Ethnography and health care

British Medical Journal, Dec 2, 2000 by Jan Savage

Like all approaches to research, however, ethnography has its limitations. These are amply spelt out elsewhere,[10] but some examples that are particularly pertinent to healthcare research are worth raising here.

Funding bodies for research in health services are often not receptive to ethnography on the basis that, as a qualitative methodology, it does not lead to generalisable findings. Some researchers dispute this argument, claiming that qualitative research requires its own criteria for generalisability.[22] Others, however, do not consider generalisation to be the purpose of qualitative research and point instead to the in depth understanding that ethnography can achieve and the way it can identify groundbreaking questions or hypotheses that can be further explored through other methodologies.[16]

Other problems are those associated with observation of participants. This method provides rich data but takes considerable time and sustained supervision to re-cast what might be familiar and apparently irrelevant as strange and interesting. The labour intensive nature of fieldwork also means that it is relatively costly. Some healthcare researchers deal with these problems by carrying out focused ethnographies in which fieldwork is shortened by entering the field with established research questions and less emphasis on participant observation. Finally, participant observation raises challenging ethical questions and practicalities with regard to informed consent that may be heightened by the lack of power seen in certain groups such as patients or junior staff. Informed consent therefore needs to be carefully considered, negotiated, and regularly reconfirmed with study participants.[23]

Conclusion

Ethnography is a complex and contested activity drawing on a range of epistemological positions and methods and often demanding different modes of evaluation from other methods more commonly used in healthcare research. As a detailed way of witnessing human events in the context in which they occur, ethnography can help healthcare professionals to solve problems beyond the reach of many research approaches, particularly in the understanding of patients' and clinicians' worlds.

Contributors: The need for a paper on ethnography and health care was initially identified by members on the Ethnography and Health Care Group (ethnog-health@egroups.com). Helen Allan, Alison Crombie, Kathryn Ehrich, Daniel Kelly, and Susie Pearce contributed to the conceptualisation and early revisions of the paper.

Competing interests: The academic department in which I am based enters the Research Assessment Exercise. Publication of this paper may therefore benefit my employing organisation, although the benefits would be marginal and indirect.

Funding: None.

[1] Jones R. Why do qualitative research? BMJ 1995;311:2.

[2] Pope C. Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research. BMJ 1995;311:42-5.

[3] Mays N, Pope C. Rigour and qualitative research. BMJ 1995;311:109-12.