4.3.1 Justification for interpretive paradigm
There are many different ways to classify and characterise different types of research, but one of the most common distinctions is between the concepts of qualitative and quantitative research. Myers (2009) argues that it should be clear that the word qualitative is not a synonym for interpretive, and qualitative research may or may not be interpretive depending upon the underlying philosophical assumptions of the researcher. However, the interpretivist paradigm in this study stands with qualitative research, in the same respect of understanding the meanings of the words or contexts from research participants, and the researcher’s involvement and interpretation to
deliver to the study as follows.
In particular, Snape and Spencer (2003) emphasise “the importance of interpretation and observation in understanding the social world”, which is an integral component of qualitative research. They point out that qualitative research tends to place emphasis and value on the human, interpretative aspects of knowing about the social world and the significance of the investigator’s own interpretations and understanding of the phenomenon being studied (p. 7). In addition, according to Ormston et al. (2013), the early development of ideas associated with qualitative research can be linked to the writing of Immanuel Kant, who in 1781 published the Critique of Pure Reason, in which he proposes that perception relates not only to the senses but also to human interpretations of what the senses tell us (p. 11).
In this sense, this study adopts the same aspects of the qualitative and interpretive approach, examining the emerging and growing social phenomenon of medical tourism in the context of South Korea by understanding the perspectives both from industry and consumers, rather than looking at casual relationships using a large sample. It is difficult to generalise the perceptions of this particular current social phenomenon from a larger population, and an interpretive and qualitative approach brings a greater understanding and richer answers that are most useful for the ‘what’,
‘why’, and ‘how’ questions of humanity.
However, Bhattacherjee (2012, p. 103) argues that although interpretive research tends to rely heavily on qualitative data, quantitative data may add more precision and clearer understanding of the phenomenon of interest than qualitative data. In this respect, the quantitative data from industry reports are included to review as a secondary data. The consumer biographical data (section 5.2.3.1) and value perceptions of South Korean medical tourism using Likert scale (Figures 36 and 37) are also presented for better and clearer understanding of this subject.
Figure 15 is presented to justify the chosen interpretive paradigm for this study, having answered the five basic questions by reading various books and journals on methodology (Collis and Hussey, 2009; Creswell, 2014; Denzin and Lincoln, 1994;
Figure 15 Research paradigm with five notions
Adapted by Guba and Lincoln (1989), Creswell (1998), Collis and Hussey (2009)
For more details related to these five questions, a common set of principles for all interpretive research, as listed by Bhattacherjee (2012), is presented with key words and considered in this study (pp. 105-106):
• Naturalistic inquiry – natural setting, situated
• Temporal nature – understanding, making sense of, immersive involvement
• Researcher as instrument – data collection instrument, personal insights, knowledge and experiences of social context
• Interpretive analysis – eyes of the participants, subject perspectives, thick description
• Hermeneutic circle – iterative process of moving back and forth from text to the entirety of the social phenomenon, diverse subjective viewpoints and experiences of the embedded participants, theoretical saturation
Walsham (2006) suggests that interpretive methods of research start from the position that the knowledge of reality, including the domain of human action, is a social construction by human actors. Theories concerning reality are ways of making sense of the world, and shared meanings are a form of intersubjectivity rather than objectivity (p. 321). In addition, Orlikowski and Baroudi (1991, p. 5) point out that interpretive studies assume that people create and associate their own subjective and intersubjective meanings as they interact with the world around them. However,
approach, which takes account of the individual’s subjective experiences and perceptions and the roles these play in constructing the tourist, or indeed host, experience has so far received scant attention (p. 40).
In line with these thoughts, this study attempts to understand the phenomenon of medical tourism by accessing the meanings from the research participants of both industry and consumers. In particular, the questions regarding South Korean medical tourism, value perceptions of medical tourism as benefits and sacrifices, and factors in destination choice for medical tourism are considered to be different based on the views or experiences of research participants. In other words, if people have experience of medical tourism or other travel to South Korea, they will have more knowledge and understanding based upon what they have experienced. Those people who have not experienced medical tourism might have different perceptions. People who are engaged in South Korean medical tourism might also have different views or ideas based on their job roles or descriptions. In this sense, this study considers what and how people understand those questions with regard to the division of the consumers into experienced and not experienced, and different job roles for industry.
Accordingly, this research aims to provide rich and in-depth understandings from multiple viewpoints with its emphasis on verstehen – ‘understanding’ – based on Wilhelm Dilthey and Max Weber (Sanpe and Spencer, 2003), with particular regard to
‘how’, ‘what’, and ‘why’ they have perceived this phenomenon of medical tourism.
This needs to be understood from the meanings in the context of the research participants rather than focusing on facts and numbers as in the positivist paradigm, since the context is what defines the situation and makes it what it is (Myers, 2009).
However, this requires the researcher to become involved with the material being researched, and this current study of the complex social phenomenon of medical tourism is also understood from my point of view operating within it (Carson et al., 2001; Goodson and Phillimore, 2004). From this perspective, it is fundamental to become involved in terms of my interactions and interpretations during the research process. As I am a research instrument, I can add to this research area based on my own understandings of research participants’ voices or contexts in terms of perceptions
Futhermore, knowledge comes after understanding and learning from something or someone, and everyone has different ideas and abilities to understand. Considering my research position, the lived experiences, knowledge and languages of both countries, South Korea and the UK, are used (Smith, 1989; Ormston et al., 2013). These specific research locations, where I have grown up with the languages of Korean and English, are the basic background of this current study. The diverse subjective viewpoints and experiences are thus delivered to this current study based on my research position.
In particular, Smith (1989) indicates that since meaning can only be realised within a context, interpretation requires a movement back and forth between event and context, and in this sense the process of social and educational inquiry is inevitably hermeneutical, because “investigators, like everyone else, are part of the circle of interpretations” (pp. 134, 136). Thus, the hermeneutics is also used as a means of qualitative data analysis (Myers, 2009). This study is value-laden on my own constant interpretations of the whole research to understand this phenomenon being studied. It is discussed more in the section 4.6.1.
Overall, this study clearly requires an interpretive and qualitative approach as follows.
Firstly, this study aims to develop the model of customer-perceived value (CPV) as key success factor (KSF) of medical tourism (MT) in South Korea as there is a lack of previous research and existing theory based on the empirical data in view of the fact that it is an emerging industry. It is not about setting and testing a hypothesis or making predictions about outcomes, nor is it about theory testing or cause and effect (Lichtman, 2014).
Secondly, value perceptions are subjective and individual, based on experience, job description or biographical data, particularly with regard to different aspects of both from industry and the consumer. Thus, rich and in-depth data of the emerging phenomenon of medical tourism are needed to examine the questions of how, what and why, particularly in the context of South Korea.
The next section follows the most suitable research strategy for this study to answer