Engagement and qualitative sociology in health research: proximal, but incongruent

Abstract This paper argues that sociology’s distinctive value in health research lies not in amplifying experiential accounts but in analysing the social structures and norms that shape them—a contribution often obscured by an assumed alignment between qualitative research and engaged health agendas. Typically rooted in a shared valuation of lived experience and patient voice as credible sources of knowledge, arguments for alignment are often aimed at carving out a niche for the qualitative social sciences within applied health research. However, such arguments can overlook the need to combine experiential accounts with analytic frameworks, and can treat experiential accounts as sufficient explanation rather than as a vital contribution to enquiry. Drawing on Niklas Luhmann’s concept of second-order observation, we problematise the assumption of alignment, situating it as the product of three developments: patient-led struggles for the recognition of lived experience in biomedicine; efforts of social scientists to distance themselves from biomedicine’s normalising gaze; and the institutionalisation of patient engagement in healthcare research. Through theoretical articulation, qualitative sociology situates patient accounts within broader transformations in health systems and society, contributing to understanding and explanation, not merely engagement and representation. Engagement and qualitative sociology are vital and distinct, and their difference enables a dialectical relationship through which each challenges and transforms the other.