Ethnography in Health Services Research

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Cubellis, L., Schmid, Ch., & von Peter, S. (2021). Ethnography in health services research: Oscillation between theory and practice. Qualitative Health Research, 31(11), 2029-2040. Web.

Keywords: health services research; ethnography; qualitative methods; Germany; USA

The authors proclaim the reasonability of including ethnographic methods in research on health service, highlighting that such approaches can smooth the difference between protocols and reality, to which they refer as the theory-practice gap. Ethnography oscillates between these two dimensions of knowledge and connects them to each other; furthermore, health service research is interdisciplinary by its nature, hence open to cooperation. Subsequently, the purpose of the writing lies in demonstrating how ethnographic findings are combinable with other forms of health-related data in the most productive way. Ethnography is an inductive field, where general conclusions are drawn from observations that consequently are the main method of gathering information. However, this particular article summarizes on the previous examples and does not involve any direct participants except the authors; therefore, there was no need for consent and no conflicts of interests.

The examples include four case studies to illustrate two basic methodological principles of ethnography, which is sufficient to show how exactly this sphere of knowledge is possible to integrate into medical science. As the research is qualitative rather than quantitative, hardly any additional analysis would be necessary. The approach that the authors actually use is sufficiently illustrative to describe what the oscillation of ethnography between theory and practice can offer. Furthermore, the possible obstacles to its integration are also guessable from the instances given. The investigators, therefore, did not apply any alternative or additional methods to compassing the purpose of their research. In fact, exemplifying is the best way to show how a certain action, in this case combining ethnography with other methods in medical science, is possible to do, and hardly any other would be relevant.

Beecham, E., Langner, R., Hargrave, D., & Bluebond-Langner, M. (2019). Children’s and parents’ conceptualization of quality of life in children with brain tumors: A meta-ethnographic exploration. Qualitative Health Research, 29(1), 55-68. Web.

Keywords: survivorship; adaptation; coping; enduring; cancer; psychosocial aspects; illness and disease; children; resilience; resistance; lived experience; health; experiences; quality of life; qualitative

The authors apply meta-ethnography to investigating on the ways in which children and youngsters with brain tumors, their families, and their healthcare professionals understand quality of life and rely on this term in decision-making. Meta ethnography involves three basic strategies, but the investigators apply two: reciprocal translational analysis and lines-of-argument synthesis. The first identifies the key concepts used and relations between them, and the second integrates the findings into a general interpretation. The article is a review of the papers on the topic that have been published between 2007 and 2016, which means that there are no new participants, hence no ethical concerns. The analysis involves systematizing the data on six patients by several criteria including the country of residence and the view of quality of life to reveal the so-called archconcepts, or predominant understandings of the latter. The broad geographical scope of the research apparently serves to eliminate the influence of sociocultural specificities on the outcomes, in other words, reduce bias and consequently improve the representativeness of the selection.

Personal opinions of brain tumor survivals and their surrounding are a sufficiently illustrative justification of the conclusive statement, in which the authors define quality of life in the way that polemizes with the existing formulation. Relying on practical data to build theoretical models as well as illustrate or disprove certain assumptions apparently is among the strength of ethnography as a method. Along with this, the selection presumably is too small, which may discredit the outcomes. This is the biggest limitation of the research; the general choice as well as use of methodology are quite appropriate. Nevertheless, a bigger selection would have added to trustworthiness of the results.

Townsend, R. C., & Cushion, Ch. J. (2021). ‘Put that in your fucking research’: reflexivity, ethnography and disability sport coaching. Qualitative Research, 21(2), 251-267. Web.

Keywords: ethnography; reflexivity; disability; disability sport; coaching

The paper seeks to illustrate the essentiality of reflection in research through the example of the outcomes of an ethnographic investigation in the field of disabled sports. In addition, it demonstrates the multidimensionality of such a concept as health, regarding it through the lens of social rather than medical science. The authors insist that reflexivity is a marker of an appropriate qualitative study and, consequently, an integral part of ethnography as a method since the latter is based on communication and observation rather than calculation. The aim of the writing, therefore, is to show how it is possible to improve criticality and self-awareness of sports coaching as well as make social studies more authentic from ethnographic viewpoint. The data were collected through 18 months of working with a disability sports team; methodologically, this means observation, communication, and direct contact, which are the cornerstones of ethnographic studies.

The authors note that the players mostly were acquainted with them, expressed their interest in the investigation and frequently gave interviews on their own initiative. Interacting with disabled athletes allowed for smoothing the boundaries between academic studies and coaching. This favors regarding the latter more critically and reflecting on the approaches and practices that had seemed to be natural and implicit, which corresponds to the research purposes. The findings require hardly any additional analysis since the article is primarily demonstrative, in other words, shows how ethnography can serve to combine science and sports, to which the authors refer as crossing fields. The main strength of the method applied is favoring critical thinking in ethnographers, which, in turn, prompts a reconsideration of the traditional research practices. This is sufficient for compassing the above purposes; therefore, no other techniques are needed.

Elmusharaf, Kh., Byrne, E., Manandhar, M., Hemmings, J., & O’Donovan, D. (2017). Participatory ethnographic evaluation and research: Reflections on the research approach used to understand the complexity of maternal health issues in South Sudan. Qualitative Health Research, 27(9), 1345-1358. Web.

Keywords: participatory; ethnographic; qualitative; PEER; South Sudan; conflict-affected fragile states; maternal health; participatory ethnographic evaluation and research

The researchers draw a parallel between health outcomes and sociocultural context, seeking to illustrate how ethnography can be helpful in identifying the origin of the barriers to appropriate care, in this case maternal. The main goal lies in providing a clearer understanding of how living in ethnically and culturally diverse, isolated, and conflict-affected area with a scarcity of resources influences making decisions on maternal health. In addition, the method of participatory ethnographic evaluation and research (PEER) solves the problem that ethnographers frequently face, specifically, the need for developing relationships of trust with many participants, which takes time and resource. Notably, this approach presupposes recruiting and training several trustworthy community members to interview their fellows and analyze the outcomes. Considering the social instability of the research setting, an ethical approval was received from the local Ministry of Health as well as the University of Medical Sciences, and anonymity was guaranteed.

The information that the delegates collected then underwent thematic analysis that lies in identifying the major themes and organizing the findings within those into coherent narrative-accompanied profiles. Such a technique enables tracing the relations between the health decisions that people make and the environment in which they live, in accordance with the above purpose. The main weakness of the given research method lies in the limited verifiability of the findings, as the participating community members not necessarily report everything accurately. To compensate for this, the delegates checked each other’s data, which improved the reliability of the outcomes in justifying the conclusions. Although a well-structured quantitative investigation on a large selection would be more valid, PEER apparently is the only method possible to use in areas of conflicts.

Sinding, Ch. (2010). Using institutional ethnography to understand the production of health care disparities. Qualitative Health Research, 20(12), 1656-1663. Web.

Keywords: cancer; ethnography; health care; health care disparities; health care professionals; health care, access to; research design; resource allocation; workplace

The author emphasizes that quantitative studies on the utilization of health services by patients with breast cancer hardly cover the categories of women that do not have an access to appropriate care. Considering this, the purpose of the research lies in detecting the origin of healthcare inequality by means of institutional ethnography. This method involves specifying the actions that females take to receive treatment and interviewing healthcare professionals to identify the stage at which the disparities appear. The investigator does not focus on ethical issues; however, considering that she observed as well as surveyed oncologists and nurses, those had apparently given their consent. Regarding the data on the routines of marginalized women, those predominantly rely on the previous qualitative studies. The method allowed for a detailed description of the standard practice at the cancer center, which the author then compared to the documents that regulate the work with patients. This revealed several contradictions, from which the disparities actually emerge; the purpose is compassed.

One of the strengths of ethnography as a scientific method is its ability to reveal and smooth the differences between theory and practice, which this research demonstrates. Meanwhile, a possible challenge is the limitedness of the selection, as the author regards only one particular medical facility. A larger scope of the investigation would have allowed for a broader perspective, hence possibly a longer list of the causes of inequality in access to health care services. In addition, quantitative analysis would be relevant as well. It, in particular, would enable assessing the share of the women who do not receive appropriate healthcare and/or are not covered by the studies that focus on health services utilization.

Molyneux, S., & Geissler, P. W. (2008). Ethics and the ethnography of medical research in Africa. Social Science & Medicine, 67, 685-695. Web.

Keywords: research ethics; Africa; medical research; vulnerable populations; human rights; transnational research; ethnography

The authors offer an ethnographic perspective on the ethics of medical research, simply stated, suggest that it has to consider the relations among social units in addition to economic and legal issues. The objective of the paper subsequently is to show the essentiality of focusing on justice in both medical and social science, while ethnography can serve to identify the existing disparities and their causes. Actually, the writing summarizes the materials of a conference, for which reason no ethical concerns emerge from the process of collecting information since there are no extra participants. Furthermore, the data are theoretical rather than practical, although illustrated with examples. The authors begin with the presentation of their own arguments for regarding health through a social lens, for which ethnography actually allows. According to them, this enables understanding not only cultural, but also political and economic context of health. Then, they provide a brief overview of the conference, which improves the persuasiveness of the article and simplifies accomplishing its objective.

As the writing is descriptive, the data did not undergo any analysis; the researchers simply provide the evidence that social justice is beyond the existing perspective on medical ethics. The evidence includes the findings of interviews, discussions, and other, which actually means using the ethnographic approach, hence serves as a practical example of the main postulate. Such illusrtativeness is the great advantage of the method that the authors apply, while its biggest limitation is the lack of reliable quantitative data. Statistics could have added to the strength of the argumentation and impressed the audience more than descriptive evidence. Therefore, statistical analysis would be relevant to use in parallel with ethnography.

Newnham, E., Small, K., Allen, J. (2021). Critical ethnography in maternity care research: bridging creativity and rigour – a discussion paper. Midwifery, 99, 103014. Web.

Keywords: ethnography; critical theory; maternity care; midwifery; qualitative research

The researchers seek to compensate for the flexibility of ethnographic methodology and improve its accuracy to enable a broader use of it in maternity care. The subsequent objective of the paper lies in demonstrating how it is possible to add to precision without losing creativity and freedom that are the most meaningful specialties of ethnography. For that, the authors describe and comment on the methodology of three separate studies that they have conducted previously. The data collection methods used in those involve observation with making field notes, personal as well as focus group interviews, and relevant texts such as documents from medical facilities. Each investigation received an ethical approval from all of the participant institutions. The studies exemplify the three existing variations of ethnography, specifically, institutional, focused critical, and critical medical anthropology as a particular subtype.

In each case, focus group interviews and references to documents provide additional accuracy of the outcomes, which makes the instances relevant in terms of accomplishing the objective. Regarding analytical techniques, they include coding, sorting, generalizing with theories and constructs, indexing, memoing, reflection, and critical analysis, which also contributes to the precision, hence justifies the conclusions. The variety of the approaches doubtlessly is the strongest point of the methodologies, as it provides a bright illustration of how precision and creativity are compatible. Therefore, there is hardly any need for other methods since the purpose of the article lies in solving a particular methodological issue, which the examples given do. It is worth noting, however, that completely ethnographic studies nevertheless lack precision in comparison with quantitative research, although frequently are more topic-specific. Therefore, a combination of these two approaches apparently allows for a maximal accuracy of the outcomes.

Jamal, F., Fletcher, A., Harden, A., Wells, H., Thomas, J., & Bonell, Ch. (2013). The school environment and student health: a systematic review and meta-ethnography of qualitative research. BMC Public Health, 13(1), 798-809. Web.

Keywords: schools; young people; adolescent health; health behaviours; risk; systematic review; meta-ethnography; qualitative

The authors regard childhood and youth from the viewpoint of their criticality for reducing health inequalities as well as improving public health. They apply meta-ethnography to answering the question, in which ways school environment influences student health outcomes. The article in a systematic review of 16 databases, which presupposes picking relevant studies, extracting topic-specific information from those and synthesizing it into a line of argument. As there are no direct participants except the authors, no ethical concerns emerge, and no consent is required. The investigation allows for identifying the key health issues that are observable in educational institutions as well as their most frequent causes. This, in turn, enables suggesting appropriate solutions and answering the research question. The methodology follows the principles of thematic analysis, which lies in identifying the key themes that are present in empirical evidence and organizing the data within those. Such approach is helpful in ethnographic research due to the possibility of compensating for the qualitative character and/or scarcity of the findings.

Considering the above, the statements that the authors make are justified with a sufficient amount of practical examples. Accessibility and variety of evidence to analyze actually are among the most important strengths of the given method. To the contrary, it presupposes a certain degree of bias since the purpose of data collection is to answer a particular question. Therefore, it is critical to investigate on a maximally big and diverse selection to minimize preconception. The given review includes 19 studies that cover diverse settings, which apparently adds to the credibility of the outcomes. Nevertheless, it would be even higher if the investigators had applied quantitative methods in addition to qualitative.

Mazzini, E., Soncini, F., Cerullo, L., Genovese, L., Apolone, G., Ghirotto, L., Mazzi, G., & Costantini, M. (2021). A focused ethnography in the context of a European cancer research hospital accreditation program. BMC Health Service Research, 21(1), 446-454. Web.

Keywords: accreditation programs; cancer; qualitative research; change management; healthcare organization

The article focuses on the accreditation program that has been developed to ensure that healthcare facilities follow the quality standards and uses ethnography to identify its relevance, which actually is the objective. The researchers conducted interviews and focus group meetings with the healthcare professionals at the selected cancer center. The respondents were methodologists, members of the patients’ association, information and communication technology managers, and those who were secondarily involved in accreditation, which provided a broad perspective. The authors note that they obtained ethical approvals from Reggio Emilia Provincial Ethics Committee; all of the participants were volunteers and gave an informed consent, including that for publishing the results and anonymous quotes. The surveys enabled collecting sufficient evidence to illustrate the reasonability of accreditation, primarily, practical examples and opinions to justify the conclusions. Analysis of the findings involved coding, which means labeling the pre-recorded texts and reducing them to a manageable size, and sorting, or categorizing for an easier interpretation.

Practicality and specificity are among the strongest points of ethnography as a research method since it focuses on the participants’ views on the strictly determined topic or topics. Such an approach, to the contrary, is hardly applicable to large selections, which limits the validity of the outcomes. The authors seek to compensate for this by means of triangulation, which term stands for gathering several different types of information about the same issue, and prolonged engagement with the research setting that reduces misinterpretation. Nevertheless, the setting includes one particular healthcare facility, which doubtlessly is not sufficient for referring to the article as an indicator of public opinion. A broader scope could have improved the validity of the findings.

Graham, S. S., Harley, A., Kessler, M. M., Roberts, L., DeVasto, D., Card, D. J., Neuner, J., M., & Kim, S.-Y. (2017). Catalyzing transdisciplinarity: A systems ethnography of cancer–obesity comorbidity and risk coincidence. Qualitative Health Research, 27(6), 877-892. Web.

Keywords: team science; health care; complexity; cancer; obesity; overweight; research design; methodology; qualitative; ethnography; Midwestern United States

The article illustrates the helpfulness of ethnography in addressing wicked, or multifactorial, health issues, in other words, the problems that have not solely biological, but also social and economic origin. Due to oscillation between theory and practice as well as the possibility of formulating maximally specific questions, ethnography is suitable for interdisciplinary studies. The objectives of the research involve developing effective strategies to catalyze complex responses to multifactorial problems and assessing the relevance of systems ethnography and qualitative modeling (SEQM) in healthcare contexts. The data were collected through observation in clinical as well as health educational settings and interviewing the participants, including both oncologists and nutritionists along with other professionals. Regarding an ethical approval and consent, the authors do not specify the way in which they received those. The findings underwent conventional qualitative analysis that lies in identifying recurrent themes and combining them with the outcomes of the previous research to build so-called knowledge maps.

The maps are in a form of flowcharts and illustrate the treatment as well as prevention of both diseases stage by stage. Uniting domain-specific diagrams into one cross-domain enabled the researchers to model an obesocarcinogenic environment and subsequently suggest the most reasonable preventative strategies. The practical evidence, on which the solutions are based, serves as a sufficient justification, and the analysis helps to accomplish the objectives of the investigation, showing how the method used can be helpful. This is the advantage of SEQM as well as other ethnographic tecniques; notably, they develop theory from practice, due to which the results are maximally topic-specific. In addition, the given investigation involves diverse settings, which favors multidisciplinary and consequently contributes to answering the research questions; hence, no other methods are needed.

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Ethnography in Health Services Research

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