Ethnography Study Design In Health Care Ethnography, derived from the Greek words “ethnos” (people) and “grapho” (to write), translates to “the written description of the folk.” It refers to both a specific naturalistic research method and the written output that results from this method. As a research process, ethnography is a comparative method that investigates human behavior and cognitive patterns through observations in their natural settings. As a written product, it offers a descriptive analysis of the beliefs, behaviors, norms, and patterns within a particular culture.
The focus on culture and cultural processes distinguishes ethnography from other naturalistic methods like grounded theory, which examines basic social processes, and phenomenology, which studies individual lived experiences.
Historical Overview
Ethnography has its roots in anthropology, where it was primarily developed as a means to understand various cultures and traditions. Although it remains a foundational research method in anthropology, it has also been embraced by disciplines such as sociology, psychology, education, and nursing.
As ethnography transitioned beyond anthropology, its focus shifted from small-scale or tribal societies to more relevant contexts within other disciplines. For example, sociologists from the Chicago School studied small urban communities, educators examined schools as microcosms of society, and nurse anthropologists explored the health beliefs and legal systems of various ethnic groups.
Ethnography and Nursing Research
Ethnography entered the nursing literature mainly through the efforts of nurse anthropologists in the late 1960s. Seminal articles by Elizabeth Byerly (1969) and Antoinette Ragucci (1972) laid the groundwork for future nurse ethnographers. As doctoral education began to emerge in nursing, several nurses chose anthropology as a focal point of study. This first generation of nurse anthropologists, including Madeleine Leininger, Agnes Aamodt, and Pamela Brink, paved the way for ethnographic research within nursing.
The second generation included figures like Juliene Lipson, Evelyn Barbee, and Janice Morse. With the development of doctoral programs in nursing, many ethnographers were trained within nursing schools, integrating ethnographic methods into nursing research.
Traditions in Ethnography
Several distinct traditions fall under the umbrella of ethnography, each with its own historical context and focus on different cultural elements. While there are over a dozen traditions, four notable examples illustrate the diversity of ethnographic approaches relevant to nursing research.
1. Historical Particularism
Developed by Franz Boas in the early 20th century, historical particularism posits that each culture has its unique history, and all elements of a culture warrant documentation. This approach has been utilized in nursing research to identify specific folk treatments used by ethnic groups and to develop structured instruments for further studies.
2. Functionalism
Functionalism examines the structural elements of a culture and their interrelated functioning. This approach has historically been the most widely employed in nursing research. An example is Leininger’s sunrise model, which aims to understand how cultural factors influence health care practices and beliefs.
3. Ethnoscience
Ethnoscience seeks to uncover folk systems of classification and the ways individuals perceive and organize their understanding of the world. It also aims to identify the rules guiding decision-making processes. An example of this approach in nursing is the Nursing Interventions Classification (NIC), which categorizes nursing actions based on ethnoscientific principles.
4. Symbolic Ethnography
This rapidly growing approach views culture as a system of shared meanings and symbols. Researchers using symbolic ethnography believe that cultural knowledge is embedded in “thick descriptions” provided by cultural members. Much of the nursing research focusing on informants’ explanatory models employs this ethnographic tradition.
Field Work in Ethnography
Fieldwork is the hallmark of ethnographic research, involving the investigator’s immersion in the target community for extended periods to gain a deeper understanding of the context surrounding the ethnographic data. The stages of fieldwork include:
- Field Entry: Gaining access to the community and establishing rapport with participants.
- Development of Relationships: Building trust and fostering relationships with community members.
- Data Collection: Gathering qualitative and quantitative data through various methods.
- Data Manipulation: Organizing and managing the collected data for analysis.
- Data Analysis: Interpreting the data to extract meaningful insights.
- Termination: Concluding the study and providing feedback to the community.
Many of these stages overlap, particularly the latter ones, which may occur concurrently.
Strategies in Ethnography
Ethnographers employ various strategies for data collection, including:
- Participant Observation: Immersing oneself in the community to observe behaviors and practices firsthand.
- Informal Interviews: Engaging in unstructured conversations with community members to gather insights.
- Structured Interviews: Conducting formal interviews with predetermined questions.
- Visual Data: Utilizing photographs and videotapes to document cultural practices.
- Census and Statistical Data: Analyzing demographic and statistical information related to the community.
- Historical Documents: Reviewing existing records and documents that provide context for the study.
- Projective Tests and Psychosocial Surveys: Using specialized tools to assess psychological aspects of the culture.
The combination of these strategies allows ethnographers to gather rich, nuanced data. While qualitative data is central to ethnography, quantitative data may also be used to enhance the findings.
Methods of Data Collection
Data manipulation methods include strategies for note-taking, memo-writing, coding, and indexing. Recent advancements in technology have led to the development of software programs such as ETHNOGRAPH and NUDIST, which assist researchers in managing and analyzing ethnographic data. Common methods of data analysis encompass matrix analysis, thematic analysis, and domain analysis.
Conclusion
In summary, ethnography is a method designed to describe and understand cultures. Ethnographers aim to gain insights into different ways of life from the perspective of those within the culture (emic view). Through participant observation and informant interviews, researchers gather data that can reveal rich cultural insights. The specific ethnographic tradition chosen by the investigator informs the nature of the research product, ultimately contributing to a deeper understanding of cultural contexts in nursing and health care. As the field of nursing continues to evolve, the application of ethnography will remain vital in addressing the complexities of patient care and improving health outcomes across diverse populations.