Best research - For what? Best health - For whom? A critical exploration of primary care research using discourse analysis
Best research - For what? Best health - For whom? A critical exploration of primary care research using discourse analysis
复制标题
DOI：
10.1016/j.socscimed.2008.02.014
复制
发表时间：
2008-06-01
影响因子：
5.4
通讯作者：
Greenhalgh, Trisha
中科院分区：
文献类型：
--
作者：
Shaw, Sara E.;Greenhalgh, Trisha
健康研究是改善健康和医疗保健发展的基础。尽管它的重要性，以及政策在指导研究中的作用，得到解决，有很少的卫生研究政策的实证研究。本文纠正这一点，探索卫生研究政策的一个领域的形成，启用和约束的手段。我们问：什么是在英国的初级保健研究政策的历史，社会和政治根源？主导辩论的关键话语是什么？话语之间的紧张关系以及这对实践者和政策制定者的影响是什么？为了回答这些问题，我们采用了福柯的话语分析方法，明确认识到政策文本的历史，社会和意识形态的起源，以及权力和知识在政策发展中的作用。我们采用了帕克的框架来区分话语，作为选择和分析29个关键政策文件的手段; 16个与历史和当代政策利益相关者的叙事访谈;以及其他上下文文件。我们的分析涉及详细的解构和跨文本的链接，以揭示流行的故事情节，意识形态，权力关系和紧张局势。研究结果表明，如何强大的政策话语塑造的历史和社会力量影响的研究类型，由谁和如何。例如，最近的政策已经形成了与知识经济相关的话语，强调微观“发现”，利用信息和高科技活动对“英国PLC”的贡献，并重新定位为战略资源和“人口实验室”的临床研究的初级保健研究。这些见解挑战了对健康研究的非政治性描述，并揭示了健康研究如何为特定利益服务。(C)2008爱思唯尔有限公司保留所有权利。
Health research is fundamental to the development of improved health and healthcare. Despite its importance, and the role of policy in guiding the kind of research that gets addressed, there are very few empirical studies of health research policy. This paper redresses this, exploring the means by which one area of health research policy is shaped, enabled and constrained. We ask: what are the historical, social and political origins of research policy in primary care in England? What are the key discourses that have dominated debate; and what are the tensions between discourses and the implications this raises for practitioners and policymakers? To answer these questions we employed a Foucauldian approach to discourse analysis to explicitly recognise the historical, social and ideological origins of policy texts; and the role of power and knowledge in policy development. We adapted Parker's framework for distinguishing discourses as a means of selecting and analysing 29 key policy documents; 16 narrative interviews with historical and contemporary policy stakeholders; and additional contextual documents. Our analysis involved detailed deconstruction and linking across texts to reveal prevailing storylines, ideologies, power relations, and tensions. Findings show how powerful policy discourses shaped by historical and social forces influence the type of research undertaken, by whom and how. For instance, recent policy has been shaped by discourse associated with the knowledge-based economy that emphasises microscopic 'discovery', exploitation of information and the contribution of highly technological activities to 'UK plc' and has re-positioned primary care research as a strategic resource and 'population laboratory' for clinical research. Such insights challenge apolitical accounts of health research and reveal how health research serves particular interests. (C) 2008 Elsevier Ltd. All rights reserved.