This research reveals strength in internal validity considering the rigor with which the

study was carried out and the extent to which the researcher considered

alternative explanations for explored causal relationships (Huitt, 1998).

The rigor of the research can be judged through a range of approaches that certifies its

progress and correctness (Mays, 1995). Firstly, the objects of this research are experimental

and they take place in the observable environment. Secondly, the results are confirmable

and repeatable. Thirdly, the study results are not stated as proofs of methods for HE and

HLP optimization, but rather as potential models. Finally, the evaluative criteria to be

considered are that research is ethical and important, reach in substance and content and

the research process is clear (Mays, 1995).

The generation of proposals was restricted to the genuine time spent for discussion and the

lacks of anonymity might impede participants contribute securely. These restraints could be

defeat by requesting participants’ proposals submission on cards prior to the meeting. The

resulting list of proposals would be distributed to participants and the procedure would start

from that point.

This version of the nominal group takes less meeting time, eliminates the one-idea-at-a-time

transcription bottleneck, gives participants more time to consult resources outside the group,

provides greater anonymity of ideas, and allows a larger group.

Suggestions

First, I would argue that rigorous research is research that applies the appropriate tools to

meet the stated objectives of the investigation.

Do the data collection tools produce information that is appropriate for the level of precision

required in the analysis? Do the tools maximize the chance of identifying the full range of

phenomenon of interest? To what degree are the collection techniques likely to generate the

appropriate level of detail needed for addressing the research question(s)? To what degree

do the tools maximize the chance of producing data with discernable patterns? Once the

data are collected, to what degree are the analytic techniques likely to ensure the discovery

of the full range of relevant and salient themes and topics? To what degree do the analytic

strategies maximize the potential for finding relationships among themes and topics? What

checks are in place to ensure that the discovery of patterns and models is not superfluous?

Second, I would argue that rigorous research must be both transparent and explicit. For

example, clearly describing how themes are identified, how codebooks are built and applied,

how models were induced would help bring more rigor to qualitative research.

The classic example occurs when

researchers conducting exploratory research are criticized for not using techniques that are

more

A range of studies have shown that the HE and HLP service provision by GPs coming from

their own initiative is far from optimal (Burke, 2003). The research results are in line with

existing evidence confirming that GPs themselves could assume the HE and HLP tasks

without reorganizing their workload and significantly increasing the time they already commit

to HE and HLP (Burke, 2003). The results highlight the fundamental components aimed at

optimizing HE and HLP and improving the quality of provided health care services within the

PHC institutions in Moldova. The first component is reorganization and redesign of PHC
institutions for successful integration of HE and HLP, involving organizations’ management,

culture, service delivery and patient self-control support. Secondly, this reorganization of

health service provision has to be founded on quality improvement concept consisting of

comprehending and improving fundamental work procedures and schemes (Leonard, 2007).

It has to be connected to the entire health system, instead of just concentrating on the health

professionals working inside the PHC system. Finally, the reorganization of PHC institutions

for successful integration of HE and HLP has to be strengthened by development of practical

and resourceful health information system facilitating evidence-based decision adoption and

improving collaboration with community partners (Cifuentes, 2005).

Leonard BA (2007) Adapting Quality Improvement to Public Health. Highlights and

Conclusions. Conference sponsored by the Robert Wood Johnson Foundation. Cincinnati,

Ohio.

emphasized the organizational and attitudinal changes

their, including (Hanifan 1916, Putnam 2000/2006,

Sozanski 2008).

assets people, including their knowledge, abilities and their social capital, physical structure

facilities and businesses (Berkowitz, Wadud 2009).

The Institute of Medicine identified effectiveness as one of six necessary attributes for a high

performing health care system.

to achieve an overall goal aim purpose

effectiveness means setting correct objectives for achieving a general goal (). In terms of HE

and HLP effectiveness consists of improving individuals abilities and capacities to undertake

actions and the groups aptitudes to perform collectively for wielding control over the health

determinants.

Drucker, Peter F, (2006) The Effective Executive The Definitive Guide to Getting

the Right Things Done (Harperbusiness Essentials). New York: Collins

as they have the confidence of the population, decision-makers the media and their influence

goes beyond social, political and economic grounds.

related to health professional organizations can show leadership and become a role model

for other professional organizations and society

Effective health promotion leads to changes in the determinants of health, both those within

the control of individuals (such as health behaviours and the use of health services), and

those outside of their direct control such as social, economic and environmental conditions.

This chapter approaches the following nine themes that emerged following thematic analysis

of the participants discussions - each is related to original research objectives:

The data analysis was performed applying both qualitative and quantitative

methods. Inductive content analysis permitted validation of information gathered in

the meetings (Patton, 1990). Therefore, individual suggestions from participants have

been verified against their written recommendations and recorded information. More

significantly, when group discussion of produced ideas happened, important insights

were obtained from individual remarks. The quantitative data analysis was produced

from the ranking process applied to summarize the meeting results and detect

priorities of the group. This process meant that the tackled questions and the
produced items were clearly understood by all participants and that it was possible to

reach a single solution.

Figures

Ideological likeness connecting HP and HE philosophy and practice based on naturalistic

approach hypothesis and processes will facilitate the implementation of research method into
the public health practice. HP considers the persons (non-professionals) aptitude to produce
valuable knowledge, information and insight, while naturalistic approach brings in scientific
authenticity to persons. Both are likely to be inductive and generate common beliefs from
specific evidence (Goldman, 1999). HP upholds that a key to an issue can emerge more
willingly from the bottom-up than the top-down. This qualitative research based on
naturalistic approach holds the same principles that notions, ideas and revelations are best
produced from the bottom-up, from specific empirical facts, rather than from a common
hypothesis (Goldman, 1999).

• Goldman, A. 1999. a priori warrant and naturalistic epistemology. In:

Tomberlin, J. E., ed., Philosophical Perspectives, v. 13. Cambridge, UK:
Blackwell.

An approach to sociological research that assumes that there are multiple views
of reality influenced by the social context and environment in which a situation is
viewed. Therefore, a question concerning a situation may have a number of valid
answers dependent on the perspective of the viewers. See also naturalistic
research method.

Read more: http://www.answers.com/topic/naturalistic-approach#ixzz1EhMVaIZu

The project of naturalization is an essential aspect of the general project of analysis.

Naturalizing a theoretical domain amounts to redefining its essential notions and relations in
terms of a different domain, which is considered acceptable by the standards of natural
science.

The project of naturalization is an essential aspect of the general project of analysis.

Naturalizing a theoretical domain amounts to redefining its essential notions and relations in
terms of a different domain, which is considered acceptable by the standards of natural
science.

Naturalistic epistemologists seek an understanding of knowledge that is scientifically

informed and integrated with the rest of our understanding of the world. Their methods and
commitments differ, because they have varying views about the precise relationship between
science and epistemology and even about which sciences are most important to understanding
knowledge.

In addressing particular issues, naturalists often make one of two general sorts of moves. The
first is to try to show the issue is empirical and then to apply scientific data, results, methods,
and theories to it directly. This is what happens when naturalists offer accounts of a priori
knowledge based on cognitive psychology, and even when they offer naturalized conceptual
analyses that they take to be based on empirical information concerning how concepts are
applied.

A second common naturalistic move is to undermine a problem’s motivation by showing it

arises only on certain false, non-naturalistic assumptions. This is what happens when
naturalists reject Cartesian skeptical problems, on the grounds those problems presuppose that
our beliefs about the external world require external validation before they can be fully
justified.

Despite its promise, naturalistic epistemology does face serious challenges from the problems
of circularity and normativity. It is far from clear they are more serious than the challenges
traditional, a priori epistemology faces, but naturalists certainly need solutions to the
problems. Finding those solutions is one of the most important philosophical projects in this
field that aims to unify science and philosophy.

References and Further Reading

• Bloor, D. 1981. The strengths of the strong programme. Philosophy of the

social sciences, v. 11, pp. 199-213.
• Davidson, D. 1984. A coherence theory of truth and knowledge. In his:
Inquiries into truth and interpretation. Oxford, UK: Clarendon.
• Gigerenzer, G., Todd, P., and the ABC Research Group. 1999. Simple
heuristics that make us smart. New York: Oxford U P.
• Goldman, A. 1967. A causal theory of knowing. Journal of philosophy, v. 64,
pp. 357-372.
• Goldman, A. 1976. Discrimination and perceptual knowledge. Journal of
philosophy, v. 73, pp. 771-791.
• Goldman, A. 1986. Epistemology and cognition. Cambridge, MA: Harvard U
P.
• Goldman, A. 1992. Liasons: Philosophy meets the cognitive and social
sciences. Cambridge, MA: MIT Press.
• Goldman, A. 1999. a priori warrant and naturalistic epistemology. In:
Tomberlin, J. E., ed., Philosophical Perspectives, v. 13. Cambridge, UK:
Blackwell.
• Goldman, A. 1999. Knowledge in a social world. Oxford, UK: Clarendon.
• Kahneman, D., Slovic, P., and Tversky, A. Judgment under uncertainty:
Heuristics and biases. Cambridge, UK: Cambridge U P.
• Kim, J. 1988. What is “naturalized epistemology”? In: Tomberlin, J. E., ed.
Philosophical Perspectives, v. 2. Atascadero, CA: Ridgeview. pp. 381-405.
• Kitcher, P. 1980. a priori knowledge. The philosophical review, v. 86. pp. 3-
23.
• Kitcher, P. 1992. The naturalists return. Philosophical Review, v. 101, n. 1.
pp. 53-114.
• Kitcher, P. 1993. The advancement of science. New York: Oxford U P.
• Kornblith, H. 1993. Inductive inference and its natural ground. Cambridge,
MA: MIT Press.
• Kornblith, H. ed. 1994. Naturalizing epistemology, 2d ed. Cambridge, MA:
MIT Press.
• Kuhn, T. S. 1996. The structure of scientific revolutions, 3d ed. Chicago: U
of Chicago Press.
• Lakatos, I. 1971. Philosophical papers. Cambridge, UK: Cambridge U P.
 • Laudan, L. 1977. Progress and its problems. Berkeley: U of California Press.
• Laudan, L. 1990. Normative naturalism. Philosophy of science, v. 57, n. 1,
pp. 44-59.
• Pollock, J. and Cruz, J. 1999. Contemporary theories of knowledge, 2d ed.
Oxford: Rowman and Littlefield.
• Quine, W. V. 1960. Word and object. Cambridge, MA: MIT Press.
• Quine, W. V. 1969. Ontological relativity and other essays. New York:
Columbia U P.
• Quine, W. V. 1980. From a logical point of view. 2d ed. Cambridge, MA:
Harvard U P.
• Quine, W. V. 1992. Pursuit of truth. Rev. ed. Cambridge, MA: Harvard U P.
• Sellars, W. 1963. Science, perception, and reality. London: Routledge and
Kegan Paul.
• Siegel, H.1990. Laudan’s normative naturalism. Studies in history and
philosophy of science, v. 21, n. 2, pp. 295-313.

METHODS: We review the evidence for interventions that separately address lack of
physical activity, an unhealthy diet, obesity, cigarette smoking, and risky/harmful alcohol use,
and evidence for interventions that address multiple behavioral risks drawn primarily from the
cardiovascular and diabetes literature.

RESULTS: There is evidence for the efficacy of interventions to reduce smoking and
risky/harmful alcohol use in unselected patients, and evidence for the efficacy of medium- to
high-intensity dietary counseling by specially trained clinicians in high-risk patients. There is
fair to good evidence for moderate, sustained weight loss in obese patients receiving high-
intensity counseling, but insufficient evidence regarding weight loss interventions in nonobese
adults. Evidence for the efficacy of physical activity interventions is limited. Large gaps
remain in our knowledge about the efficacy of interventions to address multiple behavioral
risk factors in primary care.

CONCLUSIONS: We derive several principles and strategies for delivering behavioral risk
factor interventions in primary care from the research literature. These principles can be
linked to the "5A's" construct (assess, advise, agree, assist, and arrange-follow up) to provide
a unifying conceptual framework for describing, delivering, and evaluating health behavioral
counseling interventions in primary healthcare settings. We also provide recommendations for
future research.

BACKGROUND: Smoking, excessive alcohol consumption, lack of exercise and an

unhealthy diet are the key modifiable factors contributing to premature morbidity
and mortality in the developed world. Brief interventions in health care
consultations can be effective in changing single health behaviours. General
Practice holds considerable potential for primary prevention through modifying
patients' multiple risk behaviours, but feasible, acceptable and effective
interventions are poorly developed, and uptake by practitioners is low. Through a
process of theoretical development, modeling and exploratory trials, we have
developed an intervention called Behaviour Change Counselling (BCC) derived
from Motivational Interviewing (MI). This paper describes the protocol for an
evaluation of a training intervention (the Talking Lifestyles Programme) which will
enable practitioners to routinely use BCC during consultations for the above four
risk behaviours.
Methods for evaluating practice change
toward a patient-centered medical home.
Jaén CR, Crabtree BF, Palmer RF, Ferrer RL, Nutting PA, Miller WL, Stewart EE, Wood R,
Davila M, Stange KC.

Department of Family & Community Medicine, University of Texas Health Science Center at
San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA. jaen@uthscsa.edu

Erratum in:

• Ann Fam Med. 2010 Jul-Aug;8(4):369.

Abstract

PURPOSE: Understanding the transformation of primary care practices to patient-centered

medical homes (PCMHs) requires making sense of the change process, multilevel outcomes,
and context. We describe the methods used to evaluate the country's first national
demonstration project of the PCMH concept, with an emphasis on the quantitative measures
and lessons for multimethod evaluation approaches.

METHODS: The National Demonstration Project (NDP) was a group-randomized clinical

trial of facilitated and self-directed implementation strategies for the PCMH. An independent
evaluation team developed an integrated package of quantitative and qualitative methods to
evaluate the process and outcomes of the NDP for practices and patients. Data were collected
by an ethnographic analyst and a research nurse who visited each practice, and from multiple
data sources including a medical record audit, patient and staff surveys, direct observation,
interviews, and text review. Analyses aimed to provide real-time feedback to the NDP
implementation team and lessons that would be transferable to the larger practice, policy,
education, and research communities.

RESULTS: Real-time analyses and feedback appeared to be helpful to the facilitators.

Medical record audits provided data on process-of-care outcomes. Patient surveys contributed
important information about patient-rated primary care attributes and patient-centered
outcomes. Clinician and staff surveys provided important practice experience and
organizational data. Ethnographic observations supplied insights about the process of practice
development. Most practices were not able to provide detailed financial information.

CONCLUSIONS: A multimethod approach is challenging, but feasible and vital to

understanding the process and outcome of a practice development process. Additional
longitudinal follow-up of NDP practices and their patients is needed.