Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

An analysis of qualitative and mixed methods abstracts from Japanese, UK and US primary care conferences

An analysis of qualitative and mixed methods abstracts from Japanese, UK and US primary care... Background: As research in family medicine covers varied topics, multiple methodologies such as qualitative research (QR) and mixed methods research (MMR) are crucial. However, we do not know about the difference in the proportion of QR or MMR between Japan, the UK and the US. This knowledge is needed to shape future research within countries with developing primary care such as Japan and other Asian countries. This study aims to describe the use of QR and MMR in Japanese primary care and compare this to the UK and US; then to make informed recom- mendations for primary care research. Methods: A repeated cross-sectional study (2012–2016) based on the abstracts submitted to the annual conferences of the Japanese Primary Care Association in Japan, the Royal College of General Practitioners in the UK, and the North American Primary Care Research Group in the US and other North American countries. The proportions of QR/MMR among all the posters and paper presentations for each of these three conferences were assessed. Also examined were trends and types of qualitative techniques for all three countries and participants/settings for Japan. Results: There were 1080 abstracts for Japan, 575 for UK and 3614 for US conferences. QR/MMR proportions were 7.5%, 15.1% and 28.1%, respectively. Japan’s proportion was lower than that of UK and US (p < 0.001). The proportion was increasing over time for the UK (p = 0.02). Steps for coding and analyses was most popular for Japan, thematic analysis for the UK and grounded theory for the US. Primary care doctors and hospitals were the commonest contexts for Japan. Conclusions: QR and MMR were not as popular in primary care in Japan compared to the UK and the US, whereas their use was increasing in the UK. Approaches, participants and settings may differ among these countries. Education and promotion of QR/MMR and multi-disciplinary collaborations need to be recommended in Japan with developing primary care. Keywords: Qualitative research, Primary health care, Japan, United Kingdom, United States Background world [1]. In addition, mixed methods research (MMR), Quantitative research had been predominant in health which combines and integrates quantitative methods care research for a long time. Recently, however, the with qualitative methods, has become popular in order importance of qualitative research (QR) has been rec- to capitalize on the advantages of both methods [1]. ognized as it contributes to deeper understanding and Although QR and MMR were more often used in interpretation of the meaning of phenomena in the real nursing disciplines compared to medicine [2], QR and MMR are indispensable for family medicine. The rea - son is that family medicine is, according to Miller and *Correspondence: makotok@hama-med.ac.jp Crabtree, “a clinical domain where balancing quali- Department of Family and Community Medicine, Hamamatsu tative and quantitative research styles benefits both University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu 431-3192, Japan patients and health care professionals” (A quantitative Full list of author information is available at the end of the article © The Author(s) 2018. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creat iveco mmons .org/licen ses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creat iveco mmons .org/ publi cdoma in/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Kaneko et al. Asia Pac Fam Med (2018) 17:11 Page 2 of 7 analysis of qualitative studies in clinical journals for the annual conference as a representative of primary care in 2000 publishing year page 2) [2]. Moreover, research in Japan; the Royal College of General Practitioners (RCGP) family medicine also encompasses a variety of topics annual conference for the UK; and the North American so that multiple methodologies are particularly crucial Primary Care Group (NAPCRG) annual meeting for [3]. Therefore, researchers in family medicine need to the US. The JPCA is the main primary care association acquire proficiency in QR and MMR skills. in Japan with approximately 11,000 members [9]. The In countries with long-established family medicine RCGP is the oldest primary care society in the world with systems such as the United Kingdom (UK) and the 50,000 members [10]. The NAPCRG is the major primary Unites States (US), QR and MMR have become popu- care society in the US and northern American countries lar. For instance, in the UK, a quarter of submissions to [11]. the British Journal of General Practice used qualitative The study subjects were the accepted abstracts for all methods with a similar acceptance rate to quantitative posters and oral presentations in the annual conferences studies and these articles were highly cited [4]. In addi- of the JPCA, the RCGP and the NAPCRG between 2012 tion, in the US, the Society of Teachers of Family Medi- and 2016. In April 2017, we searched these associations’ cine stressed the importance of qualitative methods in websites and if insufficient information was available, we family medicine education [5]. On the other hand, in contacted the associations for the titles and abstracts. We Japan, family medicine has not been well established, defined the studies using QR and MMR as all posters and where physicians who received an internal medicine oral presentations that included any of the words below based training program have played a principal role in in the title or abstract; for study design, “qualitative/qual- the primary care setting [6] and the system of certifica - itative research/survey”, “mixed-methods” and “qualita- tion for family physicians as a new category of special- tive and quantitative”; for analytical method, “grounded ist has just established since 2017 by an independent theory”, “phenomenology”, “ethnography”, “case study”, third-party organization [7]. “discourse analysis”, “narrative”, “KJ method”, “con- Although the editorial board of An Official Journal tent analysis”, “action research”, “field work”, “life story”, of the Japan Primary Care Association is planning to “thematic analysis”, SCAT”, “immersion-crystallization develop a guideline for submitting qualitative research approach” and “constant comparative approach”. [8], in countries with developing family medicine sys- We also categorized the participants, settings and dis- tems such as Japan and other Asian countries, the eases/conditions of the included studies in the JPCA importance of QR and MMR is not emphasized. This is conferences. The details of eligibility criteria and catego - important to know for these key research-leading coun- rization were shown in Table  1. We shared the work of tries to enable collaboration with Japanese and other classification/categorization between authors and when Asian family physicians in order to appropriately mold the classification of the study was ambiguous, discussion the future of primary care research. continued until a unanimous consensus was reached. The question is, therefore, how are qualitative and mixed methods used in primary care research in Japan Statistical analysis compared to the UK and US in recent years, and what We calculated the total proportion of the selected studies can be done to improve this? that are QR and MMR in each conference; the denomina- The aim is to describe the proportion, trend, types tors were the numbers of all studies and the numerators and characteristics of QR and MMR in primary care were the numbers of QR and MMR. research in Japan compared to in the UK and US We used Chi squared test for the comparison between between 2012 and 2016, using the numbers of abstracts the proportion in the JPCA annual conference and the submitted to major annual conferences, and to make RCGP annual conference and, separately, the NAPCRG recommendations for QR and MMR development annual meeting; the null hypothesis was of no difference based on these results. in proportions. The significance level selected was 5%. We also used the Cochran–Armitage test to assess the Methods annual change in this proportion for each conference; the We conducted a repeated cross-sectional study on the null hypothesis was that of no change. The significance numbers of abstracts accepted to major annual confer- level selected was 5% with two-sided tests. We assessed ences in primary care in Japan, UK, and US the number and proportions of the different types of qualitative approaches used for each country’s confer- Subjects ences. Finally, we assessed the number of eligible studies As major academic conferences in primary care, we in each category of participants and settings for the JPCA selected the Japan Primary Care Association (JPCA) Kaneko et al. Asia Pac Fam Med (2018) 17:11 Page 3 of 7 Table 1 Eligibility criteria and categorization of QR and MMR in the study Conference The annual conference of the JPCA The annual conference of the RCGP The annual conference of the NAPCRG Duration 2012–2016 Category of research JPCA: “Research” “Hinohara prize (research award)” RCGP: “Research”, “Clinical”, “Education” NAPCRG: all research except preliminary workshop, workshop, forum Definition of QR and MMR in the study We defined as QR and MMR all posters and oral presentations that included the words below in the title or abstract Words from Mackibbon et al. [2] “Qualitative/qualitative research/survey”, “mixed-methods”, “qualitative and quantitative” “Grounded theory ”, “phenomenology ”, “ethnography ”, “case study ”, “discourse analysis”, “narrative” Words from Saiki et al. [11] “KJ method”, “content analysis”, “action research”, “field work”, “life story” Words added by authors “Thematic analysis”, SCAT”, “immersion-crystallization approach”, “constant comparative approach” Categorization of characteristics of QR Categories based on Mckibbon et al. [2] and MMR in the JPCA Participants Patients/family/nurses/other people/physicians/other health care professionals Settings Hospital/clinic/community/nursing home/emergency department Disease/condition Various/cancer/mental health/pregnancy/cerebrovascular disease/general health/frail elderly/HIV/drugs/death and dying/diabetes/critical care/injury/asthma/pain/smoking/miscellaneous disease QR qualitative research, MMR mixed methods research, JPCA Japan Primary Care Association, RCGP Royal College of General Practitioners, NAPCRG North American Primary Care Group conferences. The statistical package used was Stata, ver - The most frequently used qualitative method in the sion 15. JPCA Annual Conference was Steps for Coding and Analyses (SCAT), thematic analysis in the RCGP Annual Results Conference, and grounded theory in the NAPCRG We searched 1080 studies for the JPCA Annual Confer- Annual Meeting (Fig. 1). ence, 575 for the RCGP Annual Conference, 3614 for the In QR and MMR in Japan, family physicians were the NAPCRG Annual Meeting respectively. The abstracts of commonest participants (31 studies). Other common the RCGP annual conference 2012 and 2013 were not participants were patients (9) and nurses (6). The most available despite enquiry and efforts by the office of the frequent study setting was hospital (29), followed by RCGP. community (24) and clinic (20). In terms of diseases/con- The total proportions of QR and MMR were 7.5 ditions, almost all of the studies were classified in Vari - (n = 81, 95% CI 5.9, 9.1), 15.1% (n = 87, 95% CI 12.2, 18.5) ous. Other diseases/conditions were mental health (2), and 28.1% (n = 1016, 95% CI 19.0, 21.7) for the confer- death and dying (2) and frail elderly (2). ences of the JPCA, RCGP and NAPCRG, respectively for the study period. The proportion of QR and MMR Discussion in the JPCA Annual Conference was significantly lower In comparing the numbers of abstracts submitted to than that in the RCGP Annual Conference (p < 0.001) and major annual conferences in primary care, the propor- the NAPCRG Annual Meeting (p < 0.001). The propor - tion that were QR or MMR in Japan were lower than tion of QR and MMR in the RCGP Annual Conference those in the UK and the US. The trend was not chang - increased yearly (p = 0.02) and those of the JPCA Annual ing in recent years, but it was increasing in the UK. SCAT Conference and the NAPCRG Annual Meeting displayed was the most popular qualitative approach for primary no significant changes. Although the proportion of MMR care research in Japan, thematic analysis in the UK and in the US was increasing, the trend was not statistically grounded theory in the US. significant (p = 0.054). Our finding of the low proportion of QR and MMR Table  2 displays these results and the breakdown of in Japanese primary care may be explained by insuf- studies into QR or MMR. QR was more often conducted ficient development of clinical research in primary care in comparison with MMR. [12], low awareness of the significance of QR and MMR, and lack of educational resources such as mentors. In Kaneko et al. Asia Pac Fam Med (2018) 17:11 Page 4 of 7 Table 2 The proportion of  posters and  oral presentations that  were QR or  MMR in  each conference and  the  annual change Year 2012 2013 2014 2015 2016 Total JPCA All research 247 170 227 208 228 1080 QR 17 11 12 11 17 68 MMR 3 2 5 2 1 13 Proportion that are QR or MMR (%) 8.1 7.6 7.5 6.2 7.9 7.5 95% CI 5.9–9.1 RCGP All research 241 170 164 575 QR 26 17 28 71 MMR 1 6 9 16 Proportion that are QR or MMR (%) 11.2 13.5 22.6 15.1 95% CI 12.2–18.1 NAPCRG All research 569 653 838 715 839 3614 QR 142 94 183 182 134 735 MMR 41 43 59 66 72 281 Proportion that are QR or MMR (%) 32.2 21.0 28.9 34.7 24.6 28.1 95% CI 26.7–29.6 QR qualitative research, MMR mixed method research, JPCA Japan Primary Care Association, RCGP Royal College of General Practitioners, NAPCRG North American Primary Care Group, CI confidence interval Japan UK US SCAT Steps for Coding and Theorization GTA: grounded theory approach Fig. 1 Qualitative approach for QR and MMR studies at each country’s conference Kaneko et al. Asia Pac Fam Med (2018) 17:11 Page 5 of 7 addition, reporting of QR and MMR studies in the Eng- physicians were the commonest participants in QR and lish language may be difficult to perform for Japanese MMR, and hospitals were the most frequent study set- researchers compared to quantitative studies because tings. The results may be explained by the fact that almost QR and MMR conducted in Japanese may be harder to of all members of the JPCA were family physicians [9] translate into English for publication due to a higher reli- and 43.7% of the JPCA certified family physicians work ance on complex language skills. English language QR not only at clinics but also at hospitals [19]. and MMR may also, therefore, be harder to understand In contrast, according to an analysis of QR in 170 Eng- for Japanese researchers, which may discourage learning lish language journals, patients and family were the first about and specializing in QR and MMR. Saiki, however, and second most common types of participants, and the indicated that QR was increasing annually in Japanese community was the commonest setting [2]. They also health-care journals overall and the number of QR stud- found that half of the qualitative studies were conducted ies had increased 10-fold in the past 10 years [13], which by nurses [2]. This situation is similar in Japan, where was explained by an increase in Japanese textbooks most QR is published in nursing journals [20]. In order about QR and MMR [13]. Therefore, although our study to enhance the use of QR and MMR for patient-centered revealed no significant change in the proportion of QR care in Japanese and other Asian countries’ primary care, and MMR in primary care, these research methods may multi-disciplinary collaborations would be useful. become popular in the near future. Based on the results To deal with the wide-range research questions in pri- of our study and the current literature, it is necessary to mary care, both qualitative and quantitative methods examine further the barriers and facilitators for QR and play important roles [3]. In Japan, Aomatsu pointed out MMR in Japan and other Asian countries with develop- that the qualitative method is indispensable to deeply ing primary care. In the UK, large organizations have understand the problems of patients with respect to not mentioned that QR/MMR are essential to primary care only the biological phenomena but also the psycho-social research, e.g. the Academy of Medical Sciences in their and contextual phenomena in primary care settings [8]. report on research in general practice [14]. Also, in line QR and MMR are also useful to describe and understand with this, almost all primary care departments have qual- complex issues without an over-simplification and can itative research groups or forums to foster these skills identify interactive relationships between problems [8]. amongst new researchers, which expands the research base, e.g. Oxford and Cambridge [15, 16]. These factors Strengths and implications may affect the increase of the proportion of QR/MMR in This study covers a largely unexamined issue that is the results. important for the global development of primary care We also do not know if the proportions of QR and via research. The large sample of studies over time and MMR in the UK and US are sufficient or appropriate for the use of abstracts of conference posters and presenta- the needs of their primary care systems. The proportion tions had possibly increased the representativeness of of QR and MMR is not the only indicator of the influ - our findings for the general state of primary care research ence of qualitative and mixed methods; we also need to in these countries. The examination of the character - consider the quality of research and relevance to clinical istics of qualitative research illustrated the need to fur- practice. ther describe the problem, and by this, seek possible In addition, the most frequently used qualitative solutions for the underuse of qualitative research. The method in the JPCA was SCAT. SCAT is a qualitative following lessons could be learned for Japan and other analytical method developed by Ohtani, Japan [17]. The Asian countries from the pattern of UK and US pri- method consists of 4-step coding and description of sto- mary care research: education and promotion of QR and ryline, suitable for the analysis of small-size qualitative MMR are highly recommended in Japanese and other data and easy to use for novices [17]. The SCAT website Asian countries’ primary care, which could be achieved has described “how to use SCAT”, “Frequently Asked by promoting domestically developed analytical meth- Questions” and “Tips and Pitfalls” for free in Japanese ods, supporting translations of their studies reported in [17]. Also, the author of SCAT has provided family phy- non-English languages into English for publication, and sicians with workshops overall Japan [17]. Moreover, multi-disciplinary collaborations. QR and MMR may also some research course for family physicians have included be made more relevant by focusing on patients and the a lecture series on SCAT [18]. These rich resources may community instead of secondary care settings. explain why it is more widely understood and used in Japan. Provision of such resources in other methods may Limitations be helpful to distribute QR/MMR among Japanese fam- We only included presented posters and oral presenta- ily physicians. This study also found that, in Japan, family tions, therefore the data from workshops, reports and Kaneko et al. Asia Pac Fam Med (2018) 17:11 Page 6 of 7 of the data and accuracy of the analysis. All authors read and approved the others were not used, which may have caused selection final manuscript. bias. We may therefore have underestimated the use of QR and MMR in Japan. Moreover, we did not differen - Author details Department of Family and Community Medicine, Hamamatsu University tiate poster presentations and oral presentations in the School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu 431-3192, process of data collection. Thus, this study could not Japan. Shizuoka Family Medicine Training Program, 1055-1, Akatuchi, Kiku- compare the proportion of oral presentations of QR/ gawa, Shizuoka 437-1507, Japan. Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, MMR with other study designs. We also assumed confer- Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan. Faculty of Community ences from the JPCA, the RCGP and the NAPCRG were Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan, Shimane 699-1221, representative of each country’s primary care research. Japan. Department of Primary Care and Population Health, University Col- lege London, Rowland Hill Street, London NW3 2PF, UK. Institute for Global The selection of the conferences was based on our knowl - Health, Institute of Child Health, University College London, 30 Guilford Street, edge and information from their websites, but selection 3rd Floor, London WC1N 1EH, UK. Junior International Committee, Royal bias may have been introduced by not examining other College of General Practitioners, 30 Euston Square, Kings Cross, London NW1 2FB, UK. conferences. If other conferences about QR/MMR and primary care included more studies with QR/MMR in Acknowledgements primary care, we might have underestimated the pro- We would like to acknowledge the JPCA, the RCGP and the Junior Interna- tional Committee of the RCGP for facilitating the primary care exchange portion of QR and MMR conducted in these countries. between the UK and Japan that inspired and stimulated this international Moreover, preference and knowledge about QR/MMR research collaboration. Finally, I would like to express my gratitude to my wife among reviewers in these conferences may have influ - and children for their warm support. enced the results. Also, we reviewed only abstracts of the Competing interests studies, and sometimes the information about the ana- The authors declare that they have no competing interests. lytic approach was not included. u Th s, our results did Availability of data and materials not necessarily describe the precise picture of the ana- The datasets used and/or analyzed during the current study are available from lytic approach due to its lack of description in conference the corresponding author on reasonable request. abstracts. The results therefore need careful interpreta - Consent for publication tion. Moreover, as the nationalities of researchers were Not applicable. not known from the title/abstracts, this study assumed that authors were from the countries in which the con- Ethics approval and consent to participate This work did not require ethical approval. ferences were based. As such, there is a possibility that the research conducted by authors from other countries Funding could have been included in the conference abstracts, This research received no specific grant from any funding agency in the pub - lic, commercial or not-for-profit sectors. therefore introducing misclassification. However, we excluded “international session” from our study. Thus, Publisher’s Note the proportion of studies by other countries’ researchers Springer Nature remains neutral with regard to jurisdictional claims in pub- may not change our results. Lastly, we shared the work of lished maps and institutional affiliations. classification/categorization, and it could have led to the Received: 2 May 2018 Accepted: 17 November 2018 variances of classification. Conclusions QR and MMR were not highly prevalent in primary care References within Japan compared to the UK and the US, whereas 1. Liamputtong P. Research methods in health: foundations for evidenced their use was increasing in the UK. Approaches, par- based practice. Victoria: Oxford University Press; 2016. 2. McKibbon KA, Gadd CS. A quantitative analysis of qualitative studies in ticipants and settings may differ among these countries. clinical journals for the 2000 publishing year. BMC Med Inform Decis Mak. Education and promotion of QR/MMR and multi-disci- 2004;4:11. plinary collaborations should be recommended in Japan. 3. Greenhalgh T. Research methods for primary health care. Oxford: Black- well Publishing Ltd; 2008. p. 57–89. 4. Sidhu K, Jones R, Stevenson F. Debate & analysis: publishing qualitative research in medical journals. Br J Gen Pract. 2017;67(658):229–30. https :// Abbreviations doi.org/10.3399/bjgp1 7X690 821. QR: qualitative research; MMR: mixed methods research; JPCA: Japan Primary 5. Stumbar S, Brown D. Qualitative Research in Family Medicine Educa- Care Association; RCGP: Royal College of General Practitioners; NAPCRG: Nor th tion. The society of teachers of family medicine. 2016. http://www.stfm. American Primary Care Research Group; SCAT : steps for coding and analyses. org/NewsJ ourna ls/Educa tionC olumn s/Octob er201 6Educ ation Colum n. Accessed 23 Apr 2018. Authors’ contributions 6. Kusaba T. Comprehensiveness and education about common disease in MK, TA and RM designed the study and MK, TA, RO and RM participated in the outpatient care of primary care clinics. In: Yokobayashi K, editor. Recom- implementation, data collection, data analysis, and writing of the manuscript. mendations: common disease in Japan generalist teachers consortium. MK also serves as guarantor. MI critically reviewed and drafted the manuscript. Tokyo: Kai-shorin; 2013. p. 104–11 (in Japanese). All authors had full access to the data and take responsibility for the integrity Kaneko et al. Asia Pac Fam Med (2018) 17:11 Page 7 of 7 7. Overview of training program for general practitioners. The Japanese 15. Health Experiences Research Group. University of Oxford. 2018. https :// Medical Speciality Board. 2017. http://www.japan -senmo n-i.jp/compr www.phc.ox.ac.uk/resea rch/healt h-exper ience s. Accessed 31 Aug 2018. ehens ive/index .html. Accessed 8 Aug 2018. 16. Qualitative Research Forum. University of Cambridge. 2018. https ://www. 8. Aomatsu M. Qualitative research in primary care and effort of editors. Off phpc.cam.ac.uk/pcu/resea rch/qrf/. Accessed 31 Aug 2018. J Jpn Prim Care Assoc. 2017;40(1):1. 17. Ohtani H. SCAT: steps for coding and theorization qualitative data analysis 9. The Japan Primary Care Association: About us. The Japan Primary Care method. 2017. http://www.educa .nagoy a-u.ac.jp/~otani /scat/. Accessed Association. 2017. http://www.prima ry-care.or.jp/. Accessed 23 Apr 2018. 23 Apr 2018. 10. Royal College of General Practitioners: Home. Royal College of General 18. Jikei Clinical Research Program for Primary Care. Division of Clinical Epide- Practitioners. 2017. http://www.rcgp.org.uk/. Accessed 23 Apr 2018. miology, Jikei Unicetsity School of Medicine. 2018. http://www.jikei .ac.jp/ 11. North American Primary Care Research Group: Home. North American ekiga ku/medic al/. Accessed 31 Aug 2018. Primary Care Research Group. 2017. http://www.napcr g.org/. Accessed 19. Toi T, Murata A, Ota H, Ohashi H, Kusaba T. Research on actual condition 23 Apr 2018. of family physician in Japan. Off J Jpn Prim Care Assoc. 2016;39:243–9. 12. Aoki T, Fukuhara S. Japanese representation in high-impact international 20. Kitajima Y, Nishihira T, Nishitani M, Tao M, Miyashiba T, Sakashita R. The primary care journals. Off J Jpn Prim Care Assoc. 2017;40(3):126–30. current state of and issues in nursing research carried out by clinical 13. Saiki-Craighill S. Overview of grounded theory approach. Keio SFC J. nurses with reference to papers in academic journals. RINCPC Bull. 2014;14(1):30–43. 2012;19:1–15. 14. Research in general practice: bringing innovation into patient care Workshop report. the Academy of Medical Sciences. 2009. https ://acmed sci.ac.uk/file-downl oad/35182 -12569 15380 1.pdf . Accessed 31 Aug 2018. Ready to submit your research ? Choose BMC and benefit from: fast, convenient online submission thorough peer review by experienced researchers in your field rapid publication on acceptance support for research data, including large and complex data types • gold Open Access which fosters wider collaboration and increased citations maximum visibility for your research: over 100M website views per year At BMC, research is always in progress. Learn more biomedcentral.com/submissions http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Asia Pacific Family Medicine Springer Journals

An analysis of qualitative and mixed methods abstracts from Japanese, UK and US primary care conferences

Download PDF
7 pages

Loading next page...
 
/lp/springer-journals/an-analysis-of-qualitative-and-mixed-methods-abstracts-from-japanese-xQU9H9G0r6
Publisher
Springer Journals
Copyright
Copyright © 2018 by The Author(s)
Subject
Medicine & Public Health; General Practice / Family Medicine; Primary Care Medicine
eISSN
1447-056X
DOI
10.1186/s12930-018-0048-8
Publisher site
See Article on Publisher Site

Abstract

Background: As research in family medicine covers varied topics, multiple methodologies such as qualitative research (QR) and mixed methods research (MMR) are crucial. However, we do not know about the difference in the proportion of QR or MMR between Japan, the UK and the US. This knowledge is needed to shape future research within countries with developing primary care such as Japan and other Asian countries. This study aims to describe the use of QR and MMR in Japanese primary care and compare this to the UK and US; then to make informed recom- mendations for primary care research. Methods: A repeated cross-sectional study (2012–2016) based on the abstracts submitted to the annual conferences of the Japanese Primary Care Association in Japan, the Royal College of General Practitioners in the UK, and the North American Primary Care Research Group in the US and other North American countries. The proportions of QR/MMR among all the posters and paper presentations for each of these three conferences were assessed. Also examined were trends and types of qualitative techniques for all three countries and participants/settings for Japan. Results: There were 1080 abstracts for Japan, 575 for UK and 3614 for US conferences. QR/MMR proportions were 7.5%, 15.1% and 28.1%, respectively. Japan’s proportion was lower than that of UK and US (p < 0.001). The proportion was increasing over time for the UK (p = 0.02). Steps for coding and analyses was most popular for Japan, thematic analysis for the UK and grounded theory for the US. Primary care doctors and hospitals were the commonest contexts for Japan. Conclusions: QR and MMR were not as popular in primary care in Japan compared to the UK and the US, whereas their use was increasing in the UK. Approaches, participants and settings may differ among these countries. Education and promotion of QR/MMR and multi-disciplinary collaborations need to be recommended in Japan with developing primary care. Keywords: Qualitative research, Primary health care, Japan, United Kingdom, United States Background world [1]. In addition, mixed methods research (MMR), Quantitative research had been predominant in health which combines and integrates quantitative methods care research for a long time. Recently, however, the with qualitative methods, has become popular in order importance of qualitative research (QR) has been rec- to capitalize on the advantages of both methods [1]. ognized as it contributes to deeper understanding and Although QR and MMR were more often used in interpretation of the meaning of phenomena in the real nursing disciplines compared to medicine [2], QR and MMR are indispensable for family medicine. The rea - son is that family medicine is, according to Miller and *Correspondence: makotok@hama-med.ac.jp Crabtree, “a clinical domain where balancing quali- Department of Family and Community Medicine, Hamamatsu tative and quantitative research styles benefits both University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu 431-3192, Japan patients and health care professionals” (A quantitative Full list of author information is available at the end of the article © The Author(s) 2018. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creat iveco mmons .org/licen ses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creat iveco mmons .org/ publi cdoma in/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Kaneko et al. Asia Pac Fam Med (2018) 17:11 Page 2 of 7 analysis of qualitative studies in clinical journals for the annual conference as a representative of primary care in 2000 publishing year page 2) [2]. Moreover, research in Japan; the Royal College of General Practitioners (RCGP) family medicine also encompasses a variety of topics annual conference for the UK; and the North American so that multiple methodologies are particularly crucial Primary Care Group (NAPCRG) annual meeting for [3]. Therefore, researchers in family medicine need to the US. The JPCA is the main primary care association acquire proficiency in QR and MMR skills. in Japan with approximately 11,000 members [9]. The In countries with long-established family medicine RCGP is the oldest primary care society in the world with systems such as the United Kingdom (UK) and the 50,000 members [10]. The NAPCRG is the major primary Unites States (US), QR and MMR have become popu- care society in the US and northern American countries lar. For instance, in the UK, a quarter of submissions to [11]. the British Journal of General Practice used qualitative The study subjects were the accepted abstracts for all methods with a similar acceptance rate to quantitative posters and oral presentations in the annual conferences studies and these articles were highly cited [4]. In addi- of the JPCA, the RCGP and the NAPCRG between 2012 tion, in the US, the Society of Teachers of Family Medi- and 2016. In April 2017, we searched these associations’ cine stressed the importance of qualitative methods in websites and if insufficient information was available, we family medicine education [5]. On the other hand, in contacted the associations for the titles and abstracts. We Japan, family medicine has not been well established, defined the studies using QR and MMR as all posters and where physicians who received an internal medicine oral presentations that included any of the words below based training program have played a principal role in in the title or abstract; for study design, “qualitative/qual- the primary care setting [6] and the system of certifica - itative research/survey”, “mixed-methods” and “qualita- tion for family physicians as a new category of special- tive and quantitative”; for analytical method, “grounded ist has just established since 2017 by an independent theory”, “phenomenology”, “ethnography”, “case study”, third-party organization [7]. “discourse analysis”, “narrative”, “KJ method”, “con- Although the editorial board of An Official Journal tent analysis”, “action research”, “field work”, “life story”, of the Japan Primary Care Association is planning to “thematic analysis”, SCAT”, “immersion-crystallization develop a guideline for submitting qualitative research approach” and “constant comparative approach”. [8], in countries with developing family medicine sys- We also categorized the participants, settings and dis- tems such as Japan and other Asian countries, the eases/conditions of the included studies in the JPCA importance of QR and MMR is not emphasized. This is conferences. The details of eligibility criteria and catego - important to know for these key research-leading coun- rization were shown in Table  1. We shared the work of tries to enable collaboration with Japanese and other classification/categorization between authors and when Asian family physicians in order to appropriately mold the classification of the study was ambiguous, discussion the future of primary care research. continued until a unanimous consensus was reached. The question is, therefore, how are qualitative and mixed methods used in primary care research in Japan Statistical analysis compared to the UK and US in recent years, and what We calculated the total proportion of the selected studies can be done to improve this? that are QR and MMR in each conference; the denomina- The aim is to describe the proportion, trend, types tors were the numbers of all studies and the numerators and characteristics of QR and MMR in primary care were the numbers of QR and MMR. research in Japan compared to in the UK and US We used Chi squared test for the comparison between between 2012 and 2016, using the numbers of abstracts the proportion in the JPCA annual conference and the submitted to major annual conferences, and to make RCGP annual conference and, separately, the NAPCRG recommendations for QR and MMR development annual meeting; the null hypothesis was of no difference based on these results. in proportions. The significance level selected was 5%. We also used the Cochran–Armitage test to assess the Methods annual change in this proportion for each conference; the We conducted a repeated cross-sectional study on the null hypothesis was that of no change. The significance numbers of abstracts accepted to major annual confer- level selected was 5% with two-sided tests. We assessed ences in primary care in Japan, UK, and US the number and proportions of the different types of qualitative approaches used for each country’s confer- Subjects ences. Finally, we assessed the number of eligible studies As major academic conferences in primary care, we in each category of participants and settings for the JPCA selected the Japan Primary Care Association (JPCA) Kaneko et al. Asia Pac Fam Med (2018) 17:11 Page 3 of 7 Table 1 Eligibility criteria and categorization of QR and MMR in the study Conference The annual conference of the JPCA The annual conference of the RCGP The annual conference of the NAPCRG Duration 2012–2016 Category of research JPCA: “Research” “Hinohara prize (research award)” RCGP: “Research”, “Clinical”, “Education” NAPCRG: all research except preliminary workshop, workshop, forum Definition of QR and MMR in the study We defined as QR and MMR all posters and oral presentations that included the words below in the title or abstract Words from Mackibbon et al. [2] “Qualitative/qualitative research/survey”, “mixed-methods”, “qualitative and quantitative” “Grounded theory ”, “phenomenology ”, “ethnography ”, “case study ”, “discourse analysis”, “narrative” Words from Saiki et al. [11] “KJ method”, “content analysis”, “action research”, “field work”, “life story” Words added by authors “Thematic analysis”, SCAT”, “immersion-crystallization approach”, “constant comparative approach” Categorization of characteristics of QR Categories based on Mckibbon et al. [2] and MMR in the JPCA Participants Patients/family/nurses/other people/physicians/other health care professionals Settings Hospital/clinic/community/nursing home/emergency department Disease/condition Various/cancer/mental health/pregnancy/cerebrovascular disease/general health/frail elderly/HIV/drugs/death and dying/diabetes/critical care/injury/asthma/pain/smoking/miscellaneous disease QR qualitative research, MMR mixed methods research, JPCA Japan Primary Care Association, RCGP Royal College of General Practitioners, NAPCRG North American Primary Care Group conferences. The statistical package used was Stata, ver - The most frequently used qualitative method in the sion 15. JPCA Annual Conference was Steps for Coding and Analyses (SCAT), thematic analysis in the RCGP Annual Results Conference, and grounded theory in the NAPCRG We searched 1080 studies for the JPCA Annual Confer- Annual Meeting (Fig. 1). ence, 575 for the RCGP Annual Conference, 3614 for the In QR and MMR in Japan, family physicians were the NAPCRG Annual Meeting respectively. The abstracts of commonest participants (31 studies). Other common the RCGP annual conference 2012 and 2013 were not participants were patients (9) and nurses (6). The most available despite enquiry and efforts by the office of the frequent study setting was hospital (29), followed by RCGP. community (24) and clinic (20). In terms of diseases/con- The total proportions of QR and MMR were 7.5 ditions, almost all of the studies were classified in Vari - (n = 81, 95% CI 5.9, 9.1), 15.1% (n = 87, 95% CI 12.2, 18.5) ous. Other diseases/conditions were mental health (2), and 28.1% (n = 1016, 95% CI 19.0, 21.7) for the confer- death and dying (2) and frail elderly (2). ences of the JPCA, RCGP and NAPCRG, respectively for the study period. The proportion of QR and MMR Discussion in the JPCA Annual Conference was significantly lower In comparing the numbers of abstracts submitted to than that in the RCGP Annual Conference (p < 0.001) and major annual conferences in primary care, the propor- the NAPCRG Annual Meeting (p < 0.001). The propor - tion that were QR or MMR in Japan were lower than tion of QR and MMR in the RCGP Annual Conference those in the UK and the US. The trend was not chang - increased yearly (p = 0.02) and those of the JPCA Annual ing in recent years, but it was increasing in the UK. SCAT Conference and the NAPCRG Annual Meeting displayed was the most popular qualitative approach for primary no significant changes. Although the proportion of MMR care research in Japan, thematic analysis in the UK and in the US was increasing, the trend was not statistically grounded theory in the US. significant (p = 0.054). Our finding of the low proportion of QR and MMR Table  2 displays these results and the breakdown of in Japanese primary care may be explained by insuf- studies into QR or MMR. QR was more often conducted ficient development of clinical research in primary care in comparison with MMR. [12], low awareness of the significance of QR and MMR, and lack of educational resources such as mentors. In Kaneko et al. Asia Pac Fam Med (2018) 17:11 Page 4 of 7 Table 2 The proportion of  posters and  oral presentations that  were QR or  MMR in  each conference and  the  annual change Year 2012 2013 2014 2015 2016 Total JPCA All research 247 170 227 208 228 1080 QR 17 11 12 11 17 68 MMR 3 2 5 2 1 13 Proportion that are QR or MMR (%) 8.1 7.6 7.5 6.2 7.9 7.5 95% CI 5.9–9.1 RCGP All research 241 170 164 575 QR 26 17 28 71 MMR 1 6 9 16 Proportion that are QR or MMR (%) 11.2 13.5 22.6 15.1 95% CI 12.2–18.1 NAPCRG All research 569 653 838 715 839 3614 QR 142 94 183 182 134 735 MMR 41 43 59 66 72 281 Proportion that are QR or MMR (%) 32.2 21.0 28.9 34.7 24.6 28.1 95% CI 26.7–29.6 QR qualitative research, MMR mixed method research, JPCA Japan Primary Care Association, RCGP Royal College of General Practitioners, NAPCRG North American Primary Care Group, CI confidence interval Japan UK US SCAT Steps for Coding and Theorization GTA: grounded theory approach Fig. 1 Qualitative approach for QR and MMR studies at each country’s conference Kaneko et al. Asia Pac Fam Med (2018) 17:11 Page 5 of 7 addition, reporting of QR and MMR studies in the Eng- physicians were the commonest participants in QR and lish language may be difficult to perform for Japanese MMR, and hospitals were the most frequent study set- researchers compared to quantitative studies because tings. The results may be explained by the fact that almost QR and MMR conducted in Japanese may be harder to of all members of the JPCA were family physicians [9] translate into English for publication due to a higher reli- and 43.7% of the JPCA certified family physicians work ance on complex language skills. English language QR not only at clinics but also at hospitals [19]. and MMR may also, therefore, be harder to understand In contrast, according to an analysis of QR in 170 Eng- for Japanese researchers, which may discourage learning lish language journals, patients and family were the first about and specializing in QR and MMR. Saiki, however, and second most common types of participants, and the indicated that QR was increasing annually in Japanese community was the commonest setting [2]. They also health-care journals overall and the number of QR stud- found that half of the qualitative studies were conducted ies had increased 10-fold in the past 10 years [13], which by nurses [2]. This situation is similar in Japan, where was explained by an increase in Japanese textbooks most QR is published in nursing journals [20]. In order about QR and MMR [13]. Therefore, although our study to enhance the use of QR and MMR for patient-centered revealed no significant change in the proportion of QR care in Japanese and other Asian countries’ primary care, and MMR in primary care, these research methods may multi-disciplinary collaborations would be useful. become popular in the near future. Based on the results To deal with the wide-range research questions in pri- of our study and the current literature, it is necessary to mary care, both qualitative and quantitative methods examine further the barriers and facilitators for QR and play important roles [3]. In Japan, Aomatsu pointed out MMR in Japan and other Asian countries with develop- that the qualitative method is indispensable to deeply ing primary care. In the UK, large organizations have understand the problems of patients with respect to not mentioned that QR/MMR are essential to primary care only the biological phenomena but also the psycho-social research, e.g. the Academy of Medical Sciences in their and contextual phenomena in primary care settings [8]. report on research in general practice [14]. Also, in line QR and MMR are also useful to describe and understand with this, almost all primary care departments have qual- complex issues without an over-simplification and can itative research groups or forums to foster these skills identify interactive relationships between problems [8]. amongst new researchers, which expands the research base, e.g. Oxford and Cambridge [15, 16]. These factors Strengths and implications may affect the increase of the proportion of QR/MMR in This study covers a largely unexamined issue that is the results. important for the global development of primary care We also do not know if the proportions of QR and via research. The large sample of studies over time and MMR in the UK and US are sufficient or appropriate for the use of abstracts of conference posters and presenta- the needs of their primary care systems. The proportion tions had possibly increased the representativeness of of QR and MMR is not the only indicator of the influ - our findings for the general state of primary care research ence of qualitative and mixed methods; we also need to in these countries. The examination of the character - consider the quality of research and relevance to clinical istics of qualitative research illustrated the need to fur- practice. ther describe the problem, and by this, seek possible In addition, the most frequently used qualitative solutions for the underuse of qualitative research. The method in the JPCA was SCAT. SCAT is a qualitative following lessons could be learned for Japan and other analytical method developed by Ohtani, Japan [17]. The Asian countries from the pattern of UK and US pri- method consists of 4-step coding and description of sto- mary care research: education and promotion of QR and ryline, suitable for the analysis of small-size qualitative MMR are highly recommended in Japanese and other data and easy to use for novices [17]. The SCAT website Asian countries’ primary care, which could be achieved has described “how to use SCAT”, “Frequently Asked by promoting domestically developed analytical meth- Questions” and “Tips and Pitfalls” for free in Japanese ods, supporting translations of their studies reported in [17]. Also, the author of SCAT has provided family phy- non-English languages into English for publication, and sicians with workshops overall Japan [17]. Moreover, multi-disciplinary collaborations. QR and MMR may also some research course for family physicians have included be made more relevant by focusing on patients and the a lecture series on SCAT [18]. These rich resources may community instead of secondary care settings. explain why it is more widely understood and used in Japan. Provision of such resources in other methods may Limitations be helpful to distribute QR/MMR among Japanese fam- We only included presented posters and oral presenta- ily physicians. This study also found that, in Japan, family tions, therefore the data from workshops, reports and Kaneko et al. Asia Pac Fam Med (2018) 17:11 Page 6 of 7 of the data and accuracy of the analysis. All authors read and approved the others were not used, which may have caused selection final manuscript. bias. We may therefore have underestimated the use of QR and MMR in Japan. Moreover, we did not differen - Author details Department of Family and Community Medicine, Hamamatsu University tiate poster presentations and oral presentations in the School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu 431-3192, process of data collection. Thus, this study could not Japan. Shizuoka Family Medicine Training Program, 1055-1, Akatuchi, Kiku- compare the proportion of oral presentations of QR/ gawa, Shizuoka 437-1507, Japan. Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, MMR with other study designs. We also assumed confer- Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan. Faculty of Community ences from the JPCA, the RCGP and the NAPCRG were Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan, Shimane 699-1221, representative of each country’s primary care research. Japan. Department of Primary Care and Population Health, University Col- lege London, Rowland Hill Street, London NW3 2PF, UK. Institute for Global The selection of the conferences was based on our knowl - Health, Institute of Child Health, University College London, 30 Guilford Street, edge and information from their websites, but selection 3rd Floor, London WC1N 1EH, UK. Junior International Committee, Royal bias may have been introduced by not examining other College of General Practitioners, 30 Euston Square, Kings Cross, London NW1 2FB, UK. conferences. If other conferences about QR/MMR and primary care included more studies with QR/MMR in Acknowledgements primary care, we might have underestimated the pro- We would like to acknowledge the JPCA, the RCGP and the Junior Interna- tional Committee of the RCGP for facilitating the primary care exchange portion of QR and MMR conducted in these countries. between the UK and Japan that inspired and stimulated this international Moreover, preference and knowledge about QR/MMR research collaboration. Finally, I would like to express my gratitude to my wife among reviewers in these conferences may have influ - and children for their warm support. enced the results. Also, we reviewed only abstracts of the Competing interests studies, and sometimes the information about the ana- The authors declare that they have no competing interests. lytic approach was not included. u Th s, our results did Availability of data and materials not necessarily describe the precise picture of the ana- The datasets used and/or analyzed during the current study are available from lytic approach due to its lack of description in conference the corresponding author on reasonable request. abstracts. The results therefore need careful interpreta - Consent for publication tion. Moreover, as the nationalities of researchers were Not applicable. not known from the title/abstracts, this study assumed that authors were from the countries in which the con- Ethics approval and consent to participate This work did not require ethical approval. ferences were based. As such, there is a possibility that the research conducted by authors from other countries Funding could have been included in the conference abstracts, This research received no specific grant from any funding agency in the pub - lic, commercial or not-for-profit sectors. therefore introducing misclassification. However, we excluded “international session” from our study. Thus, Publisher’s Note the proportion of studies by other countries’ researchers Springer Nature remains neutral with regard to jurisdictional claims in pub- may not change our results. Lastly, we shared the work of lished maps and institutional affiliations. classification/categorization, and it could have led to the Received: 2 May 2018 Accepted: 17 November 2018 variances of classification. Conclusions QR and MMR were not highly prevalent in primary care References within Japan compared to the UK and the US, whereas 1. Liamputtong P. Research methods in health: foundations for evidenced their use was increasing in the UK. Approaches, par- based practice. Victoria: Oxford University Press; 2016. 2. McKibbon KA, Gadd CS. A quantitative analysis of qualitative studies in ticipants and settings may differ among these countries. clinical journals for the 2000 publishing year. BMC Med Inform Decis Mak. Education and promotion of QR/MMR and multi-disci- 2004;4:11. plinary collaborations should be recommended in Japan. 3. Greenhalgh T. Research methods for primary health care. Oxford: Black- well Publishing Ltd; 2008. p. 57–89. 4. Sidhu K, Jones R, Stevenson F. Debate & analysis: publishing qualitative research in medical journals. Br J Gen Pract. 2017;67(658):229–30. https :// Abbreviations doi.org/10.3399/bjgp1 7X690 821. QR: qualitative research; MMR: mixed methods research; JPCA: Japan Primary 5. Stumbar S, Brown D. Qualitative Research in Family Medicine Educa- Care Association; RCGP: Royal College of General Practitioners; NAPCRG: Nor th tion. The society of teachers of family medicine. 2016. http://www.stfm. American Primary Care Research Group; SCAT : steps for coding and analyses. org/NewsJ ourna ls/Educa tionC olumn s/Octob er201 6Educ ation Colum n. Accessed 23 Apr 2018. Authors’ contributions 6. Kusaba T. Comprehensiveness and education about common disease in MK, TA and RM designed the study and MK, TA, RO and RM participated in the outpatient care of primary care clinics. In: Yokobayashi K, editor. Recom- implementation, data collection, data analysis, and writing of the manuscript. mendations: common disease in Japan generalist teachers consortium. MK also serves as guarantor. MI critically reviewed and drafted the manuscript. Tokyo: Kai-shorin; 2013. p. 104–11 (in Japanese). All authors had full access to the data and take responsibility for the integrity Kaneko et al. Asia Pac Fam Med (2018) 17:11 Page 7 of 7 7. Overview of training program for general practitioners. The Japanese 15. Health Experiences Research Group. University of Oxford. 2018. https :// Medical Speciality Board. 2017. http://www.japan -senmo n-i.jp/compr www.phc.ox.ac.uk/resea rch/healt h-exper ience s. Accessed 31 Aug 2018. ehens ive/index .html. Accessed 8 Aug 2018. 16. Qualitative Research Forum. University of Cambridge. 2018. https ://www. 8. Aomatsu M. Qualitative research in primary care and effort of editors. Off phpc.cam.ac.uk/pcu/resea rch/qrf/. Accessed 31 Aug 2018. J Jpn Prim Care Assoc. 2017;40(1):1. 17. Ohtani H. SCAT: steps for coding and theorization qualitative data analysis 9. The Japan Primary Care Association: About us. The Japan Primary Care method. 2017. http://www.educa .nagoy a-u.ac.jp/~otani /scat/. Accessed Association. 2017. http://www.prima ry-care.or.jp/. Accessed 23 Apr 2018. 23 Apr 2018. 10. Royal College of General Practitioners: Home. Royal College of General 18. Jikei Clinical Research Program for Primary Care. Division of Clinical Epide- Practitioners. 2017. http://www.rcgp.org.uk/. Accessed 23 Apr 2018. miology, Jikei Unicetsity School of Medicine. 2018. http://www.jikei .ac.jp/ 11. North American Primary Care Research Group: Home. North American ekiga ku/medic al/. Accessed 31 Aug 2018. Primary Care Research Group. 2017. http://www.napcr g.org/. Accessed 19. Toi T, Murata A, Ota H, Ohashi H, Kusaba T. Research on actual condition 23 Apr 2018. of family physician in Japan. Off J Jpn Prim Care Assoc. 2016;39:243–9. 12. Aoki T, Fukuhara S. Japanese representation in high-impact international 20. Kitajima Y, Nishihira T, Nishitani M, Tao M, Miyashiba T, Sakashita R. The primary care journals. Off J Jpn Prim Care Assoc. 2017;40(3):126–30. current state of and issues in nursing research carried out by clinical 13. Saiki-Craighill S. Overview of grounded theory approach. Keio SFC J. nurses with reference to papers in academic journals. RINCPC Bull. 2014;14(1):30–43. 2012;19:1–15. 14. Research in general practice: bringing innovation into patient care Workshop report. the Academy of Medical Sciences. 2009. https ://acmed sci.ac.uk/file-downl oad/35182 -12569 15380 1.pdf . Accessed 31 Aug 2018. Ready to submit your research ? Choose BMC and benefit from: fast, convenient online submission thorough peer review by experienced researchers in your field rapid publication on acceptance support for research data, including large and complex data types • gold Open Access which fosters wider collaboration and increased citations maximum visibility for your research: over 100M website views per year At BMC, research is always in progress. Learn more biomedcentral.com/submissions

Journal

Asia Pacific Family Medicine – Springer Journals

Published: Nov 22, 2018

References

  • Research methods in health: foundations for evidenced based practice
    Liamputtong, P
  • A quantitative analysis of qualitative studies in clinical journals for the 2000 publishing year
    McKibbon, KA; Gadd, CS
  • Research methods for primary health care
    Greenhalgh, T
  • Debate & analysis: publishing qualitative research in medical journals
    Sidhu, K; Jones, R; Stevenson, F
  • Recommendations: common disease in Japan generalist teachers consortium
    Kusaba, T
  • Qualitative research in primary care and effort of editors
    Aomatsu, M
  • Japanese representation in high-impact international primary care journals
    Aoki, T; Fukuhara, S
  • Overview of grounded theory approach
    Saiki-Craighill, S
  • Research on actual condition of family physician in Japan
    Toi, T; Murata, A; Ota, H; Ohashi, H; Kusaba, T
  • The current state of and issues in nursing research carried out by clinical nurses with reference to papers in academic journals
    Kitajima, Y; Nishihira, T; Nishitani, M; Tao, M; Miyashiba, T; Sakashita, R