I agree with Luis Gonzalez-de Paz, and think that qualitative research methods can allow for many unique opportunities. Qualitative methods can be excellent for exploring areas from the varied perspectives of each stakeholder group, and can allow intimate interaction with people and with information that will provide insights that were unavailable from the researchers' initial perspectives. As researchers or clinicians, we only see what is in front of us, but if given the opportunity participants may offer insights into what happens after we leave, what is functionally most relevant or difficult for them (as opposed to empirically proven most difficult), and what each group would like to see changed or not changed. The opportunities are huge.

In my opinion qualitative methods allows researchers to deep into issues like equipoise perception, justice and other important philosophical and ethical issues that requires more words than numbers.

I agree with Luis Gonzalez-de Paz, and think that qualitative research methods can allow for many unique opportunities. Qualitative methods can be excellent for exploring areas from the varied perspectives of each stakeholder group, and can allow intimate interaction with people and with information that will provide insights that were unavailable from the researchers' initial perspectives. As researchers or clinicians, we only see what is in front of us, but if given the opportunity participants may offer insights into what happens after we leave, what is functionally most relevant or difficult for them (as opposed to empirically proven most difficult), and what each group would like to see changed or not changed. The opportunities are huge.

Qualitative method are important because it helps in understanding the public health issues from the affected individual perspectives We get to know the real need rather than the perceived needs or felt needs. This assist in tackling the problem firs hand and can save a lot of wasted resources.

Qualitative methods in community public health practice is an important tool for understanding the in depth of human behavior and the reasons that govern the behavior. It explains why and how aspect of decision making.The data collection is done by focus group discussions using one of the theories such as grounded theory, narratology or story telling etc. Usually this is done by social scientist as not many of the public health specialist are trained in qualitative analysis of the data using these theories. Most of the public health specialist are trained in quantitative analysis of data which explains what,where and when. This is easier as the main principles of epidemiology and biostatistics are applied in quantitative research. So if you have to do qualitative research you need some of form of basic training in the field.

I agree with all of you. Qualitative methodology allows researchers to go beyond the numbers and archieve a deeper understanding of the reasons, feelings, opinions and motivations of participants. But also, qualitative research includes other techniques such as observation (for instance to observe the dynamics of an emergency ward) or documentary analysis (for instance of health promotion campaigns written material) that could very useful to understand why things are working or not (or to study the evolution of health promotion messages, or even to compare different health romotion strategies between countries). Qualitative and quantitative methods are both complementary, and needed in order to have a complete picture of the situation.

As a social scientist working in public health practice, I think the first thing is to know the meaning of what is public and then what is public health practice... if we all agree that we are working towards improving the lives of humanity, that populations are not static or same and hence diverse in cultures, upbringing, views and understanding, then you will begin to see the reason for qualitative methods in public health practice. Fundamentally, qualitiative methods are built on the assumption that we as scientists don't know the problem or the solutions and what to know how they handle the problem and hence incorporates the issue of involving the populations affected in identifying causes, designing interventions and strategies. it provide explanations or reasons to the whys. even siblings don't have the same worldview let alone populations. what is the essence of have quantitative figures/views and designing interventions that can eliminate if not eradicate health problems but not having populations utilize them? eg. in a certain country, there was an epidemic of diaherra and it was found that providing toilets and latrines will reduce the rate of defecation in the sewage and gutters and so lots of toilets and latrines were provided in those communities yet the incidence of the illness continued to increase and in an attempt to find out why, scientists realized that community members were not utilizing the toilets and latrines even though they were provided free of charge. qualitative methods provided the answer to the problem. they found out people did not feel; comfortable using the latrines because there were no doors on individual spaces and hence elders didn't like the idea of children seeing their private parts even if they were same sex!!!

That is the reason for the growing call on adapting interventions to suit local context. to find the acceptability, the cultural compatibility, the unspoken and un-quantified barriers to utilization of health interventions. in some instances, it is actually qualitative methods that provide scientist with the basis for epidemiology - providing direction to possible causes and strategies for dealing with the problem. take the issue of malaria for example, local remedies have provided the basis for the identified causes and even the development of malarial drugs like quinine, atesunate amodiaquine etc...Even the famous John Snow had to use qualitative methods to be considered one of the fathers of modern epidemiology, in his work in tracing the source of a cholera outbreak in Soho, London, in 1854. He begun by talking to local residents (with the help of Reverend Henry Whitehead), to identify the source of the outbreak as the public water pump on Broad Street.

Qualitative methods provide a holistic and integrated approach to identifying and solving health problems. There is so much that can be said about the contribution of qualitative methods to public health practice as they provide insight into ethical issues, perception, justice etc. if health interventions don't require behavior change, they will not be successful and hence a growing call for BCC strategies. whose health behavior are were changing? if we don't understand their views, how do we influence their views, understanding and behavior?

sorry for writing so much.... I tend to get carried away by issues that I am passionate about.

Gertrude I think those are lovely examples of the true uses of qualitative research which is often criticised as unscientific. I particularly like your statement that we as scientists don't know the problems or the solutions. This reflects the value of an inductive approach to qualitative research necessary to explore the true needs of communities. I liked your comments.

I agree with all the comments made by Gertrude. The examples given were also good. However I just wonder whether one could have got the answers to the problems doing quantitative research? E.g. I could have just done a simple questionnaire on why the people were not using the toilets. I probably would have got the same answer. My question is is there a fine line between Quntative research and qualitative research? So when you do quantitative research and when do you do qualitative research?

Well, Yadaw, I doubt that if you did a quantitative questionnaire you would have gotten same findings. I say this with conviction because with quantitative questionnaires you actually propose answers based on wat you think is the possible cause and yoyr worldview while qualitatively you dont propose any possible answers. You actually invite them to tell you the possible causes. Thing is, with quantitative methods, its a ticking and to make them more reflective, its always good to derive your questionnaire from qualitative data if you want your responses to be near accurate.

I agree on the need to have mixed method research to provie the figures and the explanations. I will even go as far as daring to say qualitative methods serve as the foundation for quantitative methods. No method supercedes the other method.both are relevant and complimentary.

For example, in developing countries, health care utilization in public sector is low. People do not seek medical advice until they are severely or in some cases terminally sick and this is directly related to their perception about their own health, their perceptions about role of seeking care in the improvement of their/families health. In order to understand these, we must understand the community' s perceptions, behaviors and their attitudes towards health and disease. Qualitative methods are one such tool that can help us achieve this goal.

Quantitative research uses close ended questionnaire. That means options to a question, no matter how exhaustive the list might be, are in some way limited in their ability to capture the reality. Qualitative research is one such tool, which is open ended and captures the reality in its true essence as described by the community in its own words.

In public health, qualitative research makes an important counterpoint to epidemiological studies. While the first deals with few variables to explain the magnitude of the problems, qualitative research deepens the sense of health and diseases from the point of view of the subjects. For understand and act in a comprehensive way the two aproaches are equaly importante. I understand with Thomas that if someone believes a problem as real, it becomes real in its consequences.

I was interested in Imran's answer about issues of perception and barriers to help-seeking; it is so important to understand these in community public health practice if our interventions are to be targeted and so more likely to be effective.

I work a lot with research into how people and their families experience symptoms, side-effects, psycho-education and the health system when they first come into contact with services following a first episode of psychosis. We are especially interested in how to have services be more respectful and collaborative, to better be perceived to be able to help, to foster hope (since this assists with recovery and reduces suicide risk that can accompany diagnosis and these conditions).

The opportunities for qualitative research to advance the field in this area are huge since much is not said in quantitative research alone in this area due to stigma, and much is not captured without opportunities to compare and contrast with experiences of other people and families since everything is new, confusing and almost unnameable at first for people. We find mixed methods very helpful for most research questions in public mental health.

Qualitative research approaches allow us to reach a deeper understanding of the experience of people in their processes of health - disease. And access to such knowledge is essential to adapting health interventions at 3 levels of prevention. Qualitative methods focus on understanding the human experience of pain in their uniqueness and no quantification of the pain (using scales), which allows the caregiver process of empathy understand the perspective of others, actuality be closer to each other, be in tune with each other. Empathy, compassion, closeness, understanding, be with ... makes one person feel the true company and trust to deal positively with their situation.

The contribution of qualitative research to public health has been explianed very well by Gonzalez, Gertrude, laura and all.

I suggest the use of mixed method approach to investigating public health problem. Actually mixed method can add value to most health research. We have used it successfully in our asthma and diabetes research in Melbourne

In my first comment I felt the need to highlight some aspects that I consider very positive in mobilizing the qualitative approach, because my experience of research focuses on qualitative methods, most often with Grounded Theory.

My experience of nursing care in the context of pediatric oncology has led me to understand the importance of human experience and in particular the experience of the emotions of children and their families. These deep and unique experiences required me research with qualitative approach. However, at this time was to develop a multi-Studies research which includes mixed studies, focusing on emotional labor in nursing in different clinical contexts.

Community refers to 'people' and people are a mix of bio-psycho-social elements which in public health are almost inseparable. The axiomatic statements that 'all behaviors are health-related' and ' there can be no ultimate control of any disease whose etiology is known without attending to the underlying behavioral components' are true. Behaviors / actions do not lend themselves to positivist quantitative research approaches hence no public health endeavor will be complete without an understanding of the lifestyle of the people through qualitative studies..

Assessment by Qualitative methods reflects the impact created on the community better than the quantitative methods as the former indicate the user perspectives. Quantitative measurement shows just the efficiency of the provider but not the user satisfaction. Hence the former is definitely better to learn about the level of satisfaction and impact on the the community. Qualitative methods also educate the public simultaneously, thereby enhancing their cooperation and active participation.