Sociology and Psychology in Public Health: Exploring Common Links and Differences

 
Sociology and psychology
in public health
 
Faculty of Medicine
Department of Community Medicine
Dr Sudabeh Mohamadi
 
 
 
2
 
Introduction
 
Sociology and psychology have common
links:
 
Conceptually
Methodologically
 
3
 
 
They differ in overall scope:
Psychology typically focuses on the
individual
Sociology examines the individual’s 
social
action 
(agency) and the community’s
social and physical 
context
 (structure)
within which they live, interact, work, and
play.
 
4
 
 
Important similarity between sociology and
psychology is that both disciplines have a
dedicated subfield for the 
study of health
and illness
. These subfields are, respectively:
 
Medical sociology
Health psychology
 
5
 
Sociology in public health
 
The damage caused by 
epidemics 
alerted
some British and European medical
authorities to the possible connection of
three phenomena hitherto seen as
unrelated by medical experts:
 
Social 
conditions
 in the community
Social 
behavior
Public health
 
6
 
 
Durkheim’s conceptual contribution on
the notions of ‘the 
socially 
normal 
and
abnormal
’ set the path for ‘twentieth
century medical sociology’.
 
7
 
 
Sociological theories may be classified into
two types:
 
General
 theories that address 
all human
behaviour 
and have ‘universal’
applicability
Middle-range
’ theories that have limited
applicability.
 
8
 
 
The most relevant general theories for the
sociological analysis of health and illness:
 
Structural-functional theory
Symbolic interactionism
Conflict theory
Phenomenology/ethnomethodology
 
9
 
Structural-functional theory
 
Neo-functionalism
Addresses societies as 
social systems
All components 
of society whether they
are individuals, groups, communities,
nations, or global organizations, have
functions
—both manifest and latent—for
their maintenance and growth
 
10
 
 
Approaching the analysis of health-related
phenomena from the perspective of
structural-functionalist systems theory, we
can offer two ‘models of illness’:
The ‘
deviance
’ model
Sick-role
’ or ‘
capacity
’ model
 
11
 
 
The ‘
deviance
’ model presents illness as a
state of dependency 
for the person
affected whereby therapy is expected
but seen as a 
social control system 
and
the physician as an agent of social
control.
 
12
 
 
The ‘
capacity
’ model proposes that illness
is a 
breakdown of normality 
leading to the
individual’s total or partial 
incapacity
 to
perform normal social roles.
 
13
 
Symbolic interactionism
 
The individual’s subjective perception of
the situation through 
meanings and
symbols
 has a significant impact on his/her
behaviour
.
 
14
 
 
Two models of illness:
The ‘
labelling
’ model
The ‘
negotiation
’ or ‘
crisis
’ model
 
15
 
 
The 
labelling
 model proposes that illness
may be socially defined or labelled
through a process of 
normative
evaluation
.
 
16
 
 
The 
negotiation
 model proposes that
patients have 
control
 over their illness
through negotiation:
Diagnoses and treatments by the medical
profession may be negotiated and
treatment involves the patient’s active
participation.
 
17
 
Conflict theory
 
Proposes that the potential for conflict is a
normal component 
of social relationships,
thus, 
negotiation and bargaining
 are key
elements of social interaction.
 
18
 
 
When applied to health phenomena,
conflict
 theory offers two models:
The ‘
loss
’ or ‘
stress
’ model
The ‘
domination
deprivation
’ model
 
19
 
 
The ‘
loss
’ or ‘
stress
’ model proposes that
there is a strong connection between
stress and illness; the loss of required 
social
support
 increases the likelihood of illness
 
20
 
 
The ‘
domination–deprivation
’ model
argues that the medical profession
occupies a dominant position in society
by virtue of its expertise vis-a-vis the
patient’s position of dependence.
 
21
 
Phenomenology/ethnomethodology
theory
 
‘People are the 
product 
of the very
society they create’. This phenomenology
model regards illness as belonging to ‘a
broad category of disturbing occurrences.
which breach the taken-for-granted
peace of everyday routines’
.
 
22
 
 
Compared to the other theories, has
contributed relatively less to 
empirical
research
 in medical sociology.
 
23
 
Sociological research relevant to
public health
 
The most significant social aspects that
exemplify the 
link between individuals and
groups 
in the context of public health are
cultural
 and 
social class 
influences on
health-related behaviour of individuals
and communities; 
lifestyles
; and the
creation and transformation of 
healthcare
system
s.
 
24
 
Culture and public health
 
Culture refers to 
values
 and 
beliefs
emanating from one’s 
ethnic
 and/or
religious
 ethos, typically transmitted across
generations as part of the community’s
identity
 or ‘
design for living
’.
 
25
 
 
In addition to the influence of the 
physical
and socioeconomic
 environment on the
risk of infectious diseases and chronic
illness, the impact of culture on public
health is manifold and it is manifested in at
least 
three main ways
.
 
26
 
 
Health behavior
: what people do
regarding health risks
 
Health attitudes 
and beliefs: how people
feel and think about health and illness
 
People’s 
perceptions
 of and 
responses
 to
health authorities’ public health guidelines
and recommendations
 
27
 
 
Social 
stereotypes
 held by practitioners
(whether clinicians or public health
practitioners) distort 
clinical decisions 
and
interactions with their subjects of care and
lead to linking ‘certain diagnoses to
certain patients’.
 
28
 
 
The impact of ‘
medical constructs
’, that is,
when a physical or mental condition is
defined by the health 
authorities
 ‘as a
disease
” ’ while the same condition is
considered 
normal
 by the 
community
 
29
 
 
When this clash of the expert 
versus
 lay
interpretations occur, the official
classification
 ‘has consequences for the
social legitimacy 
of the symptoms, 
access
to treatment, and 
costs
 to the health care
system’
 
30
 
Lifestyle and health
 
Persistent differences in morbidity and
mortality across 
ethnic groups 
that are
basically of 
social
 rather than 
biological
 or
genetic 
origin.
 
31
 
 
Lifestyles
 vary for men and women
particularly in 
Asia
.
 
Gender differences 
are clearly discernible
in 
morbidity
 and 
mortality 
figures.
 
32
 
 
 
A person’s lifestyle is shared and
reinforced by his/her 
social network
.
 
33
 
 
Social ties and 
social networks 
significantly
influence health-related behaviour
leading to 
obesity
, cigarette 
smoking
,
‘recreational’ 
drug use
, and 
alcohol
consumption, among other risk behaviours
 
34
 
 
The most visible influence of social
networks on health is 
negative
.
 
Social networks can be mobilized in public
health policy for the promotion of 
healthy
habits
 and health risk-avoidance in the
community.
 
35
 
Social class, social stratification, and
public health
 
A person’s 
social class
—socioeconomic
status or SES—is ascertained by means of a
composite index of three or more indicators,
the most common:
 
Personal 
income
 level
Years of formal 
education
 completed
Occupational
 prestige
 
36
 
 
The 
simplest presentation 
of SES scores is a
three-level description of lower class,
middle class, and upper class.
 
Quantitative and 
continuous
 SES scores
are preferred in sociological studies.
 
37
 
 
 
Social class reinforces the influence of
lifestyle
 on health 
behaviour
.
 
38
 
 
Under certain conditions, social class—
mostly due to the influence of 
education
and 
occupation
— may have a stronger
impact than 
cultural beliefs 
and norms on
health behaviour, on access to health
services, and on a person’s exposure to
occupational hazards.
 
39
 
 
Sociologists examine the health impact of
each SES component separately:
 
Occupational prestige
Income level
Educational level
The strength of SES as a 
predictor of health
behaviour
 
40
 
 
‘The 
theory of fundamental causes
’ states:
 
Social class ‘influences multiple disease
outcomes through multiple 
risk factors
’.
 
Social class impacts ‘
access to resources
that can be used to avoid risks or minimize
the consequences of disease’.
 
Those influences tend to 
persist
 over time.
 
41
 
Healthcare systems and public health
 
When sociologists study healthcare
systems they include the approaches
taken by nation-states towards the
creation
, 
organization
, 
distribution
, and
management
 of their healthcare
resources.
 
42
 
 
In many countries today ‘too much priority
has been given to 
hospital care 
at the
expense of the development of 
primary
care
, 
community care 
and 
public health
’.
 
43
 
 
 
Three types of studies illustrate the area of
health services research
:
 
44
 
 
The first type of study shows that 
unequal
access to healthcare 
services is preserved
by institutions and policies that constrain
and enable ‘the actions of 
health services
organizations
, 
health care providers
, and
consumers
’.
 
45
 
 
The second type of health systems
research study is the comparative analysis
of health 
financing approaches 
and
systems
 in terms of their suitability to the
socioeconomic
 needs and 
demographic
characteristics of the population.
Example: The study of insurance
 
46
 
 
The third type of study represents the
direct input 
of medical sociologists on
public policy
.
 
Example: analysis of changes in state
regulations on the collection and access
to health relevant population 
data
 for
research purposes.
 
47
 
Sociological research methods and
public health
 
Three important characteristics of
sociological research methodology that
must be taken into consideration:
 
(1) The 
kinds of data 
used in sociology
(2) The 
levels of measurement 
applied
(3) The types of research 
design
 followed
 
48
 
What kinds of data are used in sociology?
 
Two kinds of evidence or data:
 
Primary
Secondary
 
49
 
 
Primary data: collected 
first-hand
 by the
investigator
 
Example: data on people’s attitudes and
behaviour obtained through personal
interviews
, 
observation
, 
experiments
, or
surveys
; or data extracted by means of
first-hand analyses 
of documents, letters,
records, or other types of ‘raw’ data.
 
50
 
 
Secondary data: previously collected by
others, for example, official 
statistics
,
population 
censuses
, or databases with
processed or coded data sets from
surveys or completed studies.
 
51
 
What levels of measurement are used in
sociology?
 
Four levels of 
measurement:
Nominal
Ordinal
Interval
Ratio
 
52
 
 
The 
most rudimentary 
is the 
nominal
 
level
which uses names or labels (‘male’ and
‘female’).
Each name or category may be assigned
a numerical 
code
 but the numbers have
no quantitative meaning, they are only
labels.
 
53
 
 
Ordinal
 
measurement assigns ranks to
categories of the observed phenomenon
(example: ‘slender’, ‘plump’, ‘obese’)
‘The distances between ranks in an
ordinal scale are 
not necessarily equal
’.
 
54
 
 
Interval
 
measurement uses ranks with a
standard and measurable 
distance
between categories but ‘have no
meaningful 
zero
 point’ (Fahrenheit
temperature scale).
 
55
 
 
The 
ratio
 
scale that has both ‘
equal
intervals
 between categories and a true
zero
 point’ (age, income, education,
number of children, and years of
marriage)
 
56
 
What types of research designs are used in
sociology?
 
Depending on the nature of the
phenomena
 under investigation and on
the investigator’s preferred 
level of
measurement
, sociologists may use
qualitative
 or 
quantitative
 designs or a
combination of both.
 
57
 
 
One modality of the 
small-group
 method
is the 
focus group 
approach whereby the
researcher, acting as 
moderator
, gathers
together a small group of people—
preferably not acquainted with each
other—to discuss a particular topic. The
focus group method is probably the
weakest approach.
 
58
 
Three most serious limitations of focus group
 
(1)
Conversation is public and cannot
guarantee 
confidentiality
.
 
(2)The 
validity
 and 
reliability
 of data
collected in focus group discussions are low
or non-existent.
 
(3)Focus group participants are typically
influenced by 
social pressure.
 
59
 
 
 
Quantitative
 research design may involve
all four levels of measurement but mostly
interval
 and 
ratio
 levels.
 
60
 
 
A 
quantitative
 research design may include
one or more methods of 
data collection
:
document analysis, observation, personal
interviews with structured or unstructured
questionnaires, surveys, experiments or
quasi-experiments
 
61
 
 
Reliability means 
consistency
 in the
measurement: getting the same results
every time the phenomenon is measured
with the same instrument.
 
62
 
 
Validity
 has two general dimensions:
 
Internal
External
 
63
 
 
 
Internal validity focuses on the 
research
question
.
 
64
 
 
The most elementary form of internal
validity is 
content validity 
and it addresses
the question: is the instrument measuring
what it intends to measure or something
else?
 
65
 
 
There are two additional types of internal
validity:
 
criterion
-related validity and 
construct
validity
 
66
 
 
The second dimension is 
external validity
;
that is, ‘the potential for a study’s findings
to be 
generalized
 from one setting to
others’.
 
67
 
 
Representative
 samples = 
probability
samples
Gives each individual in the target
population the 
same probability 
of being
selected.
Allow the researcher to make 
inferences
 
68
 
 
There are research topics and research
situations for which random sampling is
impossible
 to obtain or is unsuitable
 
Example: stigmatization; refuse
participation in the study; or there is no
comprehensive and reliable record
 
69
 
 
The ‘
purposive sample
’ is one form of non-
probability sample.
 
Subjects are selected based on 
specific
criteria.
 
70
 
 
 
Case study 
approach: the researcher
studies only one or a few ‘cases’ of the
social phenomenon.
 
71
 
 
This approach is useful in at least two ways:
First, in 
emergency
 situations: a person or
a family affected by a 
rare
 or ‘
new
potentially 
contagious
 illness.
 
Second, in 
exploratory
 research: that is in
situations where the social phenomenon is
new or never studied before.
 
72
 
Psychology in public health
 
 
Health psychology = Clinical psychology =
Clinical health psychology
 
73
 
 
Among the health areas that suggested
could be studied by 
health psychology
in addition to mental health—are 
weight
control
, and 
addictions
 to alcohol,
nicotine, and hard drugs.
 
74
 
Psychological theories and
public health
 
 
Universal laws ‘expressed in theories that
allow prediction and explanation.
 
A range of theories clustered into 
four
groups.
 
75
 
 
(1) 
Social cognition 
models addressed to
the explanation of individuals’ health-
related behaviour and comprising the
theory of 
planned behaviour
, the 
health
belief model
, the 
trans-theoretical
 model,
and the 
health action process 
model
 
76
 
 
(2) 
Self-regulation
 models focus on risk
behaviours and include 
cognitive
adaptation
 theory, the 
self-regulation
model, and the model of 
self-efficacy
 
77
 
 
(3) The 
psycho-physiological
 models cluster
that ‘describes how psychological
processes, particularly in response to
stressors, can influence physiological
functioning’, and includes the 
gate control
theory of pain
, the 
cognitive perceptual
model, and the 
general adaptation
syndrome
 
78
 
 
(4) The 
environmental
 models cluster that
includes the 
operant learning 
theory,
conservation of resources 
theory, and the
demand-control
 model of work stress
 
79
 
Psychological research and services
relevant to public health
 
Clinical/health psychologists 
provide
direct healthcare but their actual clinical
practice is determined by government
regulations
 and, more broadly, by the
political system 
and ideology guiding the
healthcare system.
 
80
 
 
Family psychotherapy 
involving children
and youth is typically offered in
collaboration with the school system and
deals with children’s 
mental
 illness as well
as with 
behavioural
 problems including
drug
 abuse, 
truancy
, and 
academic
performance.
 
81
 
Psychological research methods relevant to
public health
 
Four main 
fundamental issues 
that impact
research:
The ‘
scientific
 versus 
humanistic
’ cultures
in psychology
Two 
ontological
 issues: the ‘
subjective
objective
’ and the ‘
individual
collective
tensions’
‘The problem of 
evaluative 
criteria’
‘The problem of competing 
worldviews
 or
value systems
 
82
 
 
It is not possible to use 
random allocation
and true experiments in health
psychology.
 
Psychologists have a preference for
quantitative
 methods.
 
83
 
 
In addition to other forms of 
systematic
observation
, psychologists have
traditionally used 
attitudinal scales 
and
questionnaires to collect systematic
responses from subjects in 
laboratory
situations or one-to-one 
interviews
 or
small-group
 contexts.
 
84
 
 
Qualitative methods 
are used now more
often than before:
 
First illustration: 
self-reports
 are the most
common method of data collection in
psychology ‘but it is open to problems of
error
 and 
bias
.
 
85
 
 
Second illustration: the assessment of 
stress
as the occurrence of negative life events
and 
emotional
 changes using 
attitudinal
scales
 
86
 
 
Third illustration: the measurement of
health and illness cognitions
’ such as the
perception of 
health risks 
through the use
of 
questionnaire scales
 
87
 
Formalizing the contributions of
sociology and psychology to public
health training
 
 
 
Research 
ethics
 is as important in medical
sociology and health psychology research
as it is in biomedical research.
 
88
 
Conclusions
 
The 
strongest tie 
binding medical
sociology and health psychology is their
interest in the 
systematic analysis 
of
health-related behaviour 
and their
attention to applicability of research
findings to the 
solution of health-related
problems
 in the community.
 
89
 
 
Medical sociology 
analyses actions, beliefs,
attitudes, and knowledge of individuals on
matters of:
Health
 and 
illness
Health-related activities 
of groups,
organizations, and institutions at all levels
of society
The impact of the 
socioeconomic
,
cultural
, 
political
, and 
physical
environment upon the actions, attitudes,
and beliefs of individuals and collective
entities of any size.
 
90
 
 
Health psychology
’s original focus was on
the analysis of the individual’s 
mental
health
.
 
Over the past two decades health
psychology has re-oriented its attention to
the analysis of all 
other aspects of health
behavior
.
 
91
 
Notes
 
 
Occupational prestige rates 
in a five-
point scale:
5 ‘excellent standing’
4 ‘good standing’
3 ‘average standing’
2 ‘below average standing
1 ‘poor standing’
 
92
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Sociology and psychology intersect in public health studies, examining individual behavior and social structures. Commonalities include dedicated subfields for health and illness research, while differences lie in focus areas. Discover the impact of sociology in public health, historical contributions, and relevant theories such as structural-functionalism.


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  1. Sociology and psychology in public health Faculty of Medicine Department of Community Medicine Dr Sudabeh Mohamadi

  2. 2

  3. Introduction 3 Sociology and psychology have common links: Conceptually Methodologically

  4. 4 They differ in overall scope: Psychology typically focuses on the individual Sociology examines the individual s social action (agency) and the community s social and physical context (structure) within which they live, interact, work, and play.

  5. 5 Important similarity between sociology and psychology is that both disciplines have a dedicated subfield for the study of health and illness. These subfields are, respectively: Medical sociology Health psychology

  6. Sociology in public health 6 The damage caused by epidemics alerted some British and authorities to the possible connection of three phenomena unrelated by medical experts: European medical hitherto seen as Social conditions in the community Social behavior Public health

  7. 7 Durkheim s conceptual contribution on the notions of the socially normal and abnormal set the path for twentieth century medical sociology .

  8. 8 Sociological theories may be classified into two types: General theories that address all human behaviour and applicability Middle-range theories that have limited applicability. have universal

  9. 9 The most relevant general theories for the sociological analysis of health and illness: Structural-functional theory Symbolic interactionism Conflict theory Phenomenology/ethnomethodology

  10. Structural-functional theory 10 Neo-functionalism Addresses societies as social systems All components of society whether they are individuals, groups, nations, or global organizations, have functions both manifest and latent for their maintenance and growth communities,

  11. 11 Approaching the analysis of health-related phenomena from the structural-functionalist systems theory, we can offer two models of illness : The deviance model Sick-role or capacity model perspective of

  12. 12 The deviance model presents illness as a state of dependency for the person affected whereby therapy is expected but seen as a social control system and the physician as an agent of social control.

  13. 13 The capacity model proposes that illness is a breakdown of normality leading to the individual s total or partial incapacity to perform normal social roles.

  14. Symbolic interactionism 14 The individual s subjective perception of the situation through meanings and symbols has a significant impact on his/her behaviour.

  15. 15 Two models of illness: The labelling model The negotiation or crisis model

  16. 16 The labelling model proposes that illness may be socially defined or labelled through a process evaluation. of normative

  17. 17 The patients have control over their illness through negotiation: Diagnoses and treatments by the medical profession may be treatment involves the patient s active participation. negotiation model proposes that negotiated and

  18. Conflict theory 18 Proposes that the potential for conflict is a normal component of social relationships, thus, negotiation and bargaining are key elements of social interaction.

  19. 19 When applied to health phenomena, conflict theory offers two models: The loss or stress model The domination deprivation model

  20. 20 The loss or stress model proposes that there is a strong connection between stress and illness; the loss of required social support increases the likelihood of illness

  21. 21 The argues occupies a dominant position in society by virtue of its expertise vis-a-vis the patient s position of dependence. domination deprivation that the model medical profession

  22. Phenomenology/ethnomethodology theory 22 People are the product of the very society they create . This phenomenology model regards illness as belonging to a broad category of disturbing occurrences. which breach the peace of everyday routines . taken-for-granted

  23. 23 Compared to the other theories, has contributed relatively less to empirical research in medical sociology.

  24. Sociological research relevant to public health 24 The most significant social aspects that exemplify the link between individuals and groups in the context of public health are cultural and social class influences on health-related behaviour of individuals and communities; lifestyles; and the creation and transformation of healthcare systems.

  25. Culture and public health 25 Culture refers to values and beliefs emanating from one s ethnic and/or religious ethos, typically transmitted across generations as part of the community s identity or design for living .

  26. 26 In addition to the influence of the physical and socioeconomic environment on the risk of infectious diseases and chronic illness, the impact of culture on public health is manifold and it is manifested in at least three main ways.

  27. 27 Health regarding health risks behavior: what people do Health attitudes and beliefs: how people feel and think about health and illness People s perceptions of and responses to health authorities public health guidelines and recommendations

  28. 28 Social stereotypes held by practitioners (whether clinicians practitioners) distort clinical decisions and interactions with their subjects of care and lead to linking certain diagnoses to certain patients . or public health

  29. 29 The impact of medical constructs , that is, when a physical or mental condition is defined by the health authorities as a disease while the same condition is considered normal by the community

  30. 30 When this clash of the expert versus lay interpretations occur, classification has consequences for the social legitimacy of the symptoms, access to treatment, and costs to the health care system the official

  31. Lifestyle and health 31 Persistent differences in morbidity and mortality across ethnic groups that are basically of social rather than biological or genetic origin.

  32. 32 Lifestyles vary for men and women particularly in Asia. Gender differences are clearly discernible in morbidity and mortality figures.

  33. 33 A reinforced by his/her social network. person s lifestyle is shared and

  34. 34 Social ties and social networks significantly influence health-related leading to obesity, cigarette smoking, recreational drug use, and alcohol consumption, among other risk behaviours behaviour

  35. 35 The most visible influence of social networks on health is negative. Social networks can be mobilized in public health policy for the promotion of healthy habits and health risk-avoidance in the community.

  36. Social class, social stratification, and public health 36 A person s social class socioeconomic status or SES is ascertained by means of a composite index of three or more indicators, the most common: Personal income level Years of formal education completed Occupational prestige

  37. 37 The simplest presentation of SES scores is a three-level description of lower class, middle class, and upper class. Quantitative and continuous SES scores are preferred in sociological studies.

  38. 38 Social class reinforces the influence of lifestyle on health behaviour.

  39. 39 Under certain conditions, social class mostly due to the influence of education and occupation may have a stronger impact than cultural beliefs and norms on health behaviour, on access to health services, and on a person s exposure to occupational hazards.

  40. 40 Sociologists examine the health impact of each SES component separately: Occupational prestige Income level Educational level The strength of SES as a predictor of health behaviour

  41. The theory of fundamental causes states: 41 Social class influences multiple disease outcomes through multiple risk factors . Social class impacts access to resources that can be used to avoid risks or minimize the consequences of disease . Those influences tend to persist over time.

  42. Healthcare systems and public health 42 When systems they include the approaches taken by nation-states creation, organization, distribution, and management of resources. sociologists study healthcare towards the their healthcare

  43. 43 In many countries today too much priority has been given to hospital care at the expense of the development of primary care, community care and public health .

  44. 44 Three types of studies illustrate the area of health services research:

  45. 45 The first type of study shows that unequal access to healthcare services is preserved by institutions and policies that constrain and enable the actions of health services organizations, health care providers, and consumers .

  46. 46 The second type of health systems research study is the comparative analysis of health financing approaches and systems in terms of their suitability to the socioeconomic needs and demographic characteristics of the population. Example: The study of insurance

  47. 47 The third type of study represents the direct input of medical sociologists on public policy. Example: analysis of changes in state regulations on the collection and access to health relevant population data for research purposes.

  48. Sociological research methods and public health 48 Three sociological research methodology that must be taken into consideration: important characteristics of (1) The kinds of data used in sociology (2) The levels of measurement applied (3) The types of research design followed

  49. What kinds of data are used in sociology? 49 Two kinds of evidence or data: Primary Secondary

  50. 50 Primary data: collected first-hand by the investigator Example: data on people s attitudes and behaviour obtained through personal interviews, observation, experiments, or surveys; or data extracted by means of first-hand analyses of documents, letters, records, or other types of raw data.

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