Anotações sobre a análise crítica de discurso em pesquisas qualitativas no campo da saúde / Notes on the critical analysis of discourse in qualitative studies in the field of health

A emergência de sistemas de saúde ancorados em uma concepção ampliada de saúde, pressupondo, em seu ideário, dimensões que interrogam a compreensão das ações nesse campo capazes de articular estrutura e sujeito, vem impulsionando pesquisas avaliativas como modalidade de investigação, notadamente propostas metodológicas orientadas pelo enfoque qualitativo. Falar em pesquisa qualitativa é aludir à epistemologia qualitativa, tradição composta por numerosas vertentes, oriundas de paradigmas e campos disciplinares diversos, que carecem de aprofundamento, na perspectiva de desvelar, para cada uma delas, sua vinculação ontológica, epistemológica e, por extensão metodológica, incluindo o plano operacional. Tal empreendimento ainda é muito escasso na literatura especializada sobre o tema, verificando-se nas publicações o predomínio de estudos empíricos, convivendo com uma notável escassez de discussões epistemológicas e teórico-metodológicas atinentes aos modelos avaliativos operacionalizados. Ante essa configuração, este artigo se propõe a colocar em relevo alguns elementos conceituais inerentes à análise, entendida como etapa epistemológica central no enfoque (crítico) interpretativo. Na sequência, o texto focaliza uma vertente específica – a Análise Crítica do Discurso – com o intuito de recuperar alguns fundamentos e registrar aspectos operacionais que vimos empregando em pesquisas qualitativas em saúde...

The emergence of health systems based on a broadened concept of health that questions the understanding of actions in the field of health capable of bringing together structure and subject has led to the development of evaluative studies as a mode of investigation and in particular methodological proposals guided by a qualitative focus in the study of human health. Qualitative research involves qualitative epistemology, a tradition composed of numerous currents derived from various paradigms and fields, which lack in-depth study, in terms of revealing the ontological, epistemological and, by extension, methodological basis of each, including an operational plan. Such undertakings are still very rare in the specialized literature on the subject, as is clear from the predominance of empirical studies in publications and the notable scarcity of epistemological, theoretical and methodological discussions regarding operationalized evaluative models. In view of this, the present article aims to highlight a number of conceptual elements inherent in analysis, understood as a central epistemological stage in a (critical) interpretative focus. The text then focuses on one specific school of thought – Critical Discourse Analysis – with a view to recovering some fundamental features and registering operational aspects that have been employed in qualitative studies in the field of health...

An Analysis of Trainers' Perspectives within an Ecological Framework: Factors that Influence Mine Safety Training Processes

BACKGROUND: Satisfactory completion of mine safety training is a prerequisite for being hired and for continued employment in the coal industry. Although training includes content to develop skills in a variety of mineworker competencies, research and recommendations continue to specify that specific limitations in the self-escape portion of training still exist and that mineworkers need to be better prepared to respond to emergencies that could occur in their mine. Ecological models are often used to inform the development of health promotion programs but have not been widely applied to occupational health and safety training programs. METHODS: Nine mine safety trainers participated in in-depth semi-structured interviews. A theoretical analysis of the interviews was completed via an ecological lens. Each level of the social ecological model was used to examine factors that could be addressed both during and after mine safety training. RESULTS: The analysis suggests that problems surrounding communication and collaboration, leadership development, and responsibility and accountability at different levels within the mining industry contribute to deficiencies in mineworkers' mastery and maintenance of skills. CONCLUSION: This study offers a new technique to identify limitations in safety training systems and processes. The analysis suggests that training should be developed and disseminated with consideration of various levels-individual, interpersonal, organizational, and community-to promote skills. If factors identified within and between levels are addressed, it may be easier to sustain mineworker competencies that are established during safety training.

O desafio de revisar aspectos éticos das pesquisas em ciências sociais e humanas: a necessidade de diretrizes específicas / The challenge of reviewing ethical aspects of social and human research: the need for specific guidelines

As diretrizes brasileiras sobre ética em pesquisas com seres humanos são um conjunto de 11 resoluções do Conselho Nacional de Saúde (CNS). A Resolução nº 196/96 era a mais antiga até 13 de junho de 2013, quando a Resolução 466/12 entrou em vigência, ambas se dirigem a pesquisas em qualquer área do conhecimento. Pesquisadores das ciências sociais e humanas têm encontrado dificuldade na aprovação das suas pesquisas pelo sistema formado pelos Comitês de Ética em Pesquisa (CEP) e pela Comissão Nacional de Ética em Pesquisa (CONEP), ainda que esses projetos não tenham problemas éticos. O cerne da questão está em que a Resolução nº 196/96 considera apenas a pesquisa biomédica e não dialoga com outras tradições de pesquisa. Entretanto, como seu âmbito de abrangência inclui todas as pesquisas com seres humanos, esse sistema a adota por referência e coloca questões inadequadas, que demonstram desconhecimento das metodologias qualitativas, muito utilizadas nas ciências sociais e humanas. Considerando que a Resolução 466/12 mantém a mesma lógica da Resolução 196/96, este texto discute as raízes históricas da Resolução nº 196/96, apresenta algumas dificuldades que esses pesquisadores vêm enfrentando com o sistema CEP-CONEP e aponta as inadequações da definição de pesquisa e dos procedimentos que as diretrizes brasileiras estabelecem para a revisão ética das pesquisas qualitativas em saúde. A Resolução 466/12 coloca possibilidade de uma resolução específica para ciências sociais e humanas que, se acompanhada de capacitação permanente dos membros do Sistema CEP/CONEP, pode melhorar essa situação.

The Brazilian guidelines on ethics in human research are made up of 11 resolutions of the National Health Council (CNS). The Resolution 196/96 was the oldest one until June 2013, when the Resolution 466/12 was enforced, and was applied to human research in all areas. Researchers from social and human sciences are facing difficulties to have their projects approved by the system made up of the Committees on Ethics in Research (CEP) and the National Commission on Ethics in Research (CONEP), even when these projects have no ethical problems. The key question is that the Resolution 196/96, and Resolution 466/12, considers only the biomedical research and does not dialogue with other research traditions. However, because its scope is all human research, this system based on this resolution asks inadequate questions, that show the lack of knowledge about qualitative research - which is very popular among social and human research. Considering that Resolution 466/12 kept the same logic of Resolution 196/96, this paper discusses the historical roots of Resolution 196/96, presents some difficulties that researchers have been facing with CONEP-CEPs system and points out the inadequacy of the research definition and the procedures established by the Brazilian guidelines to the ethical revision of qualitative research. Specific guidelines for social sciences and humanities are necessary, as well as the permanent qualification of the CEP and CONEP members. Although the Resolution 466/12, enforced in June 13, 2013, does not move in this direction, it opens the possibility to have specific resolution to socials and human sciences that, if in addition to permanent capacity building of members of the system CEP/CONEP, can improve this situation.

Dilemas éticos en el trabajo de campo: temas olvidados en la investigación cualitativa en salud en Iberoamérica / Ethical dilemmas in fieldwork: forgotten issues in qualitative health research in Iberoamerica

En este trabajo se exploran algunos dilemas éticos enfrentados durante el trabajo de campo en la investigación cualitativa en salud. La premisa es que los códigos éticos no son suficientes para orientar las relaciones entre los investigadores y los informantes siendo necesaria una práctica reflexiva para enfrentar los mismos. La reflexión se centra en cuatro situaciones del trabajo de campo y sus dilemas. El tiempo social de la vida académica estructura la agenda de trabajo y el investigador se enfrenta a la disyuntiva de seguir los tiempos y ritmos de la academia o negociar con los informantes una agenda conjunta. El investigador también debe decidir cuál de sus múltiples identidades habrá de utilizar para ser aceptado, y al mismo tiempo decidir si oculta o no quien es realmente. En el establecimiento de una relación de intimidad con los informantes el investigador debe resolver si abre su vida personal. Y al momento de definir las formas de reciprocidad, decidir si lo hará de acuerdo a los valores de la academia o a los de los nativos. Se concluye argumentando la necesidad de crear una práctica reflexiva sobre estos y otros dilemas dirigida a colocar una agenda de temas y formas de descolonización en el debate ético en Iberoamérica.

This paper explores some ethical dilemmas faced while doing fieldwork. Ethical norms are not enough to appraise the relationship between researchers and participants; a reflexivity practice is needed to understand the dilemmas aroused during this process. Here four issues faced during fieldwork are presented. The academic social time usually defines the schedule of fieldwork; hence, the researcher may decide to follow the academic schedule or to arrange a different schedule with informants. Researchers usually decide which part of their identity will be disclosed for introducing themselves to the informants; but may also decide to hide who really he/she is. Researchers may cope with the dilemma to disclose their private life to informants during the fieldwork. Researchers also may decide to behave according to academic cultural norms of reciprocity or according to the cultural norms of participants. Finally, a reflexivity movement should be developed in Iberoamerica to define an agenda on ethical issues and to develop decolonizing strategies to debate these ethical dilemmas.

El muestreo en investigación cualitativa: principios básicos y algunas controversias / Sampling in qualitative research: basic principles and some controversies

En este trabajo se presentan los fundamentos de la elección de los participantes en una investigación cualitativa, en contraste con los que rigen al muestreo probabilístico en la investigación epidemiológica. Se proponen los conceptos de generalizabilidad nomotética e ideográfica, y los de transferibilidad y reflexividad, para una mejor comprensión de las diferencias. Se mencionan los fundamentos de los principales tipos de muestreo que suelen utilizarse en investigación cualitativa, el significado del concepto de saturación y algunos de sus cuestionamientos. Por último, se plantean algunas reflexiones en torno a las controversias suscitadas en los últimos años sobre las diversas perspectivas paradigmáticas desde las cuales se puede efectuar hoy día la investigación cualitativa, sus posibilidades de combinación con la investigación epidemiológica, y algunas implicaciones para el estudio de los problemas de salud.

This paper presents the rationale for the choice of participants in qualitative research in contrast with that of probability sampling principles in epidemiological research. For a better understanding of the differences, concepts of nomothetic and ideographic generalizability, as well as those of transferability and reflexivity, are proposed, Fundamentals of the main types of sampling commonly used in qualitative research, and the meaning of the concept of saturation are mentioned. Finally, some reflections on the controversies that have arisen in recent years on various paradigmatic perspectives from which to conduct qualitative research, their possibilities of combination with epidemiological research, and some implications for the study of health issues are presented.

Qualitative research in applied situations: Strategies to ensure rigor and validity.

Traditionally, qualitative studies are founded on interpretative and constructive epistemology. The process of data collection in these studies is longer and intensive. This helps to build a strong rapport with the community, hence enabling to capture the field as naturally as possible. These characteristics provide an ample scope to take care of quality and validity of data. However, in applied situations, data collection is often a truncated activity. This robs away a number of taken-for-granted strengths of traditional qualitative research methods: No time is spent on rapport building; holism is left behind, instead we engage in selection; we focus narrowly on specific phenomenon of concern, divorced from its context; analysis does not evolve out of an iterative process. In this paper, we aim to discuss some of the issues related to rigor and quality of such studies and strategies available to address them.