Week 5
Lecture Ethnography
Ethnography in healthcare research
Ethnographic studies zoom in on (daily) practices in order to understand these in context. Ethnographic
research focuses on describing subjective realities and the understanding of that reality from the
perspective of the person who undergoes it. This understanding cannot be achieved at a distance;
practices must be 'lived' by the researcher.
Introduction in ethnography in healthcare research
Roots in Anthropology. Examines behavior, culture, practices, people. Practice based, emic perspective
(insider), understanding (not explaining), immersion, observations and fieldnotes, interviews and
document analysis.
Observational dimensions: space (physical layout of the place); actor (range of people involved); activity
(set of related acts); object (physical things that are present); act (single actions people undertake);
event (activities that people carry out); time (the sequencing of events that occur); goal (things that
people are trying to accomplish); feeling (emotions felt and expressed).
In healthcare: care as organized practices, bottom-up/critical perspectives on care (and cure),
empowerment of minority voices (patients, professionals).
Ethnography and theory In practice: abduction (inductive and deductive), sensitizing concepts, theory-
field-theory. Zooming in and out. Theory underpins research.
Quality in ethnographic research
Triangulation (Data; Methodological; Investigator; Theory)
Thich description (write down what you see, transparent, add details)
Member check (are interpretations recognized by members)
Reflexivity & audit-trial (examination of your own beliefs/research, your professional position)
Workgroup 6
Gengler 2014; observational dimensions
Gengler conducted participatory fieldwork by working as a guest service volunteer at the Kelly-Reed
University Hospital Roland House. This way she got acquainted with the families visiting the hospital.
During her volunteer work she recruited 18 families for her further research. She interviewed parents
and observed medical encounters between professionals and patients/parents.
Observational Dimensions (see the lecture on Canvas for the definitions of the observational
dimensions. The definitions are slightly adjusted because in the original article of Reeves et al 2008
(based on Spradley) the definitions of ‘act’, ‘event’ and ‘activity’ overlap):
Reflect on the use of these dimensions in practice;
Space: Kelly Reed University Hospital, guest service desk, doctor offices, ICU, grocery store, airport
Actor: parents, children, professionals (doctors, nurses, speech therapists etc.)
Activity (a set of related acts by several individuals): a medical consult between professionals, children,
parents. A medical consult consists of different related acts: asking questions, providing information and
advice.
Objects: Gengler’s observations don’t focus that much on objects. She briefly mentions in passing (also
based on interviews!): protocols, MRI, G-tube (gastric feeding tube), medical journals that parents read,
small notebook of parent to write down questions for doctor, walking devices for children/braces,
, medication logs, bouncy children seat, thank you notes, towels, shampoo, pillows, but objects they don't
play a big role in the research.
Act (single action by one individual): a parent looking up information on the internet.
Event (something out of the ordinary): No clear examples
Time (sequencing of events): children get sick, depending on their social capital parents require
information about treatments, children and parents travel (great distances) to the hospital, meet up
with healthcare professionals, follow treatments, after treatment come to follow-up appointments with
occupational and speech therapists. Following these different sequences of events requires ethnography
over longer periods of time (not quick and dirty).
Goal (of actors that are being observed, not research goal of researcher): the goal of parents is to get
good care for their child and to be there for their sick children. To achieve this goal, they ask
professionals for advice, look on the internet for good doctors, call on their network, attend
appointments with professionals, sometimes quit their job to take care of their child.
Feeling: the observations and interviews focus more on actions and strategies than feelings. Yet, the
there are differences in feelings depending on the strategy parents adopt (care entrusting of care
captaining). Care captaining parents ‘feel’ more entitled to claim the right care than caretrusting
parents. They feel more ‘in control’. Caretrusting parents that have to wait a long time for the right
treatment feel frustrated, nervous, ineffective and anguished (‘experience lengthy periods of
frustration’/ ‘feelings of inefficacy’).
Evaluate the methodology used here. Does methodology match with question?
Some thoughts on that, there might be more going on: Broad focus on CHC, very interesting site. And
very productive combination of observations and other data-sources. But no to little attention to
objects. Duration of 1,5 years of fieldwork feels long, but is relatively short in the classical sense of
ethnography (‘rapid ethnographies’). Effects of micro-advantages on health-outcomes are assumed.
Which theories are used?
Cultural health capital: concept by Janet Shim that builds on Bourdieu’s social theory of habitus,
dispositions and capital. Cultural health capital: the repertoire of cultural skills, verbal and nonverbal
competencies, attitudes and behaviors, and interactional Styles.
Gengler also develops the concept of microadvantages as a conceptual counterpoint to everyday
microaggressions. Illness management strategies Health differences. Care-interesting.
How are theories used? Use Wilson & Chadda (2009) to reflect on this.
Building on existing theory: Gengler builds on existing literature of cultural health capital (CHC) by filling
in neglect gaps (“yet few have empirically examined CHC in action”). In her research she empirically
investigates how social health capital effects illness management strategies.
Refining theoretical concepts: She further refines concepts as cultural health capital and illness
management strategies by empirically fleshing out what these concepts mean in practice: Illness
management strategies: care captaining versus care-entrusting Cultural health capital: knowledge of
medical jargon, ability to critique en hold healthcare professionals accountable, mobilizing social and
medical networks, being able to assess diverging sources of information. She also proposes the concept
of microadvantages as a conceptual counterpoint to everyday microaggression.
Note. Gengler did not start her research with the focus on cultural health capital. During her fieldwork,
she got interested in this topic: “As they spoke with me about the technologically innovative procedures
many had traveled great distances to obtain, I became increasingly interested in how they mobilized
social, emotional, and economic resources to access cutting-edge and elite care for their children.”
Lecture Ethnography
Ethnography in healthcare research
Ethnographic studies zoom in on (daily) practices in order to understand these in context. Ethnographic
research focuses on describing subjective realities and the understanding of that reality from the
perspective of the person who undergoes it. This understanding cannot be achieved at a distance;
practices must be 'lived' by the researcher.
Introduction in ethnography in healthcare research
Roots in Anthropology. Examines behavior, culture, practices, people. Practice based, emic perspective
(insider), understanding (not explaining), immersion, observations and fieldnotes, interviews and
document analysis.
Observational dimensions: space (physical layout of the place); actor (range of people involved); activity
(set of related acts); object (physical things that are present); act (single actions people undertake);
event (activities that people carry out); time (the sequencing of events that occur); goal (things that
people are trying to accomplish); feeling (emotions felt and expressed).
In healthcare: care as organized practices, bottom-up/critical perspectives on care (and cure),
empowerment of minority voices (patients, professionals).
Ethnography and theory In practice: abduction (inductive and deductive), sensitizing concepts, theory-
field-theory. Zooming in and out. Theory underpins research.
Quality in ethnographic research
Triangulation (Data; Methodological; Investigator; Theory)
Thich description (write down what you see, transparent, add details)
Member check (are interpretations recognized by members)
Reflexivity & audit-trial (examination of your own beliefs/research, your professional position)
Workgroup 6
Gengler 2014; observational dimensions
Gengler conducted participatory fieldwork by working as a guest service volunteer at the Kelly-Reed
University Hospital Roland House. This way she got acquainted with the families visiting the hospital.
During her volunteer work she recruited 18 families for her further research. She interviewed parents
and observed medical encounters between professionals and patients/parents.
Observational Dimensions (see the lecture on Canvas for the definitions of the observational
dimensions. The definitions are slightly adjusted because in the original article of Reeves et al 2008
(based on Spradley) the definitions of ‘act’, ‘event’ and ‘activity’ overlap):
Reflect on the use of these dimensions in practice;
Space: Kelly Reed University Hospital, guest service desk, doctor offices, ICU, grocery store, airport
Actor: parents, children, professionals (doctors, nurses, speech therapists etc.)
Activity (a set of related acts by several individuals): a medical consult between professionals, children,
parents. A medical consult consists of different related acts: asking questions, providing information and
advice.
Objects: Gengler’s observations don’t focus that much on objects. She briefly mentions in passing (also
based on interviews!): protocols, MRI, G-tube (gastric feeding tube), medical journals that parents read,
small notebook of parent to write down questions for doctor, walking devices for children/braces,
, medication logs, bouncy children seat, thank you notes, towels, shampoo, pillows, but objects they don't
play a big role in the research.
Act (single action by one individual): a parent looking up information on the internet.
Event (something out of the ordinary): No clear examples
Time (sequencing of events): children get sick, depending on their social capital parents require
information about treatments, children and parents travel (great distances) to the hospital, meet up
with healthcare professionals, follow treatments, after treatment come to follow-up appointments with
occupational and speech therapists. Following these different sequences of events requires ethnography
over longer periods of time (not quick and dirty).
Goal (of actors that are being observed, not research goal of researcher): the goal of parents is to get
good care for their child and to be there for their sick children. To achieve this goal, they ask
professionals for advice, look on the internet for good doctors, call on their network, attend
appointments with professionals, sometimes quit their job to take care of their child.
Feeling: the observations and interviews focus more on actions and strategies than feelings. Yet, the
there are differences in feelings depending on the strategy parents adopt (care entrusting of care
captaining). Care captaining parents ‘feel’ more entitled to claim the right care than caretrusting
parents. They feel more ‘in control’. Caretrusting parents that have to wait a long time for the right
treatment feel frustrated, nervous, ineffective and anguished (‘experience lengthy periods of
frustration’/ ‘feelings of inefficacy’).
Evaluate the methodology used here. Does methodology match with question?
Some thoughts on that, there might be more going on: Broad focus on CHC, very interesting site. And
very productive combination of observations and other data-sources. But no to little attention to
objects. Duration of 1,5 years of fieldwork feels long, but is relatively short in the classical sense of
ethnography (‘rapid ethnographies’). Effects of micro-advantages on health-outcomes are assumed.
Which theories are used?
Cultural health capital: concept by Janet Shim that builds on Bourdieu’s social theory of habitus,
dispositions and capital. Cultural health capital: the repertoire of cultural skills, verbal and nonverbal
competencies, attitudes and behaviors, and interactional Styles.
Gengler also develops the concept of microadvantages as a conceptual counterpoint to everyday
microaggressions. Illness management strategies Health differences. Care-interesting.
How are theories used? Use Wilson & Chadda (2009) to reflect on this.
Building on existing theory: Gengler builds on existing literature of cultural health capital (CHC) by filling
in neglect gaps (“yet few have empirically examined CHC in action”). In her research she empirically
investigates how social health capital effects illness management strategies.
Refining theoretical concepts: She further refines concepts as cultural health capital and illness
management strategies by empirically fleshing out what these concepts mean in practice: Illness
management strategies: care captaining versus care-entrusting Cultural health capital: knowledge of
medical jargon, ability to critique en hold healthcare professionals accountable, mobilizing social and
medical networks, being able to assess diverging sources of information. She also proposes the concept
of microadvantages as a conceptual counterpoint to everyday microaggression.
Note. Gengler did not start her research with the focus on cultural health capital. During her fieldwork,
she got interested in this topic: “As they spoke with me about the technologically innovative procedures
many had traveled great distances to obtain, I became increasingly interested in how they mobilized
social, emotional, and economic resources to access cutting-edge and elite care for their children.”
