Table 1
Characteristics of the four quality paradigms.
| CHARACTERISTICS | |
|---|---|
| Philosophy | |
| Empirical | Positivism (knowledge is information derived from sensory experience and interpreted through reason and logic) |
| Reference | Constructivism/Interpretivism (knowledge is made of facts that are socially constructed) |
| Reflective | Reflectivism and critical theory (knowledge has value to someone or something and therefore cannot be seen as being neutral) |
| Emergence | Pragmatism (knowledge is a tool for action and as such, it should be evaluated according to whether it serves our desired interests) |
| Aim | |
| Empirical | Explanation, prediction and control |
| Reference | Understanding and reconstruction |
| Reflective | Critique and transformation |
| Emergence | Interaction and co-creation |
| Methods | |
| Empirical | Use of verifiable evidence to arrive at research outcomes. Evidence is obtained through observation of scientific data collection. |
| Reference | Quantitative and qualitative methods are used to explore how reality is perceived |
| Reflective | Reflections, viewpoints, perspectives of professionals show differences in perceptions |
| Emergence | Realist evaluations, dialogue among all stakeholders and participatory research |
| Values | |
| Empirical | Accountability and accuracy |
| Reference | Success and improvement |
| Reflective | Professionalism and wisdom |
| Emergence | Flexibility and willingness to change |
Figure 1
The four quality paradigms and epistemic fluency.
Table 2
Study characteristics.
| CHARACTERISTIC | NUMBER OF ARTICLES | % |
|---|---|---|
| Total | 255 | 100 |
| Year of publication | ||
| 2015 | 45 | 17.6 |
| 2016 | 63 | 24.7 |
| 2017 | 39 | 15.3 |
| 2018 | 64 | 25.1 |
| 2019 | 44 | 17.3 |
| Type of article | ||
| Research & theory | 168 | 65.9 |
| Integrated Care Cases | 27 | 10.6 |
| Perspective papers | 25 | 9.8 |
| Editorials | 21 | 8.2 |
| Policy papers | 14 | 5.5 |
| Geographic area | ||
| Europe | 156 | 61.2 |
| Oceania | 36 | 14.1 |
| North and South America | 30 | 11.8 |
| Asia | 18 | 7.1 |
| Africa | 4 | 1.6 |
| Multi-continental | 11 | 4.3 |
| Domain of impact | ||
| Practice | 147 | 57.6 |
| Policy | 71 | 27.8 |
| Theory | 37 | 14.5 |
| Role of patient | ||
| Yes | 51 | 20.0 |
Figure 2
Percentage of articles in each paradigm (total n = 255).
Table 3
Distribution of paradigms by characteristics.
| CHARACTERISTIC | TOTAL | PARADIGM | ||||
|---|---|---|---|---|---|---|
| PLANNED | UNPLANNED | |||||
| EMPIRICAL | REFERENCE | REFLECTIVE | EMERGENCE | |||
| Total, N (%) | 255 | 55 (21.6) | 147 (57.6) | 45 (17.6) | 8 (3.1) | |
| Year of publication | ||||||
| 2015 | 45 | 9 (20.0) | 27 (60.0) | 8 (17.8) | 1 (2.2) | |
| 2016 | 63 | 16 (25.4) | 30 (47.6) | 16 (25.4) | 1 (1.6) | |
| 2017 | 39 | 9 (23.1) | 23 (59.0) | 6 (15.4) | 1 (2.6) | |
| 2018 | 64 | 15 (23.4) | 35 (54.7) | 11 (17.2) | 3 (4.7) | |
| 2019 | 44 | 6 (13.6) | 32 (72.7) | 4 (9.1) | 2 (4.5) | |
| Type of article, N (%) | ||||||
| Research & theory | 168 | 50 (29.8) | 107 (63.7) | 6 (3.6) | 5 (3.0) | |
| Integrated Care Cases | 27 | 3 (11.1) | 24 (88.9) | 0 (0) | 0 (0) | |
| Perspective papers | 25 | 0 (0) | 6 (24.0) | 18 (72.0) | 1 (4.0) | |
| Editorials | 21 | 0 (0) | 0 (0) | 20 (95.2) | 1 (4.8) | |
| Policy papers | 14 | 2 (14.2) | 10 (71.4) | 1 (7.1) | 1 (7.1) | |
| Geographic region, N (%) | ||||||
| Europe | 156 | 34 (21.8) | 89 (57.1) | 30 (19.2) | 3 (1.9) | |
| Oceania | 36 | 7 (19.4) | 20 (55.6) | 6 (16.7) | 3 (8.3) | |
| North and South America | 30 | 8 (26.7) | 18 (60.0) | 4 (13.3) | 0 (0) | |
| Asia | 18 | 4 (22.2) | 12 (66.7) | 0 (0) | 2 (11.1) | |
| Africa | 4 | 1 (25.0) | 2 (50.0) | 1 (25.0) | 0 (0) | |
| Multi-continental | 11 | 1 (9.1) | 6 (54.5) | 4 (36.4) | 0 (0) | |
| The domain of impact, N (%) | ||||||
| Practice | 147 | 29 (19.7) | 98 (66.7) | 14 (9.5) | 6 (4.1) | |
| Research | 71 | 17 (45.9) | 13 (35.1) | 6 (16.2) | 1 (2.7) | |
| Policy | 37 | 9 (12.7) | 36 (50.7) | 25 (35.2) | 1 (1.4) | |
| Role patient (yes), N (%) | 51 | 12 (23.5) | 31 (60.8) | 5 (9.8) | 3 (5.9) | |