1st Edition
Pragmatic Healthcare Ethnography Methods to Study and Improve Healthcare
This practical and accessible textbook provides an overview of the key principles for conducting ethnography in healthcare settings. Shedding new light on healthcare delivery and experiences, ethnographic research methods provide a useful set of tools for observing how people act in the world and help us understand why people act as they do. Increasingly recognized for their explanatory power, especially around behavior and social context, ethnographic methods are an invaluable approach for understanding challenges and processes in healthcare services and delivery.
This guide takes the reader step-by-step through the research process, from grant writing and study design to data collection and analysis. Each chapter, illustrated by a range of examples, introduces ethnographic concepts and techniques, considers how to apply them in pragmatic research, and includes suggestions for tips and tricks. An in-depth case study describing real-world ethnographic research in a healthcare setting follows each chapter to demonstrate both the “how to” and the value of ethnographic approaches. The case studies discuss why the researcher used ethnography, the specific approach taken, the setting for the work, and key lessons that demonstrate ethnographic principles covered in the related chapter.
This is an essential text for researchers from a range of health-related backgrounds new to ethnographic methods, including students taking courses on qualitative research methods in health, implementation science, and applied anthropology.
Foreword by David Atkins, MD, MPH
Chapter 1
Pragmatic healthcare ethnography: An introduction
Setting the stage: doing pragmatic healthcare ethnography
Introduction
Five central themes of ethnography
The importance of pragmatism
The authors as pragmatic ethnographers
Orientation to the book
Case 1: Thinking (and acting) ethnographically in VA healthcare research (Heather Schact Reisinger)
References
Chapter 2
Designing ethnography for healthcare research
Introduction
When are ethnographic methods a good fit for healthcare research?
Methods: the building blocks of an ethnographic study design
Planning an ethnographic study
Sampling: site and participant selection
A note about “N”
Getting approval to conduct ethnography in healthcare settings
Is it research?
Specifying the participants in ethnographic research
Risks to participants or research team
Dealing with setbacks
Conclusion
Case 2: Designing an ethnographic evaluation for a substance use disorder intervention (Megan McCullough)
References
Chapter 3
Conducting ethnography in healthcare research
Introduction
Where ethnography happens
Building ethnographic partnerships: trust, reflexivity, and power
Observation
Fieldnotes and other methods of documenting observation
Ethnographic interviews
Focus groups
Patient and provider interviews
Knowledge and expertise: maintaining a beginner’s mind
Periodic reflections
Team-based ethnography
Rapid, virtual, online, and video ethnographic approaches
Conclusion: rigor, trustworthiness, and constraint
Case studies 3a and 3b: Participatory approaches in pragmatic healthcare ethnography
Case 3a: Tending to partnerships (Anais Tuepker)
Case 3b: Ethnography and participatory research: Bringing in community voices (Gala True)
References
Chapter 4
Ethnography for understanding: Analytic approaches
Selecting and applying analytic strategies and tools
Approaching the data
Getting organized
Getting familiar
Getting strategic
Using tools: Memoing
Methods memos
Research question memos
Emergent discoveries memo
Future studies memo
Episode profiles
Topic memos
Using tools: Diagramming, visual displays, and analytic templates
Using tools: Coding
Synthesizing for holistic understanding
Conclusion: Rigorous pragmatic ethnography
Case 4: Visibility and participation in ethnographic analysis (Sarah Ono)
References
Chapter 5
Sharing ethnographic findings
Introduction
Getting started: what do we want to share?
Building on our data sources and analytic resources
Reaching our target audience(s)
Selecting journals and publishing ethnographic work
Presenting ethnographic work to academic audiences
Preparing non-academic products
Demonstrating rigor
Ethics: Protecting research participants
Case 5: Creating space for transparency and dialogue to improve data accuracy and tailored dissemination of ethnographic data (Justeen Hyde)
Local Whole Health leaders
Office of Patient-Centered Care and Cultural Transformation (OPCC&CT)
Congress
Conclusions
References
Chapter 6
Crafting a new ethnography
Introduction
New opportunities for ethnographic theory and methods
Ethnography as part of learning healthcare systems
References
Afterword by Annette Boaz, PhD
Biography
Alison B. Hamilton is a VA Research Career Scientist and Implementation Research Director with the Center for the Study of Healthcare Innovation, Implementation, and Policy at the VA Greater Los Angeles Healthcare System, a Professor-in-Residence in the University of California Los Angeles (UCLA) Department of Psychiatry and Biobehavioral Science, David Geffen School of Medicine, and an Honorary Professor in the Department of Psychiatry and Mental Health, University of Cape Town, South Africa. Her research interests include gender and health, mental health, implementation science, and research methods.
Gemmae M. Fix is an Associate Professor at Boston University Chobanian & Avedisian School of Medicine and a Research Health Scientist with the Center for Healthcare Organization and Implementation Research co-located at the VA Bedford/VA Boston Healthcare Systems. As an applied medical anthropologist, she has almost two decades of experience conducting federally funded ethnographic research in healthcare settings. Her research focuses on the delivery of patient-centered care, particularly for people living with HIV. She is a fellow of the Society for Applied Anthropology.
Erin P. Finley is a Professor with the Departments of Medicine and Psychiatry and Behavioral Sciences at the Long School of Medicine, University of Texas (UT) Health San Antonio, and Core Investigator and Qualitative Methods Core Lead with the Center for the Study of Healthcare Innovation, Implementation, and Policy at the VA Greater Los Angeles Healthcare System. Her research interests include veterans’ health, mental health, and diverse methods in implementation planning and evaluation.
