Competing epistemologies: a reflexive thematic analysis of research in general practice

Although most UK National Health Service (NHS) consultations take place in primary care, healthcare research is dominated by secondary care and higher education institutions. The Royal College of General Practitioners has called for increased academic activity by developing research capability in General Practice. However, little is known about the challenges for GPs involved in research. We aimed to explore general practitioners' (GPs) experiences of using a screening tool embedded in a research study.

We recruited GPs from three practises participating in the study. An independent researcher interviewed GPs virtually. The interviews were recorded, transcribed verbatim, checked against recordings, and de-identified. We used Reflexive Thematic Analysis to develop essential themes.

We developed four themes giving insight into barriers to research activity: (1) it's rare that things are black or white, (2) it's a clinical tool, not a clinician, (3) it's about balancing valuable time, (4) we don't see every patient face-to-face anymore.

Quantitative research design, underpinned by positivist epistemology does not always align with primary care practice. Our findings highlight competing epistemologies that can make it challenging for GPs to complete standardised measures in a primary care setting. General practice involves a complex reasoning process grounded on interpretive knowledge. Closed questioning does not always comfortably align with a primary care setting where "a simple answer" is rare. Compatibility with primary care should be considered in all research design.