倡导全科医学的质性研究

doi:10.12114/j.issn.1007-957.2024.A0027

摘要/Abstract

摘要： 背景中国的全科医学研究需要从哲学思想和方法学上进一步拓展突破学科发展瓶颈的路径。目的通过与对标期刊的质性研究发表文章进行比较分析，提出进一步倡导我国全科医学质性研究的策略。方法对《英国全科医学》杂志发表的研究文章类别、研究主题和研究对象进行简要分析，反思医学界开展质性研究的现状和挑战，提出促进全科医学质性研究的策略。结果《英国全科医学》杂志的质性研究占研究类型文章的38%（41/107）。全科医学以人为本的宗旨，促使研究者探索患者、居民、医生、护士和相关者的体验、观点、感知、意见，从而筹划和提供具有人性化及响应性和参与性的基本医疗服务。社会科学的方法学专家和对社会学研究方法感兴趣的学术型全科医生，是质性研究在全科医学领域应用的主要推动力量。以实证主义为哲学思想的传统的生物医学模式，是医生开展质性研究时需要逾越的学科篱笆。学术型全科医生要理解本体论和认识论的不同，承认和尝试解释主义的思维方式。与相对容易掌握的质性资料收集技术和编码技术不同的是，在质性研究培训和学习过程中，要特别关注突破思维惰性，以解释主义作为了解世界和全科医学的另一个窗口。结论质性研究是全科医学学科发展的重要方法，更好质量的质性研究首先取决于丰富的思想，以及为实现思想而操作的工具。

关键词: 动机性访谈, 质性研究, 全科医学, 实证研究, 解释主义, 研究方法

Abstract:

Background

General practice research in China needs to further explore the path for breaking through the bottleneck of the discipline development from the perspective of philosophy and methodology.

Objective

By comparing and analyzing qualitative research articles published in benchmark journals, strategies for further advocating qualitative research in general practice medicine in China are proposed.

Methods

Based on a brief analysis of the categories and topics research articles published in the British Journal of General Practice, the author reflects on the current relevant publications and challenges of qualitative research in medical discipline and proposes strategies to promote qualitative research in general practice.

Results

Qualitative research in the British Journal of General Practice accounts for 38% (41/107) of research articles in 2024. The people-centred orientation of general practice encourages researchers to explore experiences, views, perceptions and opinions of patients, laypersons, doctors, nurses, and stakeholders, to plan and provide primary care that with humanity, responsiveness, and participatory. Social science methodologists and academic general practitioners who are interested in sociological research methods are the main driving force for the application of qualitative research in the field of general practice. The tradition of biomedicine philosophy with positivism is a disciplinary barrier that medical-trained need to overcome when conducting qualitative research. Academic general practitioners must understand the difference between ontology and epistemology, and acknowledge and try the interpretivist way of thinking. Different from qualitative data collection and coding techniques that are relatively easy to learn, during the training and learning process of qualitative research, special attention should be paid to breaking through the inertia of thinking and using interpretivism as another window to understand the world and primary care.

Conclusion

Qualitative research is an important area for the development of general practice disciplines. Better quality qualitative research first depends on the enrichment of philosophical thoughts and then use the tools and tactics to realize another understanding of the world.

Key words: Motivational interviewing, Qualitative research, General practice, Empirical research, Interpretivism, Research methods

杨辉. 倡导全科医学的质性研究[J]. 中国全科医学, 2025, 28(12): 1421-1426. DOI: 10.12114/j.issn.1007-957.2024.A0027.
YANG Hui. Advocating Qualitative Studies in Territory of General Practice[J]. Chinese General Practice, 2025, 28(12): 1421-1426. DOI: 10.12114/j.issn.1007-957.2024.A0027.

图/表 1

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第一作者	原文题目	研究问题
Kate LA Dunlop	Acceptability of risk-tailored cancer screening among Australian GPs：a qualitative study	全科医生是否接受癌症筛查，他们对癌症筛查的看法是什么？
Susan Moschogianis	Patient experiences of an online consultation system：a qualitative study in English primary care post-COVID-19	患者使用线上诊疗系统有什么样的体验？
Laiba Husain	Developing user personas to capture intersecting dimensions of disadvantage in older patients who are marginalised：a qualitative study	通过模拟角色，发现弱势老年人在远程和数字医疗上面临什么经历和挑战？
Michelle Rickett	Collaboration across the primary and specialist care interface in Early Intervention in Psychosis services：a qualitative study	参与精神病早期干预的工作人员和全科医生对全科医生发挥的作用有什么看法?
Abi Eccles	GP's role in supporting women with anal incontinence after childbirth injury：a qualitative study	全科医生和妇女怎样看为分娩损伤后肛门失禁的妇女提供服务？
Eddie Donaghy	Primary care transformation in Scotland：a qualitative evaluation of the views of patients	患者对苏格兰"扩大的多学科团队"的全科医疗服务的看法是什么？
Erica di Martino	Understanding GPs' referral decisions for younger patients with symptoms of cancer：a qualitative interview study	全科医生对有癌症症状的年轻患者是怎样做转诊决策的？
Adam WA Geraghty	Distinguishing emotional distress from mental disorder in primary care：a qualitative exploration of the Four-Dimensional Symptom Questionnaire	社区居民和患者对能区分一般心理困扰和精神病学问题的四维量表的看法是什么
Fay Bradley	Negotiating new roles in general practice：a qualitative study of clinical pharmacists	怎样协商全科医学服务中的新角色（临床药师）？
Elizabeth T Thomas	GPs' perspectives on diagnostic tests for children：a qualitative interview study	全科医生对给儿童安排诊断辅助检查有什么看法？
Clare Clement	Implementation of the CHIldren with acute COugh（CHICO）intervention to improve antibiotics management：a qualitative study in primary care	全科医生认为儿童急性咳嗽干预项目怎样对改善抗生素使用发挥作用？
Danielle Jones	Dementia prevention and the GP's role：a qualitative interview study	全科医生认为在预防痴呆症上能发挥什么作用？
Isabel Leach	Understanding patient views and experiences of the IDENTIfication of PALLiative care needs（IDENTI-PALL）：a qualitative interview study	患者对姑息照顾需求识别过程有什么看法？有什么体验？
Eddie Donaghy	Primary care transformation in Scotland：a qualitative study of GPs' and multidisciplinary team members' views	全科医生和团队成员对初级保健多学科团队转型的看法是什么？
Helen Gibson	Providing care to marginalised communities：a qualitative study of community pharmacy teams	人们对社区药房为社会弱势群体提供服务的看法是什么？
Donna Bramwell	Implementing the Additional Roles Reimbursement Scheme in seven English Primary Care Networks：a qualitative study	初级保健工作人员对招募额外人员加入全科医生队伍对初级保健网络的作用是什么？
Rebecca Gudka	Primary care provision for young people with ADHD：a multi-perspective qualitative study	初级保健人员在给注意缺损多动障碍儿童提供服务时有什么样的体验和经历？
Miranda Pallan	Supporting healthcare professionals to address child weight with parents：a qualitative study	初级保健人员怎样与父母一起解决儿童的体重问题？
Julia Hiscock	Hidden systems in primary care cancer detection：an embedded qualitative intervention development study	全科医生认为怎样才能改进初级保健中的癌症检测？
Bethan Jones	Challenges and enablers to implementation of the Additional Roles Reimbursement Scheme in primary care：a qualitative study	初级保健工作人员对招募额外人员加入全科医生人力队伍的看法是什么？
Faraz Mughal	How GPs can help young people avoid future self-harm：a qualitative study	全科医生在帮助年轻人避免自我伤害上的能力、机会和动机是什么？他们认为需要什么培训？
Jennifer Voorhees	A paradox of problems in accessing general practice：a qualitative participatory case study	人们获得基本医疗服务的障碍是什么？
Lucy C Potter	Improving access to general practice for and with people with severe and multiple disadvantage：a qualitative study	处于严重和多重劣势的人怎样获得全科医学服务的机会？
Jennifer MacLellan	Unpacking complexity in addressing the contribution of trauma to women's ill health：a qualitative study of perspectives from general practice	全科医生怎么看待与女性患者沟通创伤对健康的影响？
Kaiyang Song	Media depictions of primary care teleconsultation safety：a thematic analysis of UK newspapers	媒体对基本医疗线上服务的安全性是怎么描述的？
Roxanne M Parslow	Collaborative discussions between GPs and pharmacists to optimise patient medication：a qualitative study within a UK primary care clinical trial	全科医生和药剂师怎样看待和反思跨专业的协作？
Monica L Molinaro	Family physicians' moral distress when caring for patients experiencing social inequities：a critical narrative inquiry in primary care	全科医生在给遭遇社会不公的患者提供服务时，有什么样的道德困扰？
Marianne McCallum	Multimorbidity and person-centred care in a socioeconomically deprived community：a qualitative study	社会弱势群体认为什么是高质量的以人为本服务？这对多重慢病管理有什么影响？
Lisa Eveline Maria Davies	Patients' perspectives about the role of primary healthcare providers in long-term opioid therapy：a qualitative study in Dutch primary care	长期使用阿片类药物的患者对全科医学在该药使用中发挥作用的看法是什么？
Daniel Butler	'Challenging but ultimately rewarding' — lived experiences of Deep End Northern Ireland GPs：a qualitative study	全科医生在社会经济贫困地区工作的动机是什么？他们对面临的挑战，以及改进和改革的看法是什么？
Myriam Dell'Olio	Addressing hidden tensions and grey areas of general practice：a qualitative study of the experiences of newly qualified GPs attending a course on generalist medicine	高级全科医生认为应该怎样重新设计初级保健系统从而支持全科医生的工作？
Nina Smyth	People from ethnic minorities seeking help for long COVID：a qualitative study	少数民族群体的长新冠患者在寻求医疗服务中的经历是什么？这对恢复人们对医疗保健的信任有什么意义？
Charlotte Archer	GPs' views of prescribing beta-blockers for people with anxiety disorders：a qualitative study	全科医生怎么看给焦虑患者开β受体阻滞剂？
Charlotte Archer	Prescribing benzodiazepines in young adults with anxiety：a qualitative study of GP perspectives	全科医生怎么看给焦虑年轻人开苯二氮卓类药物？
Carina Meißner	What helps and what hinders antidepressant discontinuation? Qualitative analysis of patients' experiences and expectations	抑郁障碍患者使用和停用抗抑郁药的经历是什么？以及他们对停药的期望是什么？
Alice M Harper	Understanding the patient's experience of coeliac disease diagnosis：a qualitative interview study	乳糜泻患者有怎样的诊断经历？
Patrick Burch	Factors affecting the experience of joined-up，continuous primary care in the absence of relational continuity：an observational study	在缺乏连续性的基本医疗中，有哪些影响合作和持续服务的因素？
Brooke Swierzbiolek	'Let's talk about sleep health' within primary care：a qualitative study of patients' willingness to engage in psychological interventions for insomnia	失眠患者对初级保健中的睡眠健康心理干预的看法是什么？
Farjana Islam	Digitalised primary care in the UK：a qualitative study of the experiences of minoritised ethnic communities	少数族裔在使用数字化初级保健服务的经历和障碍是什么？这对健康公平有什么影响？
Samuel W D Merriel	Acceptability of magnetic resonance imaging for prostate cancer diagnosis with patients and GPs：a qualitative interview study	患者和全科医生对磁共振成像诊断前列腺癌的看法是什么？
Suzanne McDonald	Acceptability and optimisation of resources to support antidepressant cessation：a qualitative think-aloud study with patients in Australian primary care	全科医生对抗抑郁药停药的看法是什么？

第一作者	原文题目	研究问题
Kate LA Dunlop	Acceptability of risk-tailored cancer screening among Australian GPs：a qualitative study	全科医生是否接受癌症筛查，他们对癌症筛查的看法是什么？
Susan Moschogianis	Patient experiences of an online consultation system：a qualitative study in English primary care post-COVID-19	患者使用线上诊疗系统有什么样的体验？
Laiba Husain	Developing user personas to capture intersecting dimensions of disadvantage in older patients who are marginalised：a qualitative study	通过模拟角色，发现弱势老年人在远程和数字医疗上面临什么经历和挑战？
Michelle Rickett	Collaboration across the primary and specialist care interface in Early Intervention in Psychosis services：a qualitative study	参与精神病早期干预的工作人员和全科医生对全科医生发挥的作用有什么看法?
Abi Eccles	GP's role in supporting women with anal incontinence after childbirth injury：a qualitative study	全科医生和妇女怎样看为分娩损伤后肛门失禁的妇女提供服务？
Eddie Donaghy	Primary care transformation in Scotland：a qualitative evaluation of the views of patients	患者对苏格兰"扩大的多学科团队"的全科医疗服务的看法是什么？
Erica di Martino	Understanding GPs' referral decisions for younger patients with symptoms of cancer：a qualitative interview study	全科医生对有癌症症状的年轻患者是怎样做转诊决策的？
Adam WA Geraghty	Distinguishing emotional distress from mental disorder in primary care：a qualitative exploration of the Four-Dimensional Symptom Questionnaire	社区居民和患者对能区分一般心理困扰和精神病学问题的四维量表的看法是什么
Fay Bradley	Negotiating new roles in general practice：a qualitative study of clinical pharmacists	怎样协商全科医学服务中的新角色（临床药师）？
Elizabeth T Thomas	GPs' perspectives on diagnostic tests for children：a qualitative interview study	全科医生对给儿童安排诊断辅助检查有什么看法？
Clare Clement	Implementation of the CHIldren with acute COugh（CHICO）intervention to improve antibiotics management：a qualitative study in primary care	全科医生认为儿童急性咳嗽干预项目怎样对改善抗生素使用发挥作用？
Danielle Jones	Dementia prevention and the GP's role：a qualitative interview study	全科医生认为在预防痴呆症上能发挥什么作用？
Isabel Leach	Understanding patient views and experiences of the IDENTIfication of PALLiative care needs（IDENTI-PALL）：a qualitative interview study	患者对姑息照顾需求识别过程有什么看法？有什么体验？
Eddie Donaghy	Primary care transformation in Scotland：a qualitative study of GPs' and multidisciplinary team members' views	全科医生和团队成员对初级保健多学科团队转型的看法是什么？
Helen Gibson	Providing care to marginalised communities：a qualitative study of community pharmacy teams	人们对社区药房为社会弱势群体提供服务的看法是什么？
Donna Bramwell	Implementing the Additional Roles Reimbursement Scheme in seven English Primary Care Networks：a qualitative study	初级保健工作人员对招募额外人员加入全科医生队伍对初级保健网络的作用是什么？
Rebecca Gudka	Primary care provision for young people with ADHD：a multi-perspective qualitative study	初级保健人员在给注意缺损多动障碍儿童提供服务时有什么样的体验和经历？
Miranda Pallan	Supporting healthcare professionals to address child weight with parents：a qualitative study	初级保健人员怎样与父母一起解决儿童的体重问题？
Julia Hiscock	Hidden systems in primary care cancer detection：an embedded qualitative intervention development study	全科医生认为怎样才能改进初级保健中的癌症检测？
Bethan Jones	Challenges and enablers to implementation of the Additional Roles Reimbursement Scheme in primary care：a qualitative study	初级保健工作人员对招募额外人员加入全科医生人力队伍的看法是什么？
Faraz Mughal	How GPs can help young people avoid future self-harm：a qualitative study	全科医生在帮助年轻人避免自我伤害上的能力、机会和动机是什么？他们认为需要什么培训？
Jennifer Voorhees	A paradox of problems in accessing general practice：a qualitative participatory case study	人们获得基本医疗服务的障碍是什么？
Lucy C Potter	Improving access to general practice for and with people with severe and multiple disadvantage：a qualitative study	处于严重和多重劣势的人怎样获得全科医学服务的机会？
Jennifer MacLellan	Unpacking complexity in addressing the contribution of trauma to women's ill health：a qualitative study of perspectives from general practice	全科医生怎么看待与女性患者沟通创伤对健康的影响？
Kaiyang Song	Media depictions of primary care teleconsultation safety：a thematic analysis of UK newspapers	媒体对基本医疗线上服务的安全性是怎么描述的？
Roxanne M Parslow	Collaborative discussions between GPs and pharmacists to optimise patient medication：a qualitative study within a UK primary care clinical trial	全科医生和药剂师怎样看待和反思跨专业的协作？
Monica L Molinaro	Family physicians' moral distress when caring for patients experiencing social inequities：a critical narrative inquiry in primary care	全科医生在给遭遇社会不公的患者提供服务时，有什么样的道德困扰？
Marianne McCallum	Multimorbidity and person-centred care in a socioeconomically deprived community：a qualitative study	社会弱势群体认为什么是高质量的以人为本服务？这对多重慢病管理有什么影响？
Lisa Eveline Maria Davies	Patients' perspectives about the role of primary healthcare providers in long-term opioid therapy：a qualitative study in Dutch primary care	长期使用阿片类药物的患者对全科医学在该药使用中发挥作用的看法是什么？
Daniel Butler	'Challenging but ultimately rewarding' — lived experiences of Deep End Northern Ireland GPs：a qualitative study	全科医生在社会经济贫困地区工作的动机是什么？他们对面临的挑战，以及改进和改革的看法是什么？
Myriam Dell'Olio	Addressing hidden tensions and grey areas of general practice：a qualitative study of the experiences of newly qualified GPs attending a course on generalist medicine	高级全科医生认为应该怎样重新设计初级保健系统从而支持全科医生的工作？
Nina Smyth	People from ethnic minorities seeking help for long COVID：a qualitative study	少数民族群体的长新冠患者在寻求医疗服务中的经历是什么？这对恢复人们对医疗保健的信任有什么意义？
Charlotte Archer	GPs' views of prescribing beta-blockers for people with anxiety disorders：a qualitative study	全科医生怎么看给焦虑患者开β受体阻滞剂？
Charlotte Archer	Prescribing benzodiazepines in young adults with anxiety：a qualitative study of GP perspectives	全科医生怎么看给焦虑年轻人开苯二氮卓类药物？
Carina Meißner	What helps and what hinders antidepressant discontinuation? Qualitative analysis of patients' experiences and expectations	抑郁障碍患者使用和停用抗抑郁药的经历是什么？以及他们对停药的期望是什么？
Alice M Harper	Understanding the patient's experience of coeliac disease diagnosis：a qualitative interview study	乳糜泻患者有怎样的诊断经历？
Patrick Burch	Factors affecting the experience of joined-up，continuous primary care in the absence of relational continuity：an observational study	在缺乏连续性的基本医疗中，有哪些影响合作和持续服务的因素？
Brooke Swierzbiolek	'Let's talk about sleep health' within primary care：a qualitative study of patients' willingness to engage in psychological interventions for insomnia	失眠患者对初级保健中的睡眠健康心理干预的看法是什么？
Farjana Islam	Digitalised primary care in the UK：a qualitative study of the experiences of minoritised ethnic communities	少数族裔在使用数字化初级保健服务的经历和障碍是什么？这对健康公平有什么影响？
Samuel W D Merriel	Acceptability of magnetic resonance imaging for prostate cancer diagnosis with patients and GPs：a qualitative interview study	患者和全科医生对磁共振成像诊断前列腺癌的看法是什么？
Suzanne McDonald	Acceptability and optimisation of resources to support antidepressant cessation：a qualitative think-aloud study with patients in Australian primary care	全科医生对抗抑郁药停药的看法是什么？