THEORIES OF NEEDS AND HEALTH NEEDS ANALYSIS

Theories of Needs and Health Needs Analysis



Theories of Needs and Health Needs Analysis

Introduction

Medical research does not pay a great deal of attention to theories, but systems of health care need them in order to maintain themselves (Popper, 1999). Theories will influence how research is done, what sort of information is considered most important to be collected, and what applications are being sought. The amount of influence a theory or set of theories can have in a system of healthcare is overwhelming, and it is important to understand what sort of theories is driving the system.

"Medical journals and research funders are mainly concerned with practical factual research, not with research that develops theories" This widespread view includes several assumptions: that research and facts can be separated from theory; that considering theories is not necessarily practical or useful; and that thinking about theories means developing them.

But theories are at the heart of practice, planning, and research. All thinking involves theories, and it is not necessary to read academic texts about theories before using them--any more than it is essential to read texts on reproductive medicine before having a baby. Because theories powerfully influence how evidence is collected, analysed, understood, and used, it is practical and scientific to examine them. Hypotheses are explicit, but when theories are implicit their power to clarify or to confuse, and to reveal or obscure new insights, can work unnoticed (Popper, 1999).

Theories of Needs and Health Needs Analysis

A scientist gazing through a microscope symbolises positivist objective examination, the distance and difference between the observer and the observed, the effort to examine intensely the tiniest part isolated from its context, the use of reliable, visible "hard" data. In medicine, the emphasis on specific body parts, conditions, and treatments assumes that these are universally constant, replicable facts. Positivism aims to discover general laws about relations between phenomena, particularly cause and effect. Experiments are designed to measure and explain associations and to test whether a law can be disproved (Bendelow and Williams, 1995).

Researchers put pain under the microscope when they develop and test analgesics and measure patients' physiological responses. One example is a randomised trial of babies having surgery with or without analgesia. Physiological tests showed "massive shock reactions" in the babies not given analgesia. The evidence questioned the standard treatment of withholding analgesia and the theories that babies cannot experience pain.

The four hourly hospital drug round expresses positivist beliefs that clinical norms and standard treatments can be set for effective pain control. Positivism's concentration on the body and brain sees real pain as neurological reactions to visibly damaged tissue, like Descartes's view of a "mechanism" of impulses travelling from the damaged site to the brain, as when "pulling on one end of a cord, one simultaneously rings a bell which hangs at the opposite end" (Bendelow and Williams, 1995)

Pain relief has been refined through rigorous experiment and cautious insistence on firm evidence. Yet pain is a paradox: an intense personal sensation, it provides no ...