How can ‘lay knowledge’ add to the ecological approach?

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By Rachel Brown

Earlier this year, I attended an excellent day of discussions and presentations on the role of qualitative data in intervention planning and delivery. The sessions looked at different methods of qualitative data synthesis, a developing and much debated field, which involves taking data from multiple qualitative studies and synthesising, comparing or further analysing these. This can facilitate richer description, identification of common themes or the development of new theory.

Each speaker approached the synthesis of qualitative data from a slightly different standpoint, but all shared the belief that rich, participant-centred data gained in qualitative studies can enhance our understanding of public health problems. One who stood out for me was Dr. Mike Robling of Cardiff University, who discussed the key role of qualitative research in uncovering some of the complex issues presented during trial implementation. He highlighted the value of understanding the experience of those who participate in intervention studies, for example in identifying what may make people more or less likely to continue participating in a trial over a long period.

As someone who’s tended to assume that trial automatically means quantitative, I found it enlightening to hear about the added value that qualitative accounts can contribute to such work, and to think about the potential value of qualitative synthesis in ecological assessments of public health problems. The socio-ecological approach, which is central to research here at DECIPHer, involves identifying multiple levels of influence that impact health, and understanding the reciprocal relationships between the individual and their environment. I think it’s important that, as well as recognising the complexity of health and identifying these multiple levels, we identify and use multiple sources of data, including the collection and synthesis of qualitative accounts. 



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From my previous work in drug services, I’m a keen advocate of service user involvement as a means of countering the stigma and marginalisation experienced by this client group, and ensuring that they are fully involved in decisions about their treatment and care. I’ve heard many service users complain about being treated as incapable of contributing to their own wellbeing, and this can lead to withdrawal from treatment programmes and missed opportunities for positive change.

I’m attracted to qualitative research as it seems to align with this emphasis on hearing the voices of those impacted by a situation, behaviour or intervention. For this reason, I particularly enjoyed the session delivered by Professor Jennie Popay of Lancaster University, on the value of lay knowledge – that gained through experience, and held by someone not considered an ‘expert’ in the subject –  and its role in ‘defining the problem’. She spoke passionately about the value of qualitative data as a means of uncovering this experiential knowledge, and its role in addressing the potential power imbalance between researcher and ‘researched’ or between service user and service deliverer.

Lay accounts are fundamental to understanding public health issues from the perspectives of those whose behaviour we, as researchers, are trying to affect. In this paper from 1998, Popay and others argue that lay accounts reflect people’s own understanding of their health as located in the broader context of their lives. This has great implications for understanding why behaviours which are unhealthy are maintained even when the potential negative outcomes are fully understood.

I would argue, then, that the inclusion of qualitative accounts of lay knowledge is complementary to a genuinely socio-ecological approach. They can give valuable insight into the personal, social and cultural influences on health behaviour, and the role of individual agency as well as wider structural considerations. This isn’t limited to the lay knowledge of participants in your own research; at the pre-intervention planning stage, thorough interrogation of existing qualitative literature (including syntheses) on the subject in question may help to identify potential barriers to successful implementation.

As a new researcher, I’m looking forward to using these methods for myself and am convinced that incorporation of self-reported understanding of participants will benefit my work. I’ll discuss attempts to incorporate this into my research in a future blog-post but for anyone looking to understand more about qualitative synthesis, this is a good paper to get started with.



Rachel Brown is a PhD student at DECIPHer. She attended “The Whole Picture: Synthesising Evidence in Clinical Trials”, a QUEST Master Class run by Swansea University.

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