LETTERS T O THE EDITOR
antivaccination literature, or at least the outlines of the
arguments arising from it.
Finally, we would appeal for health practitioners to take
a more flexible attitude to the rules during an outbreak.
Our own experience is instructive in this respect.
Our son Geordie (aged 11 months 3 weeks at the time)
was in frequent, close contact with the unvaccinated sister
of someone with active measles. When we asked the City
Health immunisation clinic nurses for a vaccination we
were told that Geordie was too young, and that we should
wait until he turned one year. In the meantime, and still in
contact with other unvaccinated children, he contracted a
viral infection, possibly roseola. Our general practitioner
advised us to wait until full recovery before vaccinating
Geordie. He was eventually vaccinated on 17 December.
This was too late to prevent him contracting measles, which
began to manifest on Christmas Eve, was confirmed by a
doctor and continued into the New Year.
We do not believe that Geordie’s metabolism miracu-
BOOK REVIEWS
Infectious diseases of humans: dynamics and
control
Roy M. Anderson and Robert M. May. Oxford:
Oxford University Press, 1991, 757 pp., index,
bibliography, $140 (hardback),ISBN 0 19 854599 1.
This book discusses models that describe the spread of
infectious diseases in communities and concerns itself with
the insights that such models are able to provide and the
way they can be used to predict the consequences of inter-
ventions such as immunisation schedules.
The material is important because models provide the
best way of translating our knowledge about the modes of
transmission of an infectious disease, at the level of con-
tacts between individuals, to a description of its spread
through the community. As a consequence models play a
crucial role in interpreting observed epidemiological
trends and in assessing the likely consequencesof proposed
immunisation schedules.
The models are described in terms of mathematical
equations and much of the discussion is in mathematical
terms. This has the advantage of making the discussion pre-
cise and unambiguous, but it means that only readers with
the ability to interpret mathematical equations can gain a
full appreciation of the material. Only necessary math-
ematics is used in the text, with technical details deferred to
eight appendixes.
Few will read this book from cover to cover, as it is not
light bedtime reading. The book is long (757 pages) and
comprehension of the text requires concentration,
although the use of many graphic displays and tables eases
the burden on the reader.
Who should read it ?
All people concerned with infectious diseases at a com-
munity level should not only have a copy on their shelves as
a reference book but should work through the material rel-
e v k t to their interest. Even persons without an adequate
mathematical background will find the discussion of
epidemiological concepts, as well as the synthesis of data
and results presented in numerous tables, graphs and dia-
grams, most useful. Readers with a stronger background in
mathematics, including Year 12 mathematics, will enjoy a
208 AUSTRALIAN JOURNAL OF PUBLIC HEALTH
lously changed on his first birthday, that being one year old
materially altered the effectiveness of a vaccination-
surely the risk of infection outweighed the usual caveats
under the circumstances? We have been advised since then
that the presence of a virus should not have delayed vacci-
nation. All in all, it seems highly likely that Geordie’s bout
of measles could have been avoided had a more flexible
approach been adopted.
A large part of the problem, it seems to us, was that we
were not really believed when we said that Geordie had
been exposed to measles. The five doctors and several
nurses we saw over that month expressed surprise, said
they had heard of only a few cases and that they hadn’t been
notified by ‘the authorities’. The principal of our local pri-
mary school had no idea that any of his students had been
absent because of the disease, so no warning notes were
sent home. This reinforces our argument for notification.
1 March 1992 Shane Marsh and Ian Lucas
Canberra
discussion that is relevant to real-world epidemics and will
appreciate the clarification of concepts such herd immun-
ity, basic reproduction rate of a parasite and threshold host
density, among others, which is achieved through math-
ematics. Every teacher of public health courses should be
familiar with the content of this book.
The role of mathematical nwa2l-s
Most people involved with public health probably have lim-
ited knowledge about disease transmission models and
have the impression that these models are oversimplifiedto
the point where they are of interest mainly to mathema-
ticians. It’s certainly true that the vast literature on the
mathematical theory of epidemics contains much that has
mainly mathematical interest. However, it is equally true
that mathematical models can be a substantial help when
designing public health programs. The trick is to get access
to those parts of the theory that are most relevant, and this
book certainly helps in this respect.
Mathematical models provide the best way of assessing
the likely consequences of proposed immunisation sched-
ules, and thereby help us to choose an effective schedule.
Models are also a useful tool for interpreting
epidemiological trends and, more generally, mathematics
helps in the precise communication of ideas and concepts.
The study of these models can point to the data that are
most needed for estimating central parameters and for
making informed decisions on control measures.
Sceptics might argue that mathematical models are
usually oversimplifiedto the point of doubtful relevance to
the practical problems of public health. Well, clearly a
model must contain the essential characteristics of the
spread of the disease, but a strong case can be made for
including only the essential characteristics. Simpler models
are convenient for communication and they do not have
the essential characteristics clouded by the presence of a
large number of features of minor consequence.
Crucial concepts, like herd immunity, are present and
emerge clearly from simple models. It is only their precise
quantitative form which might be different in more com-
plex models. The authors of this book start with the sim-
plest models, using them to introduce many of the
concepts, and then consider how generalisations, such as
1992 VOL. 16 NO. 2

social, genetic and spatial heterogeneity, affect the
results.
Strengths and weaknesses of the book
There is a considerable gap between the literature on the
biology of infectious diseases and the literature on the
mathematics of epidemics. This book helps to bridge the
gap by including an emphasis on the biology of specific dis-
eases and the synthesis of data from many different
sources.
Nice use has been made of graphs and diagrams, in par-
ticular, but also of tables, to convey information effectively.
In view of its mathematical content and the fact that it i:;
intended for epidemiologists, public health workers,
parasitologists and ecologists, the book should havt:
included a section containing a tutorial introduction to
concepts such as partial derivatives and integrals. Math-
ematics involving these concepts is deferred to appendixes,
but the concepts are displayed in quite a few equations in
the text.
This very comprehensive book covers a large range of
diseases, considers what happens to results when the
assumptions are relaxed and pays separate attention to
developing countries. The extensive list of references
(about 750), with an author index, makes the book a good
pointer to the literature on the mathematical theory of epi-
demics and their control.
The discussion of probability models for epidemics is
rather light, reflecting a natural bias towards the research
work of the authors. There are irregularities in the spread
of diseases, and this warrants consideration of models with.
a chance component. Bailey’s 1975 book, which is getting
somewhat dated now, places greater emphasis on prob-
ability models.’
The authors make a genuine attempt to relate the models
to public health data from the literature, and in particular
they use summary statistics to assign values to parameters
of the models. In doing so, no formal account is taken of
the uncertainty introduced by the fact that the parameters
are estimated. My own little book is helpful in this regard,
because it is specifically concerned with formal statistical
inferences for parameters of infectious disease models and
formal tests of model assumptions.*
More specifiG comments about the content
The material is divided into two parts, distinguished by the
type of model needed to describe the dynamics of the
spread of the disease or, more correctly, by the character-
istics of the diseases which require the different types of
models. Part I deals with diseases spread by microparasites
(such as viruses, bacteria and protozoa) and makes up
about two thirds of the material. Part I1 is concerned with
diseases spread by macroparasites (helminths and
arthropods). Microparasitic infections tend to be charac-
terised by a relatively short duration of infection and an
acquired immunity against reinfection. Macroparasitic
infections tend to be longer lasting, with continual
reinfection of the host.
In each of the two parts the material is presented in
roughly the following pattern. Biological characteristics
are introduced and followed by a discussion (with illus-
tration) of the different types of data usually recorded.
Then a basic model of transmission is formulated, followed
by a discussion of various complications. After this, atten-
tion turns to consideration of the steady state of the basic
model with particular reference to eradication and control,
followed by a similar discussion for the dynamics over time.
The basic model is then modified in turn to accommodate a
number of different factors, such as heterogeneity, age-
AUSTRALIAN JOURNAL OF PUBLIC HEALTH 1992
BOOK REVIEWS
related transmission rates, specific diseases (e.g. sexually
transmitted diseases) and endemic infections in developing
countries.
In conclusion
This book effectively illustrates the use of mathematical
models as a tool for interpreting trends in disease
incidences and for the design of control measures for infec-
tious diseases. It is comprehensive and will be a focal point
to the relevant literature for some time.
Niels G. Becker
Department of Statistics
h Trobe University, Melbourne
References
1. Bailey NTJ. The mathematical t h e q of infectim diseases and its
application. London: Griffm, 1975.
2. Becker NG. Analysis of infectious disease data. London: Chap
man & Hall,1989.
Bilhania: a history of imperial tropical medicine
John Farley. Cambridge: Cambridge University
Press, 1991, 359 pp., index, $135 (hardback),
ISBN 0 521 40086 4.
When I first joined the staff of the School of Public Health
and Tropical Medicine at the University of Sydney I
believed that the edict forbidding fraternisation between
parasitologists and bacteriologists resulted from a long-
standing feud between the respective department heads.
Having read John Farley’s excellent book I now know that
it was a feud with its roots in the history of English tropical
medicine. From the very beginning of the London School
of Tropical Medicine, which opened in 1899 at Greenwich,
the emphasis in teaching was on protozoology and helmin-
thology, with little importance attached to bacterial dis-
eases such as cholera, and even less to ‘hygiene in the
tropics’. This bias was partly due to the indifference of Pat-
rick Manson to bacteriology but was also a result of
attempts by the Professor of Bacteriology at King’s College,
Dr E. Crookshank, to convince the fat cats of the Colonial
Office that training in bacteriology was essential for col-
onial medical officers. Naturally, it was pointed out, King’s
College had the best laboratory facilities in the country and
should be given the money to carry out the teaching, with a
few lectures in tropical medicine and hygiene at Greenwich
thrown in for good measure. Had this proposal been
accepted the Greenwich school would have lost its power-
ful position. Patrick Manson, a man of influence, prevailed
and bacteriology was, to a large degree, omitted from the
courses of the Greenwich school. The artificial division
between parasitology and bacteriology, partly based on rec-
ognition of biological differences between the aetiological
agents, has persisted to the present and is only now break-
ing down, largely in response to the all-pervading influence
of molecular biology. Parasitologists are now inserting
genes from their beloved protozoans and worms into bac-
teria which then produce highly desirable molecules in
large quantities. One group of parasites for which these
techniques have been well developed is the schistosomes,
the cause of schistosomiasis or, as John Farley prefers to
call it, bilharzia.
Bilharzia has been used in this book as a ‘case study’ in
which the author has examined the broader issue of the
social and political aspects of tropical medicine in the Brit-
ish and American empires from 1898 to the 1970s. It
begins in the year in which the British Colonial Office
began initiatives which led to the opening of schools of
VOL.16 NO. 2 209
BOOK REVIEWS
tropical medicine in Liverpool and London, a time when
the American Army was being ravaged by tropical diseases
in Cuba, Puerto Rico and the Philippines, following the
Spanish-American War. It ends at a time when the British
empire had collapsed, when the influence of the Inter-
national Health Division of the Rockefeller Foundation
had significantly declined, and tropical medicine had
become more international and less imperial.
There were a number of reasons for the choice of
schistosomiasis as the model for the study. In the first
place, it is normally a disease of rural populations and
rarely causes major problems for colonial officials, particu-
larly if they are careful not to mix pond water with their
whisky. Consequently questions of motivation and pri-
orities could be examined in isolation from self-interest,
though the American and Australian experience in Leyte in
1944, which was the catalyst for an intensive program of
research, was certainly motivated by concern for their
troops, not the local population. The fact that
schistosomiasis did not occur in India (with the exception
of one small focus, no longer active), meant that Farley
could concentrate on the documents of the British Colonial
Office and ignore those of the British India Office, a con-
siderable narrowing of the focus of his research. A third
reason for the choice lay in the fact that schistosomiasishas
increased in prevalence as a result of human activitydespite
the extensive application of the technology of Western
medicine, thus providing a continuous backdrop against
which to highlight changes in attitudes and methods.
Farley’sbasic proposition is that from 1898 to the 1970s,
the assumptions, methods, goals and priorities of tropical
medicine were fundamentally imperialistic. It was an
important part of the building and maintenance of
empires, with a goal of making the tropics safe for white
habitation and investment. The policies which were
implemented in the name of tropical medicine and hygiene
were aimed at the protection of colonial officials, armies of
occupation and the employees of mining and fruit com-
panies. They were set in place without any consultation
with the local inhabitants, whose health became a concern
only if their diseases threatened the wellbeing or profits of
the white man. To a considerable degree this imperialistic
attitude continued after the Second World War because
health policies continued to be imposed by outside
agencies, particularly the increasingly influential pro-
fessionals and international organisations. The technical
and scientific capabilities of Westernised tropical medicine
continued to be imported, usually unasked for. Even when
control of programs passed into the hands of the local
people little changed, because those who then performed
the tasks had been trained in Western methods and ways of
thinking. It is interesting to speculate on the ultimate
course of tropical medicine had its origins not so closely fol-
lowed the postulation of the germ theory of disease. Prac-
titioners of tropical medicine focused on the pathogens to
such an extent that the parasites and the’diseasebecame, in
their eyes, the same thing, and they lost sight of the cul-
tural, socioeconomic and political aspects of health. They
defined the health problems of the tropics and the sol-
utions to those problems and imposed them without con-
sultation with the indigenous populations. As Farley points
out, one of the health problems which was ‘defined by
Western experts was schistosomiasis itself.
Whist there can be no doubt that this disease can be sev-
ere, in most cases it is not, and attempts to measure its
impact on communities have usually met with little success.
Weisbrod et al. were unable to detect any significant effect
of schistosomiasis on economic performance in St Lucia.’
Perhaps, by modem standards, their methodology may
have been unsophisticated, but a disease which, in the
210 AUSTRALIAN JOURNAL OF PUBLIC HEALTH
1980s, was the object of between a fifth and a quarter of all
research in tropical medicine should surely have made sig-
nificant inroads into the populations exposed to infection.
But they were never asked about their health priorities. On
the other side of the coin, however, there have been some
significant successes, two of the most striking being the
eradication of smallpox and the great reduction in the
prevalence of onchocerciasis in West Africa, a victory
which has had immense benefits for communities once
almost destroyed by river blindness -a victory won by the
application of insecticides and drugs developed by Western
science yet, significantly, resulting from an unprecedented
degree of cooperation between the countries of the
region.
Farley believes that the shift away from imperial tropical
medicine began in the 1980s, after the World Health
Organization endorsed the principle that ‘all people have
the right to participate in their own health care planning
and implementation, to dictate priorities, and to utilise
methods that they can use and afford.
As one who has been involved in the practice of tropical
medicine for 25 years, I must agree with Farley’s assess-
ment, and while one should not automatically conclude
that the outcomes of this superimposed, Western, scientific
medical system have been entirely negative, it is sometimes
difficult to convince oneself that many of the investigations
into tropical diseases have really benefited the right people.
The costly, academic research on schistosomes, most of
which takes place in the United States of America, has cre-
ated a great deal more information on the nature of para-
sitism and of immunity than about ways to control the
disease. The real beneficiaries have, in most cases, been the
scientistswho have been employed at considerable expense
to investigate intellectually stimulating problems in
biology.
This well-written and well-presented book should appeal
to most readers. As in any good history, the importance of
individuals in determining the course of events is
highlighted, in the same way as in Gordon Hamson’s Mos-
quitoes, malaria and m a n 2 Those who are directly involved
in tropical health teaching and research will probably be
well aware of many of the points raised by Farley, but there
will also be much that is new. Laboratory scientists engaged
in manipulating the genes and antigens of schistosomesand
other parasites should read the book to learn about the his-
torical background of their research and, hopefully, to
begin to question some of the reasons for its very
existence.
Above all this book should be read by people who believe
that if those who suffer from tropical diseases continue to
live in a state of poverty and semi-starvation, there can be
no talk of progress. ‘The year 2000 will have passed long
before there will be health for all’ (p. 304).
John Walker
Department of Parasitology
Centrefor Infectious Diseases and Microbiology
Westmad Hospital
References
1 . Weisbrod BA, Andreano RL, Baldwin RE, Epstein EH, Kelly
AC. Disease and economicdcvelopmenl: the impact of parasitic dis-
eases in St Lucia. Madison: University of Wisconsin Press,
1973.
2. Harrison G . Mosquitoes, malaria and man: a h i s t q ofthe
htililies sincc 1880. New York: EP Dutton, 1978.
1992 VOt. 16 NO. 2

Multi-disciplinary teamwork community mental
handicap teams
Morag McGrath. Aldershot, Hants: Avebury
(Gower Publishing Co.), 1991,211 pp., index,
E29.50 (hardback), ISBN 1 85628 152 3.
Despite being a study of the experiences of specific teams
working with a specific client group in Wales, this book
addresses generic issues which are relevant in many set-
tings. It is a useful account of the transition of a servicc:
attempting to move from fitting clients to services to fitting
services to clients. It provides service planners! managers
and health and welfare professionals with useful ideas on
key features of successful multidisciplinary teamwork.
In 1983 the Welsh Office published the All-Walesstrategy
for the deuelopmat of servicesfor mentally handicapped people.
The strategy emphasised the
right of mentally handicapped people to normal patterns of
life in the community; to be treated as individuals;and their
need for additional help from the community in which they
lived and for professional services if they are to develop their
full potential as individuals. In addition, the All Wales Strat-
egy looks to the development of comprehensive and inte-
grated services for mentally handicapped people and to the
participation of consumem and their families in the planning
of these services at levels.’
Substantial additional funding was proposed to support
the implementation of the Strategy over 10 years.
The community ‘mental handicap teams were set up to
help coordinate services at the local (i.e. county) level. By
1987 37 teams had been set up in Wales-only one had
existed in 1983 at the time of the All Wales Strategy launch.
The teams varied markedly in size, professional mix of staff,
the size of the populations they serviced, management and
organisational structures, and in the roles they performed.
Approximately three years after the teams had been set
up Morag McGrath conducted a descriptive study of the
development of community mental handicap teams in
Wales. The focus of the study was on the issues surround-
ing multi-disciplinary teamwork and the experience of
team members themselves. Data collection methods
included postal questionnaires, team interviews, interviews
with senior or middle managers and examination of docu-
ments. The book is a report on the results of the study.
The book had two aims:
- first to examine the different models of community mental
handicap teams (CMHTs) in Wales and to assess some of the
evidence from a survey of the Welsh CMHTs about the
implementation and outcome of multi-disciplinaryteamwork;
secondly,to provide an insight into multidisciplinary teamwork
mainly from the viewpoint of team members [p. 171.
It begins with a brief history of the development of
multidisciplinary teams in the United Kingdom and the
United States of America and goes on to summarise the
literature on the strengths and weaknesses of the
multidisciplinary teamwork. The policy context in which
the teams were set up in Wales is outlined. Using a combi-
nation of theory and the stated a i m s and philosophy of the
All Wales Strategy as the standards against which to
measure practice, McGrath reports on the actual work and
workings of the teams.
The result is a very honest account of the real experi-
ences of the team members, who were being called upon to
address complex issues with seemingly little guidance or
experience upon which to draw. It is also a fascinating
description of the issues faced by professionals working
together in the human service field. The positive features
of working in teams as well as the problems are well pre-
sented. The integration of theory and findings from the
AUSTRALIAN JOURNAL OF PUBLIC HEALTH 1992
BOOK REVIEWS
literature is very useful,juxtaposed as it is with the findings
from this study of practice.
The book has been well structured. Each chapter begins
by setting out the issues and the study findings. The dis-
cussion section then highlights the implications of these
and this is followed by a summary of key points.
On the level of describing the process of the develop
ment of multidisciplinary teams the book is excellent. For
anyone either working in or managing a multidisciplinary
team the book would make useful and interesting reading.
It is certainly not an idealised account of what working in
such teams should be-rather, it provides an insider’s view
of the experience and highlights strengths and weaknesses
of the approach in practice. Issues such as the tension
between case work and community development work, the
need for team leadership and management, the skills and
time required to plan services and the balancing of the
needs of many individuals within limited resources and
time are all discussed.
The book raised several questions which seem pertinent
in the Australian context also. As has often been the case
for human service agencies, the outcomes expected of the
teams were unclear. At the time of the study, ‘teams per-
ceived their main achievements as being either improve-
ments in team working or service developments’ (p. 1).
While these achievements are significant, they do not
necessarily nor automaticallymean that the program’s out-
comes will be achieved. There appeared to be no mechan-
ism to assess how relevant or effective services were from
the point of view of consumers. The author pointed out
that ‘it was not possible to assess whether resources could
have been used more effectively but with over 5,000 men-
tally handicapped individuals on team caseloads, service
developments and help from team members to both indi-
viduals and groups are likely to have enhanced the lives of
many mentally handicapped people and their families’ (p.
158). Given that the teams were a new initiative, set up to
improve the services and lives of ‘mentally handicapped’
people and their carers, and that they represented a signifi-
cant allocation of resources, evaluation would seem to be
necessary. Certainly, given the intention to make the ser-
vices more client-centred it would seem necessary to exam-
ine the achievements from clients’ perspectives. No formal
systems appeared to be in place to enable measurement of
their views.
Other issues of importance in setting up and managing
an effective service of this kind include the need for clear
role delineation for agencies and for individual staff mem-
bers, for continuing staff training, for clear lines of
responsibility and for senior management support. Some
of the consequences of the lack of these are exposed by this
study.
Unfortunately, the book‘s layout makes it difficult to
read. The pages are too densely printed, distracting the
reader from the clear writing and useful chapter structure.
However, it is a minor quibble about what is, otherwise, an
interesting and thought-provoking book. The exploration
of real experience in attempting to provide a more client-
centred, needs-based approach to service delivery, crossing
interdisciplinary boundaries, is timely in Australia too.
Marilyn J. Wise
Rmiew of National Health Goals and Targets
Departmat of Public Health
University of Sydney
Reference
1. Welsh Office. All- Wales strategy for the development of serviccs
for mentally handiurppd peopk. Cardiff: Welsh Office,
1983.
VOL. 16 NO. 2 21 1
BOOK REVIEWS
In-depth interviewing: researching people
Victor Minichiello, Rosalie Aroni, Eric Timewell
and Loris Alexander. Melbourne: Longman
Cheshire, 1990, 357 pp., index, $23.95
(paperback), ISBN 0 582 71272 6.
In recent years, in the fields of health promotion and pub-
lic health, there has been growing interest in the use of
qualitative research methods to assist in developing more
effective strategies to promote health. The most effective
health promotion programs have been those which have
been based upon good analysis of the reasons for the
actions taken by people and communities. Qualitative
research has helped to ensure that the planning and action
taken to achieve improved health status in populations has
improved chances of success.
In-depth interuiewing: researching people is an Australian
text, providing a systematic account and discussion of the
use of a single qualitative method-
a method for understanding people. The book is written for
undergraduate and postgraduate social science and health sci-
ence students who are studying research methods, for
researchers who want a thorough exposition of the value of
in-depth interviewing, and for clinical practitioners who wish
to hone their skills.
It is intended to stimulate interest in the in-depth inter-
viewing method, to teach basic skills in its use and to assist
readers in selecting this method to address the research
question being asked.
The authors selected in-depth interviewing for specific
attention from among qualitative methods because they
believe that ‘in-depth interviews are definitively the best
way of getting to know how someone thinks’.
The book begins by placing qualitative methods in gen-
eral and in-depth interviewing in particular in the context
of scientific inquiry. Later chapters explain the stages of
conducting research using in-depth interview
methodology-from preparatory work, through the inter-
viewing itself and finally, data management, analysis and
reporting. As such, it is a comprehensive overview and
covers issues such as sampling, validity, reliability, ethics
and the development of research questions. Each chapter
ends with a glossary.
Although the book is not meant to be a prescriptive man-
ual, it is written for the practitioner and has been designed
to teach skills to those who have not used the method
before. The authors have covered practical issues such as
ways to open and close interviews, note taking and the
assembly and organisation of data as well as exploring theo-
retical and philosophical issues which are the subject of
debate in the field. They have drawn extensively (and
usefully) on their own research and that of others to illus-
trate the text, providing ‘real world’ examples to highlight
significant points.
The book covers well the range of issues which must be
addressed by those wanting to conduct research using the
in-depth interviewingmethod. It provides readers with suf-
ficient information to enable them to understand both the
theoretical underpinnings of the method and the skills
required to conduct research using in-depth interviewing.
The glossariesand reference lists at the end of each chapter
are valuable additions to the text.
In addition to the use of in-depth interviewing for
research, however, the authors have included a useful
chapter addressing issues which arise from use of the
in-depth method for the conduct of clinical interviews,
pointing out the difference between these and research
interviews. For all professionals using interview methods in
their work with clients, the issues raised about the purpose
21 2 AUSTRALIAN JOURNAL OF PUBLIC HEALTH 1992
and conduct of the interview should stimulate debate and
reflection.
In my view, to make the most of this book, it should be
accompanied by face-to-face instruction. There are times
when the text requires discussion and elaboration in order
to clarify the major issues while some of the concepts intro-
duced are complex and difficult to understand without
further explanation and illustration. Clearly, too, the skills
required to conduct research, particularly when using
in-depth interviewing, are best learned through practice.
The book is, on the whole, easy to read. It is well set out,
with good use of headings and a useful index. The language
and concepts are necessarily sophisticatedand the jargon is
well explained in the glossaries. It would be helpful, how-
ever, if at the end of each chapter the main threads were
gathered together and summarised. There were times
when, after careful reading of the chapter, I was left uncer-
tain as to the implications of the discussion for research
practice.
I also remained uncertain as to when it is most appropri-
ate to use qualitative methods in general and in-depth
interviewing in particular and when quantitative methods
might be used. It is clear that different methods provide
different information about people and society, about
reasons for action and about human experience. While the
authors do point out that much qualitative research is used
to develop and build theory, and that quantitative research
is often used to test hypotheses, I would have liked more
discussion of the relationship between the two-
particularly given that many of the results of social research
are used to set directions for social change. It was not clear
to me how, for example, the uses of quantitative and quali-
tative methods suggested below fit with the authors’
views.
Quantitative methods can establish the extent and patterning
of the acceptanceof ideas and importantlywhether they can be
treated as sets.
On the other hand,
qualitative analysis allows the investigation of how ideas fit
together in people’s accounts and behaviour, the range of
meanings put on them, the relationship between ideas and
action, and the processesby which people remake ideology.’
In fact, for many of those working in public health, quali-
tative methods can make a real contribution to the develop-
ment of effective social change. The in-depth research
method, in taking the fundamental unit of interpretive
explanation as the individual person, at first appears to
have little to offer people working with groups, communi-
ties and populations. However, its focus on the under-
standing and meanings ascribed to events and
circumstances by individuals is a useful balance to an
approach which requires us to work with people on the
basis of their membership of larger groups or classes.
For public health practitioners, more substantial dis-
cussion of the ways in which such research might contrib-
ute to our understanding of society and the interaction
between society and individualswould have been helpful.
Overall, the book is a comprehensive and useful intro-
duction to the information and skills needed by those want-
ing to conduct research to better understand and explain
people’s behaviours. The challenge is to integrate the
results of such research to inform planning and action to
improve population health.
Marilyn Wise
Review of National Health Goals and Targets
Deparlment of Public Health
University of Sydney
Reference
1. Richards L. Nobody’s home. Melbourne: Oxford University
Press, 1990: xii.
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