Centre for Healthcare Resilience and Implementation Science, Australian Institute for Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW, 2109, Australia.
BMC Med Res Methodol. 2018 Nov 14;18(1):131. doi: 10.1186/s12874-018-0597-4.
The dominant medical and health research paradigm continues to be quantitative. While the authors sense a sea-change in opinion about mixed-method research, underpinned by two decades of highly-cited publications in medical journals, much of the medical literature still widely favours the Randomised Control Trial.
This debate article examines whether it is the beginning of the end of the dominant quantitative paradigm and the interest this holds for researchers and clinicians at the forefront of care delivery. It examines the Third Research Paradigm, signifying the importance of mixed-methods, and discusses the power of the patient voice and person-focused research activity. The authors discern the coming of age of a Fourth Research Paradigm integrating mixed-methods with data collected 'on the hoof'. Within this new paradigm, the article explores the power of available, real time, and emergent data - from smart phones, wearable devices, and social media, as well as more creative approaches to data collection. The Fourth Research Paradigm will require the support of multi-disciplinary teams, moving through the world alongside their research subjects. The impact of a Fourth Research Paradigm on the health researcher is assessed, as the researcher's gaze moves away from considerations of methodological superiority to re-considerations of their role in the brave new world of research multiplicity.
The Fourth Research Paradigm offers extensive opportunities to tell more complete research stories in real-time settings. It concentrates on contextual notions of everyday happenings within the ever-changing world of healthcare delivery. There will be challenges ahead, not least the management of large, complex datasets and adaptive study designs. But rigorous planning will enable unique insights into the relationships played out in the world of the patient and healthcare provider. Better care and new delivery models are likely to result, but how this will manifest is not yet clear.
主导的医学和健康研究范式仍然是定量的。虽然作者感觉到人们对混合方法研究的看法发生了重大变化，这一变化得到了医学期刊上二十年来高引用出版物的支持，但医学文献仍然广泛倾向于随机对照试验。
本文探讨了这是否是主导定量范式的终结的开始，以及这对处于护理前沿的研究人员和临床医生的兴趣。它考察了第三代研究范式，标志着混合方法的重要性，并讨论了患者声音和以人为中心的研究活动的力量。作者发现，一种整合混合方法和“实时”收集数据的第四代研究范式正在到来。在这个新的范式中，文章探讨了利用现有、实时和新兴数据的力量——来自智能手机、可穿戴设备和社交媒体，以及更具创造性的数据收集方法。第四代研究范式将需要多学科团队的支持，与研究对象一起在现实世界中行动。本文评估了第四代研究范式对健康研究人员的影响，因为研究人员的关注点从方法论优势转移到重新考虑他们在研究多样性的新时代中的角色。
第四代研究范式为在实时环境中讲述更完整的研究故事提供了广泛的机会。它集中于在医疗保健提供的不断变化的世界中，日常发生的情境概念。未来将面临挑战，尤其是在管理大型、复杂数据集和适应性研究设计方面。但严格的规划将使人们能够深入了解在患者和医疗保健提供者的世界中发挥作用的关系。更好的护理和新的交付模式可能会出现，但这将如何体现尚不清楚。
