Ethnography and health care

British Medical Journal, Dec 2, 2000 by Jan Savage

The way in which ethnography is used, however, depends on several factors, including the philosophical stance of the researcher or the practicalities of research funding.[12] There is, for example, no overall consensus among ethnographers about the epistemology, or theory of knowledge, that underpins an ethnographic account. Instead, different kinds of ethnographies rest on different ideas of what constitutes legitimate knowledge.[12] Some ethnographers, for example, use an interpretive approach, drawing on experiential knowledge gained from physical participation in the field,[13] knowledge that others might discount as unverifiable.

It might be argued that such an approach represents a narcissistic shift of focus from the experience of the participants in the research to that of the ethnographer,[8] yet it offers one response to the crisis of representation in the social sciences. This crisis has arisen partly because of uncertainty about how to describe social reality and partly because of the challenge to traditional assumptions, referred to earlier, about whose voice has authority. Additionally, there is growing acknowledgement that the knowledge generated by an ethnographic approach is strongly shaped by the nature of the relationship between the researcher and the researched.[14] This has prompted the development of new forms of ethnography, such as critical ethnography, which attempt to restructure the research process in ways that promote the views of those who are often silent or marginalised.[15]

Awareness of the diverse positions within ethnographic research is important for at least two reasons. Firstly, many researchers agree that the epistemological foundations of an ethnography should continue to exert a strong influence throughout the entire research process.[11] Take the example of an ethnography concerned with the implications of physical intimacy in clinical encounters. This study was based on an epistemology that extended legitimacy to knowledge from all the senses, not only sight, which suggested the researcher's participation in, rather than mere observation of, clinical work, to collect experiential data.[13] Ethnography is thus not a simple matter of the ad hoc mixing of several methods.

Secondly, these diverse epistemological stances raise questions about the evaluation of ethnographic research and the appropriateness of criteria such as relevance and validity. These questions are particularly important for the broader acceptance and funding of this methodology in healthcare research, but provision of set criteria for the assessment of ethnographic research is notoriously difficult. While Hammersley makes some helpful proposals in this respect (box 2), it is doubtful that every ethnographer would accept all his suggestions or give them equal emphasis.[10] Perhaps the best way of examining this complex issue here is by reference to more detailed discussions of the evaluation of qualitative research.[4 16]

Box 2: Possible criteria for assessing ethnographic research[10]