3.4.1 Quantitative and qualitative approaches
Creswell (2003) suggests that there are three approaches to research;
quantitative, qualitative or mixed. Quantitative research is based on a scientific approach through measurement and quantification, with an importance placed on reliability and validity of measures and on the generalisability of findings
Research
questions
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(Robson, 2011). The use of a scientific approach is thought to increase the likelihood that information is reliable and unbiased (Davies and Hughes, 2014). In contrast, qualitative research produces little or no numeric data and
describes situations from the perspective of those involved; generalisability of findings is not paramount (Robson, 2011). Qualitative research places the observer in the setting of interest and uses an interpretive and naturalistic approach to this world (Denzin and Lincoln, 2011). Punch (2005) suggests that there is a knowledge payoff between quantitative and qualitative approaches and the researcher should determine which affords more useful knowledge. There are a number of key differences in the quantitative and qualitative research approaches: their underlying philosophical assumptions; analytical objectives; strategies of enquiry; methods employed (question format, data format); flexibility in study design; and practices used (Mack et al., 2005; Creswell, 2003) (table10).
This study is based on a scientific approach and may therefore be classified as quantitative research. Adoption of the post-positivist perspective necessitates the quantification of diagnostic delay through the systematic collection and analysis of pertinent information. Delay relates to an interval between two time points, measured in numerical data. Thus, logically, a quantitative approach is best suited to describe delay. Furthermore, the consequences of delayed diagnosis (e.g. meniscal tears) have been linked to time periods following ACL injury, and as one of the key reasons for improving time to diagnosis and
specialist consultation is to minimise these complications, investigating delay in a quantitative manner allows meaningful discourse to take place. Other primary research questions ‘whether delay times are lower in sites operating acute knee clinics’, and ‘whether there are differences in the assessment of acute knee
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injuries between specialist orthopaedic, non-specialist orthopaedic and A&E clinical staff’ ask more specific questions relating to comparison.
Table 10: Comparison between qualitative and quantitative research approaches
Quantitative Qualitative Philosophical assumptions • Positivist/ post-positivist
knowledge claims
• Constructivist/ advocacy/ participatory knowledge claims
Strategies of enquiry • Surveys and experiments • Phenomenology, grounded theory, ethnography, case study, narrative
General framework/ Research practices
• Identifies variables to study • Relates variables in
questions or hypotheses • Uses standards of validity
and reliability
• Seek to confirm hypotheses about phenomena
• Use highly structured methods such as
questionnaires, surveys and structured observation • Objectivity is sought • Detailed specification of
procedures
• Collects participant meanings • Focus on a single concept or
phenomenon
• Brings personal values into the study
• Studies the context or setting of participants
• Instruments use more flexible, iterative style of eliciting and categorising responses to questions • Use semi-structured methods
such as in-depth interviews, focus groups and participant observation
Analytic objective • To quantify variation • To predict causal
relationships
• Generalisation of findings is sought
• To describe variation • To describe and explain
relationships
• To describe individual experiences
• To describe group norms
Question format • Closed-ended • Open-ended
Data format • Observes and measures information numerically
• Textual (obtained from audiotapes, videotapes and field notes)
Flexibility of study design • Study design stable • Some aspects of the study are flexible
adapted from (Robson, 2011; Mack et al., 2005; Creswell, 2003)
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Creswell (2003) argues that research problems which identify factors that influence an outcome or the utility of an intervention, such as those examined in this thesis, are also best managed with a quantitative approach.
3.4.2 Deductive and inductive approaches
Deductive reasoning starts with a theory developed from more general ideas which can be tested through observation and analysis (Bowling, 2014). It can be
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regarded as the process of developing specific observations from general principles (Brink et al., 2006). Conversely, inductive reasoning starts with factual observations which can be used to make generalisations and develop testable hypotheses (Bowling, 2014; Brink et al., 2006).
Inductive learning, developed in the sixteenth and seventeenth centuries by Francis Bacon, and popularised by John Locke who established empiricism, was thought to be preferable to a hypothetico-deductive approach as it uses observation to avoid the problem of poor hypothesis generation and resulting tendency to defend the indefensible (Gabbay and Guenthner, 2002). Whilst the inductive and deductive approaches may seem diametrically opposed they are not mutually exclusive and can be used in combination depending upon the research question(s) under investigation (Gray, 2013; Speziale et al., 2011). Within this thesis, elements of both inductive and deductive approaches are appropriate. For the question regarding the nature of delay following ACL injury an inductive approach is used to observe elements of delay upon which
patterns may be identified and theories developed. However, for more specific theories such as whether AKCs reduce time to diagnosis and specialist
consultation, a deductive approach is regarded as more appropriate.
3.4.3 Exploratory, descriptive and explanatory approaches
Studies may be classified based on research methodology but also according to the purpose of research. Three purposes of research have been proposed; to
explore, to describe and/or to explain (Robson, 2011). It has been claimed that
research should, in the main, seek to provide explanations and therefore exploratory and descriptive research has been regarded as inferior (Robson,
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2011). However, it is also argued that exploratory and descriptive studies are more appropriate where there is a paucity of descriptive information and little is known about a phenomenon (Gray, 2013). Robson (2011) points out that under these circumstances achieving a clear description is a reasonable priority and many research questions are better suited to a focus on exploration or
description. With reference to this study, as identified in the literature review, information regarding delay is incomplete and therefore exploratory/descriptive research is appropriate to provide a clearer picture of the phenomenon. This will afford greater appreciation of the elements of, and factors associated with, overall delay. However, there is also an acknowledgement that there is a clear need to identify causal factors responsible for, or contributing to, delay;
something that only an explanatory design will be able to supply. Only once an explanation has been established will it be possible to identify the key areas that need to be addressed in order to improve the overall experience of those
suffering ACL injury. Whilst the primary aim of this study was to provide a greater understanding of the factors which affect delay to diagnosis, some factors have been identified from the literature review as being potentially impactful on delay to diagnosis. This includes the limited success of
inexperienced or non-specialist clinicians in diagnosing acute ACL injury and also the role AKCs might play in reducing time to diagnosis. Both of these areas warrant an explanatory approach.