Page - viii - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

To introduce the textbook, let us first clarify its scope: What is “theory”? What is “health informatics”? Why “interdisciplinary” theory? 2. Varying Perceptions of “Theory” Our recurring experience in the production of this book has been the diversity of opinion about what exactly “theory” means. From our initial discussions, through the process of defining scope, commissioning chapters, inviting peer reviews and appraising author re- visions we have repeatedly had to step back to reflect and question our own common understanding and that of our numerous contributors. We found the Nilsen theory categories [6] a helpful anchor point to specify various types of theory (discussed further in the next chapter) and we cited the Nilsen paper in our brief to authors. Even then, we found that authors and reviewers did not always apply the categories uniformly or in line with our own editorial perceptions. We think that this tells us something about our field. While there will inevitably be some continuing aca- demic pedantry and diverse schools of thought around particular concepts in the meta- physics of epistemology and methodology, we were surprised by the degree of diver- gence. Of course, there is also “theory” in the more generic sense of “a body of knowledge”, such as “social theory” or “economic theory”, but that is a different level of abstraction to our subject matter of specific theories (though not always a distinction that can be neatly maintained). Our experience is that health informatics is not a field that has a recognized common language to talk about its foundational ideas. Hence, we recall Kuhn’s seminal discussion of the progression of science and his reference to the “paradigm” of a discipline [7] and must question whether health informatics is yet a “mature” science. We return to this discussion in our final chapter. There are “soft” and “hard” definitions of theory. To some extent these may reflect their respective disciplinary research tradition as primarily qualitative or quantitative in approach, but that is by no means a fixed rule and in any case is not unique to health informatics. The interdisciplinary nature of health informatics necessarily brings together people with varying cultural and practice norms, as we discuss further below. A “soft” definition might be that a theory comprises a hypothesis or a set of general principles within a defined conceptual model (a “determinant framework” in Nilsen’s terminology). A “hard” definition might be that a theory will make testable and quantitatively measur- able predictions (a “classic theory” in Nilsen’s description). If we can accept a spectrum of theory types that incorporates both “soft” and “hard” definitions, then we have an approach that is broad enough to include everything from a theorised qualitative expla- nation (such as a “grounded theory”) through to equations that predict the relative clinical utility of particular laboratory tests. For this textbook, we have pragmatically adopted a flexible and inclusive view of theory. We asked chapter authors to work with the theory description: “abstract enough to permit generalization, but concrete enough to permit testing”. After Merton, we characterised these as “middle-range” [8] theories, not grand “theories of everything” but “special theories from which to derive hypotheses that can be empirically investigated”. By “testability” and “empirical investigation”, we mean simply that the given theory can be shown to have made a difference in some aspect of a health informatics lifecycle: design, validation, verification, implementation and eval- uation. viii