1st Edition

Pragmatic Healthcare Ethnography Methods to Study and Improve Healthcare

    148 Pages 13 B/W Illustrations
    by Routledge

    148 Pages 13 B/W Illustrations
    by Routledge

    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 behaviour 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, David Atkins, MD, MPH


    Chapter 1

    Pragmatic Healthcare Ethnography: An Introduction

                Setting the stage: doing pragmatic healthcare ethnography


                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, PhD)



    Chapter 2

    Designing Ethnography for Healthcare Research


                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


    Case 2: Designing an Ethnographic Evaluation for a Substance Use Disorder Intervention (Megan McCullough, PhD)



    Chapter 3

    Conducting Ethnography in Healthcare Research


                Where ethnography happens

                Building ethnographic partnerships: trust, reflexivity, and power


                            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 3a: Tending to Partnerships (Anais Tuepker, PhD, MPH)

    Case 3b: Ethnography and Participatory Research: Bringing in Community Voices (Gala True, PhD)



    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, PhD)



    Chapter 5

    Sharing Ethnographic Findings


                Getting started: what do we want to share?

                Building on our data sources and analytic resources

                Reaching our target audiences

                            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, PhD)



    Chapter 6

    Crafting a New Ethnography


                New opportunities for ethnographic theory and methods

                Ethnography as part of learning healthcare systems



    Afterword, Annette Boaz, PhD


    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 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 US Department of Veteran Affairs, Center for Healthcare Organization and Implementation Research. 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.