Fraser John
New England Area Rural Training Unit, Australia.
Fam Pract. 2004 Feb;21(1):87-91. doi: 10.1093/fampra/cmh119.
The GP and qualitative researcher use similar patient-centred approaches, but their roles are different. Guidelines for conducting GP research in small communities are limited. I planned a qualitative study about hospital closure in a small rural Australian town where I worked. Few studies have researched community reaction to hospital closure and this process of change.
I used historical analysis to improve external reliability, and purposeful sampling to develop and pre-test a qualitative semi-structured research instrument. Newspaper articles, minutes and tape recordings of public meetings, annual reports from 1991 to 1997, quality assurance data and interviews with two health professionals were analysed in this process. These sources were coded using content and thematic analysis. Ethical issues arose during early stages of planning. Ethical guidelines and bioethics principles were discussed with colleagues and a member of an ethics committee. I validated my findings with three other community members involved in the hospital closure.
Themes of a transition, from resistance to change and divisions between key stake holders, to a need to appreciate the benefits of change emerged in coding material from 1991 to 1997. The principle of non-maleficence outweighed the principle of beneficence in this study. Existing health services could be harmed by examining the process of change after spending time and resources to reconcile community differences. Individuals could be harmed as confidentiality in a small community was difficult to maintain, and discussions about sensitive issues could produce adverse public criticism. The autonomy of participants to give informed consent was complicated by the author providing clinical services in the community, raising concerns about patients feeling an obligation to participate.
A justified case for discontinuing this study was made by the researcher on ethical grounds. Use of bioethical principles and community representatives to validate findings was a useful technique to guide decisions in a small rural community. This discussion has application in planning other small community studies.
全科医生（GP）和定性研究人员采用类似的以患者为中心的方法，但其角色不同。关于在小社区开展全科医生研究的指南有限。我计划对我工作所在的澳大利亚乡村小镇医院关闭情况进行一项定性研究。很少有研究探讨社区对医院关闭及这一变革过程的反应。
我采用历史分析来提高外部可靠性，并通过目的抽样来开发和预测试一种定性半结构化研究工具。在此过程中，分析了报纸文章、公众会议记录和录音、1991年至1997年的年度报告、质量保证数据以及对两名卫生专业人员的访谈。这些资料来源采用内容分析和主题分析进行编码。在规划的早期阶段出现了伦理问题。与同事和一名伦理委员会成员讨论了伦理指南和生物伦理原则。我与参与医院关闭事宜的其他三名社区成员对研究结果进行了验证。
在对1991年至1997年的编码材料分析中出现了一些主题，从对变革的抵制和关键利益相关者之间的分歧，到认识到变革益处的必要性。在本研究中，不伤害原则比行善原则更为重要。在花费时间和资源协调社区差异后，审视变革过程可能会损害现有的卫生服务。在小社区难以维持保密性，讨论敏感问题可能会引发公众的负面批评，从而可能对个人造成伤害。由于作者在社区提供临床服务，使得参与者自主给予知情同意变得复杂，引发了对患者感到有义务参与的担忧。
研究人员基于伦理理由提出了终止本研究的合理理由。运用生物伦理原则和社区代表来验证研究结果是指导农村小社区决策的一项有用技术。这一讨论适用于规划其他小社区研究。
