Today is the first of 20 days of what I am calling a “Learning Road Trip.” Each day’s post will present the planned activity and be revised later to indicate how it went.
A significant feature of what I would call qualitative epidemiology is that the subjects’ interaction with the researchers provides an opportunity for empowerment or a sense of agency. That happens to a small degree in quantitative epidemiology when, for example, people recruited into a study begin to pay better attention to their health. That happens, it seems, because they feel that someone—the researchers—are paying attention to them. Generally, however, it is not an empowering experience to supply one’s weight, blood pressure, cholesterol levels, etc. or to answer a bank of survey questions.
In qualitative epidemiology subjects are given a space and a structure in which to reflect on their experiences. Such reflection can allow people to move ahead in new directions, not simply to continue along previous lines. Indeed, the design of the interviews in, say, a Brown or Dervin style could be evaluated and refined not only with respect to coding of responses for quantitative analysis, but also with respect to their effect on reflection-based empowerment.
Even when there is not a direct empowerment effect, the coding and quantitative analysis of Brown and Dervin-style interviews allows categories and relationships to emerge that have a closer relation to variables that people can act on than do the typical risk factors of quantitative epidemiology. Instead of single versus married, for example, we might find “partner to confide in” or “has relatives and friends close at hand in time of need.” Or whatever—what emerges obviously depends on the particular situation and group of subjects. This situation-specificity can well lead to concerns about extrapolation and generalizability of findings. The response of researchers to such concerns cannot be to claim that the same factors will apply in other cases, but instead to suggest that what they have found might stimulate someone else’s thinking about what to look into in other situations. In other words, there’s no need for the researchers in the new situation to start from scratch.
Under the life-course perspective that has developed in social and psychological epidemiology since the 1990s, researchers seek to reconstruct the complex causal processes that generate specific diseases and behavioral attributes (Kendler et al. 2005, Kuh and Ben-Shlomo 2004). However, some prominent social epidemiologists are becoming skeptical about the availability of the kinds of data and analyses needed to separate the effects of diverse biological and social factors that operate on a range of temporal and spatial scales and build up over a person’s life course (Davey-Smith 2007), or more generally, to “to identify modifiable causes of disease that can be utilized to leverage improved population health” (Davey-Smith 2008a, b; but see Lynch 2007). Grounds for such skepticism are amplified by the possibility of heterogeneity, that is, when similar responses of different individual (e.g., genetic) types are observed, researchers need not assume that similar conjunctions of risk or protective factors have been involved in producing those responses.
This state of play leads me to emphasize the possibility of an agent-oriented focus, in which researchers depart from the traditional emphasis on exposures impinging on subjects and, instead, elucidate people’s resilience and reorganization of their lives and communities in response to social changes (Sampson et al. 1997). The patterns those studies establish might not extrapolate readily over time, place, and scale. They can, however, provide a point of departure for research and policy engagements in the next situation studied. An agent-oriented epidemiologist would need to be conversant with studies of resilience and reorganization in communities, but also train in participant observation and qualitative methods for research on population health changes that arise through grassroots and professional initiatives and grow into loosely-knit social movements, e.g., around innovations in short-term therapy for depression (e.g., Griffin and Tyrell 2003, White and Denborough 1998).
I am interested in conversations with others who wish to examine the epidemiological significance of an agent-oriented focus.
Davey Smith, G. (2007). “Lifecourse epidemiology of disease: a tractable problem?” International Journal of Epidemiology 36(3): 479-480.
Davey Smith, G. (2008a). “Epidemiology and the ‘gloomy prospect’: why epidemiologists are not in the business of understanding individual-level risks” (Lecture, January, Department of Social Medicine), University of Bristol. See (2011) “Epidemiology, epigenetics and the ‘Gloomy Prospect’: embracing randomness in population health research and practice,”International Journal of Epidemiology 40 (3): 537-562.
Davey-Smith, G. (2008b). “‘Something funny seems to happen’: J.B.S. Haldane and our chaotic, complex but understandable world.” International Journal of Epidemiology 37: 423-426.
Griffin, J. & I. Tyrrell. (2003). Human Givens: A New Approach to Emotional Health and Clear Thinking. Human Givens Pub.
Kendler, K. S., C. O. Gardner, C. A. Prescott (2002). “Towards a comprehensive developmental model for major depression in women.” American Journal of Psychiatry 159: 1133-1145.
Kuh, D. and Y. Ben-Shlomo, Eds. (2004). A Life Course Approach to Chronic Disease Epidemiology. Oxford, Oxford University Press.
Lynch, J. W. (2007). “Relevant Risk, Revolution and Revisiting Rose – Causes of Population Levels and Social Inequalities in Health.” http://www.sph.umn.edu/ce/roundtable/Roundtable_032307.asp. (viewed 9 Sept. 2009)
Sampson, R. J., S. W. Raudenbush, F. Earls. (1997). “Neighborhoods and Violent Crime: A Multilevel Study of Collective Efficacy.” Science 277(5328): 918-924.
White, C. & D. Denborough, eds. (1998). Introducing Narrative Therapy. Dulwich Centre Publications