06/02/2023

ABERDEEN 2040

BU5594: Health Policy

and Systems Research
(HPSR)
Session 1.2 Core Concepts 2 (Part 2)

Doing HPSR: practical aspects rigour and ethics

Lucia D’Ambruoso PhD FHEA

Senior Lecturer School of Medicine Medical Sciences and Nutrition

Session 1.2 Learning outcomes

a) Describe and critically reflect on enquiry paradigms

informing heath policy and systems research (HPSR);
b) Describe approaches to ensure study rigour and
quality, demonstrate an appreciation of ethical
considerations in HPSR

ABERDEEN 2040

2
 06/02/2023

Recap, relativist perspectives

• Contribute evidence about ways in

which health patterned by social
factors and processes
• Examines lived experience of health,
illness, perspectives, opinions etc
• Beyond associations - addresses
questions of complex intervening social
processes mediating associations
• Contribute understanding of why some
interventions work and others do not

ABERDEEN 2040

Quality and rigour in HPSR

a) What is rigour?
b) How do ideas about
rigour apply in
HPSR?

ABERDEEN 2040

4
 06/02/2023

What makes a study rigorous?

• Reliability
• Validity
• Generalisability

ABERDEEN 2040

How does rigour apply in HPSR?

• HPSR can be characterised by distinct ontological,

epistemological + methodological assumptions...

• Does not seek to establish complete objectivity &

accepts and embraces subjectivism and relativism

• Debate exists as to whether the same quality criteria

can be applied
ABERDEEN 2040

6
 06/02/2023

“It is argued that the transference

of terms across paradigms is
inappropriate; however, if we
reject the concepts of validity and
reliability, we reject the concept
of rigour. Rejection of rigour
undermines acceptance of
qualitative research as a
systematic process that can
contribute to the advancement of
knowledge” (Tobin & Begley, 2004:388)
ABERDEEN 2040

How does rigour apply in HPSR?

• Validity: credibility of findings to those studied
• Generalisability: translation (not transplantation) of
findings to other settings and groups
• Reliability: extent to which same methods will yield
the same results
• Sampling: comprehensive and rigorous approaches
capable of capturing a sufficient number of
perspectives, experiences etc. to generate meaningful
renditions of the phenomena of interest (e.g.
purposive, convenience, theoretical, snowball…)
ABERDEEN 2040

8
 06/02/2023

Emerging criteria

• Goodness situatedness, plausibility, authenticity

• Trustworthiness credibility, transferability,
dependability, confirmability, authenticity
• Triangulation data from one source are used to corroborate another
• Crystallization infinite variety of angles of approach, complex but inclusive
• Reflexivity continuous reflection on the researcher’s position
• Innovation, creativity, transparency
ABERDEEN 2040

Rigour is the means by which

we show integrity and competence

• HPSR adheres to a distinct enquiry

paradigm, notions of truth and knowledge
• HPS researchers should not reject rigour,
but make it relevant to aims
• In HPSR it is necessary to be explicit about
rigour, why and how it is defined and
applied
• Demonstrate logical + transparent
approach to what we do, how and why
ABERDEEN 2040

10
 06/02/2023

Rigour in HPSR
HSPR requires critical + questioning approach

• Questioning and checking during enquiry

• Conceptualising and re-conceptualising
• Interpretive judgments, cf. context
• Policy relevance, real world problems
• Embeddedness: working with and for, not on
• Researcher reflexivity and positionality

ABERDEEN 2040

11

Embeddedness, 1
• “…embedding of research in real
world policy, practice and
implementation is needed to
strengthen health systems
worldwide (Ghaffar et al 2017)
• “when embedding happens,
researchers and decision makers are
linked through a systems in which
the need for evidence to inform
policy is understood by decision
makers” (WHO, 2012)
Source: Olivier
ABERDEEN 2040 2017

12
 06/02/2023

Embeddedness, 2

• Insider research: inside systems

• Changeable, flexible and adaptable
process
• Interdisciplinary and intersectional
• Highly relational
• Aligned with local priorities
• Locally driven, locally owned
• Democratises research process

Source: Olivier
ABERDEEN 2040 2017

13

Reflexivity and positionality

• Greater reflexivity is needed: on institutional power, resources

and positions, defining research agendas and generating
knowledge. What is our accountability to those ‘researched’?
• Great attention to the research team: composition, roles,
insiders and outsiders, nationalities, need to negotiate and
reflect, consider effects on data collection and interpretation
• Long term approaches are needed to building capacity. Allowing
space for different frameworks to arise from different
positionalities, and build critical mass

Source: Walt
ABERDEEN 2040et al 2008

14
 06/02/2023

Research ethics

• Issues of power – who is doing research

and who is being researched and why
• Kantian vs. utilitarian views
• Applied examples
• VA technology - feeding back cause of
death conclusions at individual level
• Photovoice – equipping research
participants to generate and appraise
visual evidence

Sources: BBC,
ABERDEEN 20402013; Young and Barrett, 2000

15

Ethics in HPSR

• Scientific validity and trustworthiness of data

• Social value and favourable risk
• Informed consent and respect for participants
• Independent review
• Policy relevance
• People-centeredness
ABERDEEN 2040

16
 06/02/2023

Participatory research

• Positioning of researchers: Relationships

with communities. Strong interpersonal
+social competencies are necessary
• Time/resource demands: enabling
context + communications skills for
mutual understanding + trust to develop
• Power and consequences: whose
interests drive the process; privacy and
protecting information; risks in
participating in action phases
ABERDEEN 2040

17

Session 1.2 Learning outcomes

a) Describe and critically reflect on enquiry paradigms

informing heath policy and systems research (HPSR);
b) Describe approaches to ensure study rigour and
quality, demonstrate an appreciation of ethical
considerations in HPSR

ABERDEEN 2040

18
 06/02/2023

Any questions?

ABERDEEN 2040

19