality care and expect that financial considerations will not adversely affect their capacity to do so. Sadly, however, the reality is that limited resources, even in the most affluent countries, are progressively compromising the clinician's ability to meet the expectations of consumers. Indeed, in many health services world‐wide, there appears to be an increasing preoccupation with quantity rather than quality. However, intentions are often presented using such remarkable euphemisms as ‘health improvement plans’, which are very thinly disguised attempts to reduce costs. The majority of those involved in research in pediatric allergy and immunology would have no hesitation in declaring that quantitative hypothesis‐driven laboratory and clinical investigation is the only way to generate an evidence base that has any chance of improving the management of allergic disease in children. Indeed, many would declare that this is the ‘be all and end all’ of the discipline. Double‐blind placebo‐controlled clinical trials in homogenous groups of very carefully selected patients are the only trials considered in meta‐analyses, which are used to create the evidence base from which we are all expected to practice. Clinical anecdote has become a despised and antediluvian art. Observational laboratory and clinical research is dismissed as a fishing exercise. In our drive for scientific objectivity, have we become guilty of throwing the baby out with the bath water? As clinical science has become progressively more of a left‐brain enterprise, social science has been evolving a new and, I believe, an exciting and important right‐brain approach to understanding the ills of humanity. Qualitative research is progressively gaining credibility, to the extent that all of us should now begin to understand and incorporate its concepts into our research programmes. Indeed, I would go so far as to suggest that if we neglect the qualitative approaches, we will fail to deliver the highest quality of care to the maximum number of patients. It is, for instance, quite clear that despite all our best efforts, a high percentage of asthma sufferers do not adhere to our therapeutic recommendations. We may believe that this is due to our own inadequate exhortations, but social scientists would suggest that we have failed to listen to the consumers. Quantitative research relies entirely on us believing that we know the questions to ask. Qualitative research does not make this arrogant assumption. Basically, it creates a situation in which unpredictable, unsolicited information may be acquired. This may appear to be a fishing exercise, but unless it occurs the basic questions that might subsequently evolve into hypothesis‐driven quantitative research will not even be generated. Thus qualitative approaches may on one level be considered as the fuel for the quantitative research engine. However, it is very much more than that. At a health services research level, delivery of care will only be universally effective if we understand the wishes, needs and expectations of our customers. Far too often, we preach to our patients and assume that we know what they need. This certainly explains our inability to always handle allergic diseases effectively. Research in this area should not be viewed as soft. Qualitative approaches have been thoroughly validated and can be considered as scientifically credible and important as the hypothesis‐driven quantitative approach. The approaches are mutually complementary. This is to a certain extent incorporated into the concept of Quality Life Years (QALYs), which is a quantitation of the quality improvements achieved by any intervention. We are beginning to receive a few papers for Pediatric Allergy and Immunology that are adopting this qualitative approach. I am looking forward to receiving many more in future years, which I am sure will be of considerable benefit to our discipline.
Pediatric Allergy and Immunology – Wiley
Published: May 1, 2000
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