Advances in Skin & Wound Care:
Richard “Sal” Salcido, MD, EdD, is the Editor-in-Chief of Advances in Skin & Wound Care and the Course Director for the Annual Clinical Symposium on Advances in Skin & Wound Care. He is the William Erdman Professor, Department of Physical Medicine and Rehabilitation; Senior Fellow, Institute on Aging; and Associate, Institute of Medicine and Bioengineering, at the University of Pennsylvania Health System, Philadelphia, Pennsylvania.
As editor-in-chief of this journal, I have the distinct honor and privilege to observe subtle and important changes in the wound care field through the lens of the editorial and peer-review process. The incremental changes I see are represented in the increasing quantity, quality, and the impact of the accepted peer-reviewed manuscripts. As the wound care profession matures, we are observing a more diverse approach to the presentation of wound care research.1–3 We seem to be moving from the practice of relying on case studies and case series,1–3 to the tendency to overvalue statistical significance (quantitative research) over clinical significance or qualitative measures.3 This month’s continuing medical education activity (page 182) exemplifies the qualitative aspect of research in wound care.
Qualitative research can be used as the appropriate methodology for deriving “a complex, detailed understanding” of the phenomenon to be explored.4 Yin5 describes the case study approach as “an empirical inquiry that investigates a contemporary phenomenon… set within its real-world context,” and as particularly useful “when the boundaries between the phenomenon and context are not clearly evident.”4,5
The article in this issue by Kuhnke et al nicely explains the qualitative aspect of research in wound care by demonstrating its use to “explore states of health maintenance, and illness from the perspective of the individual, family member, caregiver, or clinician, rather than reporting only the researchers’ perspective.” This type of research truly exemplifies the recent concepts of patient-oriented research (POR).6
The need to refocus on POR may be intuitive for some, but there is good reason to specifically restate, redirect, and accelerate the efforts of scientific discoveries6—from mice to men. I am of the informed opinion that the wound care field has made great strides in the development of wound therapeutics and advanced technology, but significant opportunities to study the delivery of those products to the patient and incorporate how they add to the quality for the patients remain an opportunity gap. Shaywitz et al6 suggest the need to “develop broader, more integrative approaches to understanding how component molecules and physiologic systems function in the context of the whole person.” 6 One method of teaching POR is to change the mindset, as described by the acronym “PASTUER” (Patient-Associated Science: Training, Education, Understanding, and Research).6 This training program is applicable to all students learning the value of POR.
Given the complexity of our systems of care and research structures, it is sometimes daunting to connect the dots back to the patient’s overall health rather than focusing on the discrete wound, disease process, the latest scientific development, and the quest for a dramatic cure from research. One of my mentors described the problem this way, “There is a reason they call it the National Institutes of Health and not the National Institutes of Cells, Organs, and Body Parts”; it is about trying to achieve health, function, and quality of life for the patient.
In attempting to make the case for the need for more qualitative research in our field, I must acknowledge that the truth lies in the middle. Each research scientific method has a unique position or attributes7,8; for example, qualitative research is exploratory or “bottom up.” The researcher generates or constructs knowledge, hypotheses, and grounded theory from data collected during fieldwork. Juxtaposed, quantitative research is confirmatory or “top down.” It is hypothesis-driven research and test theory (often generated by previous qualitative studies) with data.
To find the middle perspective, there is a resurgence of the use of “mixed methods research,”7,8 a procedure for collecting, analyzing, and “mixing” both quantitative and qualitative research methods into a single study to understand a research problem from a broader perspective. Each methodology can be viewed through the specialized lenses analogy, revealing different attributes; for example, the quantitative “focus” is an analogous narrow-angle lens used to test a very specific hypothesis. The qualitative focus is a wide-angle and “deep-angle” lens, examining the breadth and depth of phenomena to learn more about them.7
And, in the middle is the mixed method,8 which uses a multifocal lens and has the capacity to view the phenomena from a different perspective and even triangulate the data points for precision.
Richard “Sal” Salcido, MD, EdD
1. Creswell JW. Qualitative inquiry and research design: choosing among five approaches. ( 2nd ed). Thousand Oaks, California: Sage Publications; 2007; .
2. Creswell JW, Hanson WE, Plano VLC, Morales A. Qualitative research designs selection and implementation. Couns Psychol. 2007; 35: 236–64.
3. Chenail RJ. Presenting qualitative data. The Qual Rep. 1995; 2.3: 1–8.
4. Yin RK. The case study crisis: some answers. Adm Sci Q. 1981; 26:(1): 58–65.
5. Yin RK. Case study research: Design and methods. Thousand Oaks, CA: Sage Publications. ; 2009.;
6. Shaywitz DA, Martin JB, Ausiello DA. Patient-oriented research: principles and new approaches to training. Am J Med. 2000; 109: 2136–40.
7. Chapter 2. Quantitative, qualitative, and mixed research design: qualitative. Table 2.1. In: Emphases of Quantitative, Mixed, and Qualitative Research. www.uk.sagepub.com/upm-data/38123_Chapter2.pdf
. Last accessed February 17, 2014.
8. Johnson RB, Onwuegbuzie AJ. Mixed methods research: a research paradigm whose time has come. Educ Res. 2004; 33:(7): 14–26.