Theoretical foundations of qualitative inquiry 

No inquirer…ought to go about the business of inquiry without being clear about just what paradigm informs and guides his or her approach. (Guba & Lincoln, 1994: p. 116)

All knowledge production is based on a set of philosophical assumptions about the nature of reality (ontology), the nature of knowledge (epistemology), and the ways in which we acquire knowledge (methodology). These are known as paradigms, or worldviews (Kuhn, 1970). They refer to researchers’ assumptions about the world and are often implicit or taken for granted. Paradigm assumptions include claims about notions such as subjectivity, objectivity, truth, knowledge, and reality. Paradigms inform the kinds of questions that can be asked and answered through research – and those that cannot. Paradigms guide both the researcher and the research inquiry (Kuhn, 1970; Guba & Lincoln, 1994).

For example, a post-positivist qualitative researcher may favour results presented as description to better fit with the dominant ideas of the post-positivist paradigm. An assumption of this paradigm is that the researcher should stay as close as possible to participants’ words and their descriptions of events. Interpretive qualitative researchers, on the other hand, would explicitly engage with interpretation throughout the study process. They want to not only describe a phenomenon but to also explain analytical insights they have gleaned about it through the study. Interpretive researchers might develop a new concept based on a theoretically informed analysis and interpretation of participants’ words and their descriptions of events. They might offer an explanation that is analytically or conceptually generalizable beyond the study itself  and possibly transferable to other contexts, such as the  “discourse of abuse” in Eakin (2005) or the concept of “talk” in Facey (2010).

Researchers can identify their knowledge-producing paradigms or worldview by thinking about whether they acquire knowledge by being “objective” and “unbiased,” by being detached, value-free observers, or by acknowledging their subjectivity. They can also consider whether they see themselves as intimately involved in co-producing knowledge, whether they think the research process and the knowledge produced is, or can be, value-free; and whether they can know and produce knowledge about how things really are and how they really work.

Table 1. Underlying assumptions of positivism, social-critical and interpretivist-constructivist paradigms

Adapted from Lincoln, Lynham & Guba, 2011

Guba and Lincoln (Guba & Lincoln, 1994) propose four paradigms: positivism, post-positivism, critical social, and constructivism/interpretivism.  Both (post-)positivist paradigms assume that a stable reality exists “out there,” that phenomena such as health and disease exist whether we look for or find them or not, and that what exists as health and disease are real only if they can be observed through or are amenable to the senses. “Stable” means for example that realities such as our understandings of disease are not affected by factors such as social, political, historical, or economic processes; only what is observable can be considered valid, and knowledge is achieved through the accumulation of verified facts.

From a (post-)positivist perspective, metaphysical notions such as one’s feelings would be considered valid knowledge only if they could be observed or measured (Guba & Lincoln, 1994; Green & Thorogood, 2004; Denzin & Lincoln, 2011). This philosophy also holds that researchers must be objective, which means they must rid themselves of their biases because these can taint the research process and thus undermine the validity of the knowledge produced. This orientation is more appropriate for research in the natural sciences. In the health sciences, it focuses on prediction of behaviour and functionalist frameworks to explain social relations.

The second paradigm that is very influential in the health sciences is the critical-social paradigm. In this paradigm, reality is shaped by socio-economic, political, historical, and cultural contexts. Researchers acknowledge their subjectivity and as a result, recognize that truths (e.g., research findings) are value-mediated (Guba & Lincoln, 1994). Critical-social theories are concerned with issues of power – underlying power structures and how they impinge on individuals and groups. Within this paradigm, theories such as neo-Marxism, feminism, postcolonialism, poststructuralism, postmodernism, and critical race studies, among others, explore the power relations that shape current social relations. Researchers are involved in advocacy and committed to social justice (Guba and Lincoln, 1994). Their objective is to produce knowledge to promote social change by identifying forms of oppression and supporting the empowerment of disadvantaged groups (Denzin, 2015). They study how we came to have groups of privileged people benefiting from the current power arrangements while others experience unnecessary suffering and deprivation. For example, why does the nursing profession have less social prestige and remuneration than the medical profession despite providing essential health care? Or, why is there a lack of access to dental care for part-time workers and their families?

Constructivism/constructionism/interpretivism lies at the other end of the continuum in Guba and Lincoln’s (1994) typology of paradigms. The theories organized under this paradigm that are better known in the health sciences are phenomenology, social constructionism, and symbolic interactionism. This perspective assumes that reality is multiple, contingent, and socially constructed through social interactions. And, unlike (post-)positivism, it has the capacity to include metaphysical considerations. Interpretivism is concerned with meaning and subjective experiences, with understanding phenomena from the perspective of those who experience it (Green & Thorogood, 2004).

Further, where (post-)positivist researchers assert that knowledge and understanding of health and diseases are products of accumulated facts, constructivist/ interpretivist researchers argue that they are social constructions and that our understandings and experiences of them are informed by social, historical, and political contexts (Singer, 2004).  For example, TB sufferers in Canada experience their disease as stigma, depression, fear, isolation, and anxiety; as a limitation on their freedom and autonomy; and as an intrusion that is related to surveillance through Directly Observed Therapy (DOT) programs (Bender, 2009; Bender, Peter, Wynn, Andrews & Pringle, 2011). A constructivist/interpretivist researcher would note that their experiences are shaped in part by their social status as new and/or racialized immigrants, the construction of TB as contagion, and the personal moral judgments that inform such understandings of this disease (Bender, Guruge, Hyman & Janjua, 2012). The assertion that diseases are “social constructions” does not mean they do not exist. Diseases objectively do exist, but this perspective prompts us to carefully consider the ways in which we think and talk about them. As the TB example above suggests, prevailing attitudes toward a particular disease have implications for the people diagnosed with that disease.

Also, in this paradigm, the researcher’s values and roles hold primary places in the research process; the researcher is the “orchestrator and facilitator of the inquiry” (Guba & Lincoln, 1994; Denzin & Lincoln, 2011). The researcher and the participant are also inexorably linked in a research relationship. This means, for example, that the research data and by extension research results are co-created in the research process. From this perspective, researchers do not make claims of objectivity, but rather acknowledge and engage their thoughts and feelings during the research process. They “account for themselves” through the ethical and epistemological lens of reflexivity (Denzin and Lincoln, 2011). These reflexive practices not only become a resource that informs the research inquiry and outcomes, they also buttress the rigour or quality of research because they contribute to transparency in research practice and process.