June 2, 2020
Can our search for the truth lead us astray?
I am in the middle of presenting a research study report to a full room. I lay out one of our key findings regarding physicians’ reasons behind a certain behavior. As soon as I finish, an audience member jumps in, “But is that the real truth? Or just what they are saying?” Fast forward to a few weeks later, and I am listening to a patient talking about the various ‘natural’ methods she uses to try and manage her condition, when a comment pops up in the chat about the need to educate patients so they know the truth about their condition and effective treatment options.
While I am not denying the need for patient education on disease states, or the need to dig deep beyond the surface to truly understand why someone behaves a certain way, it felt like a good time to pause and ask: Are we putting aside something of great value if we are no longer listening – really listening – to the stories people tell us? What do we risk losing if we don’t take seriously the explanations people provide for their own behaviors, dismissing these as not quite truths, in favor of THE truth that we can uncover if we only dig deep enough? We can learn a great deal from understanding what respondents perceive as the truth and then seeking to explain any disconnects that may emerge.
We have always told stories to explain and understand the world around us. As qualitative researchers, we encourage patients and physicians to tell us their stories. Stories about what it is like to live with Lupus, or what they felt and thought when they received a triple negative breast cancer diagnosis, or why Oncologists choose to do what they do, what makes them proud and what scares them the most. Through the telling of these stories, they not only help us better understand their experiences, but also shape a narrative that helps them make sense of what has happened to them, how they see themselves and their place in the world. If we ask whether those stories or aspects of those stories are ‘true’, we are perhaps asking the wrong question in qualitative research. What if we become interested instead in understanding the ‘truths’ that people (physicians and patients) believe and live by, and understand why these are their truths? This deep understanding of subjective ‘truths’ enables us to then think about what stories they may need to hear from us in order to shift perceptions and motivate action.
For example, when Jen expressed her frustration with getting her A1C numbers under control despite making lifestyle changes, we didn’t dig deeper to find out if she was indeed staying away from desserts and exercising daily. Instead, we asked her to tell us what she really struggles with, what she finds most challenging and how it makes her feel, and we listened closely. She then told us how she feels like eyes are constantly on her and she’s being judged for every food choice she makes and that, even when she deprives herself for days on end, that still doesn’t allow her to feel that she “deserves” a small treat and can indulge just a bit, like everybody else can. In fact, she shared that, at a party celebrating her son’s fifth birthday, she had sneaked into the bathroom to eat a slice of birthday cake – and about the intense shame and embarrassment she felt afterwards. Listening to stories like Jen’s helped us to get to a deeper understanding of the perceived relentlessness of the requirements of managing T2D, and the daily struggles of people trying their best to manage it. We realized that the effort and work they put into managing their condition often feels unrecognized, and instead they face a lot of negativity such as the shame and stigma they experience and internalize. Such insights in turn became the foundation for a hugely successful positioning for a blood glucose monitoring device that was built around the idea of recognizing effort, which then helped shake off the shame and stigma associated with having diabetes.
In this current context of uncertainty and fear, hard, cold facts and correct information are more crucial than ever. But it is equally important to recognize that there is a lot we don’t know or fully understand yet, and to listen to the new stories people are creating and telling to make sense of it all. Let’s keep telling stories and listening to stories, because the insights we glean through them are more likely to lead us to braver and more innovative places than a quest for the singular truth.
Arpita Chakrabarti, PhD, Social Scientist and Senior Strategist at Insync.