|LETTER TO THE EDITOR
|Year : 2013 | Volume
| Issue : 3 | Page : 116-117
Qualitative research in thyroidology
Sanjay Kalra1, Bharti Kalra2, Vibha Pathak3
1 Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India
2 Department of Gynaecology, Bharti Hospital and BRIDE, Karnal, Haryana, India
3 Department of Clinical Research, BRIDE, Karnal, Haryana, India
|Date of Web Publication||6-Aug-2013|
Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kalra S, Kalra B, Pathak V. Qualitative research in thyroidology. Thyroid Res Pract 2013;10:116-7
With the increase in prevalence of thyroid disease, improvements in diagnosis, and management of various thyroid disorders, and an understanding of the public-health impact of this gland, thyroidology is gradually receiving its due attention in medicine.
Most research related to the thyroid, however, follows the biological or quantitative model, as opposed to the psychological model. This is surprising because even a brief interview or history talking with an average thyroid disorder patient unearths a multitude of felt needs and concerns, many of which are related to qualitative functioning.  It is challenging (and inappropriate) to reduce qualitative symptoms such as "feeling tired," "lack of zing," and "I feel something is missing" to mere statistics or numbers. Though, researchers and clinicians try to explain these complaints by invoking tissue hypothyroidism or concomitant medical and psychiatric illnesses, this is not always possible.
One reason why clinicians are sometimes unable to address patient concerns is that conventional praxis is to view the patient (rather, the disease), through a quantitative prism. In thyroidology, this would mean assessing thyroid hormone levels, ordering surrogate biochemical markers, and advising appropriate imaging and invasive investigators if needed. These numbers, however, may not convey the actual well-being of the patient. As the clinician is not trained in qualitative assessment, she or he finds it difficult to bring about a qualitative improvement in patient-health, with resultant patient dissatisfaction. 
One way of improving this is to encourage qualitative and mixed methods research in thyroidology, along with the quantitative methodology that we practice.
Qualitative health research is a distinct subject, with well-grounded theoretical framework and practical applicability. , It is used extensively in various fields of endocrinology, including diabetes, intersex, and ageing. Though, both qualitative and mixed methods research  have the tools required to improve enquiry, their potential has not been utilized by thyroidologists.
To be practiced scientifically, basic tenets of any discipline must be followed. Qualitative research is similar to quantitative research in that both are scientific methods of enquiry, follow well laid down rules of theory, work with scientific rigor, and aim to achieve reliable, valid, objective answers to pre-specified research questions. Qualitative researchers, however, accept flexibility and creativity of research design as a part of science, basing their work on concepts of methodological plurality and theoretical plurality. They aim to achieve scientific rigor by methods such as triangulation, respondent validation, purposeful sampling, transparency of methodology/analysis, and reflexivity, some or all of which need to be embedded in research design. ,
Ethonography, phenomenology, and grounded theory are some examples of qualitative research methodology that can be followed. Data collection can be done through interviewing, focus group, open-ended questionnaires, journals, and documentary data. Analysis of data is done based upon the objective of the study. Iterative thematic analysis, done by system coding procedures is one method of analysis. This can be done by using paper and pen, or commercial software such as Nvivo, NUDIST or Atlas More Details ti. ,,
Examples of the potential placement for qualitative research abound in thyroidology. Attitudes toward health-care, response to health-care, satisfaction with health-care are all issues which need qualitative research. Concerns of adolescent hypothyroid girls regarding marriage, of young women with hypothyroidism and infertility, and of elderly patients with neck nodules who fear malignancy : t0 hese too, require qualitative answers. Attitudes of society toward environmental thyroid disruptors and their usage should be given cogent, yet qualitative, thought.
For some issues where qualitative research alone may not suffice, mixed methods research is an alternative. Qualitative research can be utilized as an exploratory step, prior to quantitative research, to create a more patient-focused or patient-relevant questionnaire, for example. Simultaneous use of both methods can serve to study different aspects of the same question, for example, a quantitative assessment of usage of radiocodine with a qualitative analysis of attitudes toward the therapy. Another way is to use qualitative questioning to validate answers obtained from quantitative research (mixed methods triangulation) performed earlier. 
Thyroid Research and Practice has carried articles related to the qualitative aspect of thyroidology in the recent past.  This trend has been noted in other Indian endocrine journals as well.  Further growth is needed to optimize the use of qualitative research in thyroid disease, so as to help benefit patients with these disorders. Thyroid care professional should be exposed to qualitative research, and encouraged to use this robust methodology in the research. Alone, as well as in combination with traditional biomedical research, this scientific method of enquiry has the ability to improve the quality of our research, and our clinical practice as well.
| References|| |
|1.||Kalra S, Khandelwal SK. Why are our hypothyroid patients unhappy? Is tissue hypothyroidism the answer? Indian J Endocrinol Metab 2011;15:S95-8. |
|2.||Kalra S, Kalra B. Improving compliance in hypothyroidism: What can we do?. Thyroid Res Pract 2012;9:78-80. |
|3.||Hansen EC. Successful Qualitative Health Research: A Practical Introduction. Crows Nest, Australia: Allen & Unwin; 2007. |
|4.||Glesne C. Becoming Qualitative Researchers: An Introduction. Boston, USA: Pearson; 2011. |
|5.||Creswell JW, Clark VL. Designing and Conducting Mixed Methods Research. Thousand Oaks, USA: Sage; 2011. |
|6.||Kalra B, Agarwal S, Magon S. Holistic care of menopause: Understanding the framework. J Midlife Health 2012;3:66-9. |