9

Ethnography

Introduction

Ethnography is a qualitative approach to research. Traditionally, it involves the in-depth study of a culture. The term ‘culture’ refers to the ways in which people live together, their behaviours, thoughts, feelings, beliefs and ways of doing things. In the past, ethnographic research tended to investigate cultures that were very different from that of the researcher. For example, an ethnographer might live for a time in a distant country, meet and talk to the people, observe them in everyday life and then write a detailed report of his or her findings. Increasingly, the ethnographic approach has grown to include studying cultural aspects of everyday life in the researcher’s own culture and studying the ‘culture’ or organisations or specific groups of people. For example, a researcher might use an ethnographic approach in studying how people cope after major surgery. This would be a kind of sub-culture consisting of recovering patients¹.

Previously, instructions on the methods used in ethnographic research were few. Students of ethnography would be told simply to go out into a culture and look at what happened there and then write their report. Increasingly, as is the case with other forms of qualitative research, methods have tended to become more focused and specific.

It sometimes helps to distinguish between ethnography and ethnographic methods. An ethnography usually arises in the fields of anthropology or sociology and is the ‘classic’ form, described in the first paragraph. As we have noted, the ethnographer might live in a distant country and write a book about his or her experiences and observations. Ethnographic methods, on the other hand, while drawing on the traditional ethnographic approach, may refer to interviews and observations made in other contexts and, sometimes, used in combination with other forms of research methods. In the latter case, the term ‘mixed method research’ is sometimes used.

The stages of an ethnographic study

Organising an ethnographic study takes time but that organisation follows similar principles to any other research. First, the researcher must identify the question that he or she is seeking to answer. As is the case with other forms of research, inexperienced researchers tend to ask questions that are too large and all-encompassing and it is important to work with a supervisor who can help make the question more focused and particular. This can be especially problematic with ethnography, as, by their very nature, the sorts of topics addressed are already very broad.

Second, the researcher has to learn or rehearse the methods of data collection and data analysis that are to be used. Often, doing ethnographic research is a ‘one-off’ process. It is rarely possible to return to respondents (or even places) to clarify issues that have not been covered in the original encounter. If this is possible, then so much the better. As the ideal, it is good to take an iterative approach to data collection.

That is to say that the researcher meets respondents (or goes to places) on many occasions, in order to deepen an understanding of the culture or to clarify data that have been collected previously. In practice, however, most researchers have neither the time nor the funds to do this. They need, therefore, to be confident in using data collection methods that will obtain the right data and in sufficient quantities.

Third, arrangements have to be made to access the field of study. This may involve complex practicalities such as buying plane or train tickets, booking accommodation, agreeing leave. It may also involve having the research proposal checked and agreed by one or more ethics committees. While not all countries have ethics committees, many – if the researcher wants to access patients or healthcare workers – do. Clearly, adjustments may have to be made to a proposal in the light of an ethics committee decision and there is always the possibility that a proposal may be rejected by such a committee.

The issue of having to obtain ethical approval and also of obtaining informed consent from informants may add a problem to the research plan. If the researcher wants to collect ‘naturalistic’ data – data about ordinary people, doing ordinary things in a ‘natural’ rather than controlled environment, the fact of their knowing that research on them is taking place may alter their behaviour. Thus, the resulting study is not one of ‘natural observation’ but ‘observation of people who know they are being studied’. In the end, there is no easy answer to this issue. It is right and proper that ethical approval and consent to take part in a study are obtained and these two take precedent over the ‘authenticity’ of the study. Clearly, however, there are instances where it is impossible to get consent (e.g., in an observational study of risky behaviour in crowds, it would be impractical to seek consent from every member of a football audience). By the same token, in such situations the degree of intrusion into an individual’s life is trivial, and so the need for their consent is thereby diminished.

Fourth, the researcher has to move into the field. This means making personal adjustments to life in a different place and a different culture, and this can be as true of researching in an unfamiliar culture in one’s own country (say, amongst homeless intravenous drug users) as in the more obviously different environment of an overseas study. At first, everything seems new and different. This can be both a good and a bad thing. The good thing is that the researcher arrives with ‘fresh eyes’ and notices all those things that might be lost to a person who was native to that culture. The bad thing is that all this new input may daze the researcher and he or she may be unsure either what to note and record or what it all means. This is sometimes called ‘ethnographic dazzle’. In the author’s experience, it is surprising how quickly this initial phase passes and the ‘strange’ becomes ‘ordinary’. Everyone wants to fit in and become comfortable in the place they are living – even if they are living there only temporarily. As a result, we probably try to accept what is going on very quickly. Again, this is both good and bad news for the ethnographic researcher. On the one hand, he or she quickly adapts to cultural differences. On the other hand, a considerable amount of cultural sensitivity may be lost in the process. The researcher may, fairly quickly, take for granted that which he or she observes. Added to this is the possibility that the researcher’s taken-for-granted view of what he or she observes may be erroneous – in the understandable rush that he or she has to ‘fit in’.

Fifth, the researcher needs to collect data and the methods used for this are described below – as are the methods used to analyse and report on those data.

Finally, the researcher removes him or herself from the field and is free to ponder on the experiences that have been observed. Again, there are positive and negative elements to this withdrawal. Being distanced from the field allows time for reflection and consideration of the data. However, the very fact of being out of the culture may mean that erroneous conclusions are drawn from that data. It is very easy to theorise about culture when the person is many miles away from it. There may also be little opportunity for ‘fact checking’ with a person or a respondent from the culture that has been observed. Consideration should always be made, in initial planning, to make sure, where at all possible, that such contacts are available. We have found that the best solution to this problem is, when possible, to undertake joint research with a person who is native to the culture under consideration. This may mean linking with a colleague who is an HCP, a researcher, or simply someone who lives in the culture.

General methods used in ethnographic research

The aim of ethnographic research, as we have seen, is to capture something of another culture. Thus, the ethnographer or ethnographic researcher uses his or her senses to capture aspects of that culture. A summary of the methods used in this approach is now described. Everyday observation is one of the major methods. The ethnographer lives in the chosen setting, observes what is going on and keeps detailed ‘fieldnotes’. He or she has constantly to question what is being observed. It is a fact that we carry our own culture with us at all times and tend, if we are not careful, to compare and contrast everything we see with our own cultural beliefs and our own learned behaviour. Thus, we may erroneously draw conclusions about what we see in a different culture, based on our own background. The skilled ethnographer, then, tries hard to see things afresh and simply to act as a detached observer, while, at the same time, living amongst the people whom he or she is observing. Clearly, this is no easy task. The accent, in ethnographic research is on ‘normal’, everyday behaviour: the ethnographer is seeking to describe (and later, perhaps, to explain) how ordinary people, in different cultures, live their lives.

Alongside observation, the ethnographer talks to people and tries to get them to explain aspects of their culture. This is done through interview, conversation and even through chance encounters on an everyday basis. The point, again, is not simply to compare and contrast what others do with the cultural background of the researcher but to attempt to describe what is going on, in the culture’s own terms. Again, this is not an easy thing to achieve. It is easy for the ethnographer to draw the wrong conclusions based on his or her own lack of understanding of the ‘different’ culture. Similarly, the person who ‘in’ the other culture may not question his or her own practices nor even know why he or she does something in a particular way. We are all, to a small or large extent, blind to our own culture.

An example, here, may help and it is drawn from my own (PB) experience of doing ethnographic research, in healthcare communication, in Thailand.

In Thailand, when people go out for a meal, it is standard practice for the most senior person at the table to pay the bill. This is also true for friends or colleagues going out for a drink in a bar (in Thai bars, all drinks are paid for when people leave the bar and not on a pay-as-you-go basis as is the case in some countries – including the UK). The senior and junior issue, in Thailand, is an important one and all Thais are able to assess, very quickly, who is senior and who is junior to them. This, broadly, can be identified in terms of the other person’s age, their relative wealth, their job title, but also in a range of other, more subtle ways. Suffice to say that Thai people do not usually make mistakes in these distinctions.

This senior–junior ranking, although it happens, is not so clear-cut in Northern European or American countries. So, let us consider a Northern European person observing the end of a meal at a restaurant in Thailand. He or she observes that one person picks up the bill for all of those present. That person does not suggest a sharing of the bill and no one else at the table makes such an offer. The bill is received and paid quickly. To the Thai person, this is not remarkable and would neither be commented on or thought about. It just happens. However, to the Northern European observer, a variety of ‘wrong’ conclusions may be drawn. First, he or she might think that the person who paid the bill had invited all the other guests for a meal. Second, he or she might imagine that the person who paid was ‘generous’. Third, he or she may believe that the person paying the bill is in some way ‘returning the compliment’ and choosing to pay, having been at previous meals where others paid. Without cultural insight, that observer is very unlikely to appreciate the ‘real’ reason behind this action. Thus, the observer is ‘blind’ to an aspect of culture, while the Thai guests think nothing of it. If this meal was to be part of an ethnographic study, an important aspect of Thai culture might be lost.

The ethnographic researcher, then, has constantly to challenge the ordinary and to be prepared to ask the questions: ‘why does that happen?’, ‘how did that happen?’ or ‘what does that mean?’ Those questions must be addressed both, internally, to the researcher him or herself and to those he or she observes or talks to. This often involves great tact and diplomacy. The author recalls being asked, by a group of friends, in Thai bar: ‘why do you ask so many strange questions?’

Interviews, in ethnographic research, need to be recorded. While this is normally done with the aid of a tape recorder, as noted in Chapter 7, this may not be practical in natural, informal settings, in which case very detailed notes are an important substitute.

Consideration needs to be given to the storing of data when the researcher is in the field. This may be done through the use of notebooks, or – better – through the use of a laptop computer. If the former method is used, notebooks must be safely stored and if the later method is used, regular back-ups to a CD ROM or a USB portable storage device should be made. Another safety measure is to e-mail data files to yourself, the researcher. On returning home, the data are then safely stored in your e-mail account.

Fieldnotes should be kept. It is useful to complete these, where possible, at the same time, every day. Time should be set aside to type up an account of what has been observed and what has been done during the day. These notes can include tentative theories about what has been observed and include useful reference material. As is always the case, references to papers and research should be very carefully recorded so that those references can lead directly to the papers themselves.

Notes, on computer, can either be stored in word-processing files or by using a freeform database such as askSam or OneNote. While most database programs are highly structured in their layout, these programs allow you to store notes of any length, each as separate ‘cards’ in the database system. Particular pages can then be found or the entire database can be searched using keywords or Boolean operators (e.g. undertaking searches such as ‘Stress NOT physiotherapist’, will identify pages that contain information about stress but not pages that include the terms ‘stress’ and ‘physiotherapist’. Other operators can also be used). These freeform database programs serve as useful containers for large amounts of textual information, linked to a particular project. They can also contain photos, graphics and other forms of computer data – including pages from the internet.

As we have noted, it is useful to make notes about ideas and theories as the research project unfolds. However, as with all theorising, it is best to keep theory to the absolute minimum and to proceed with great caution in developing those theories. The more elaborate the theory, the more likely it is to be wrong. It is often tempting to feel: ‘I understand why that is happening!’ but it is also vital to look for what can be called disconfirming evidence. In other words, as a potential theory emerges from the data, the researcher must always be asking: ‘Could I be wrong?’ and search for evidence that confounds the theory. In many cases, searching in this way will lead the researcher to question the appropriateness or ‘fit’ of the theory.

What should be observed?

This is a question that often baffles the first time ethnographic researcher. Much will depend upon how clearly the initial research question has been articulated. A clear question can direct the researcher to make fairly specific observations (by ‘observations’, in this context, we mean: ‘what should be observed and what should be talked and asked about?’) On the other hand, by its nature ethnography is concerned with the description of culture and this is, necessarily, often wide ranging. Many ordinary and everyday events can easily impinge on a wide range of (for example) healthcare practices.

A metaphor that may serve to help in this debate is that of a camera. Sometimes, the photographer will want a broad, landscape shot of a scene. At other times, he or she will want to zoom in on a detail, thus leaving out much of the background information. Similarly, the ethnographic researcher might want to work on two levels. First, he or she should remain open to observing very general, everyday practices within the culture under observation. Thus, fieldnotes might include details of a trip to the supermarket as well as the layout of hospital wards. Both of these areas are part of people’s everyday, cultural experience.

However, he or she should be prepared, very quickly, to home in on particular, focused situations. What, for example, does an occupational therapist do when he or she talks to a patient about going home? What does he or she say? Where does he or she choose to speak to the patient? How does the patient respond? And then the researcher may choose to ‘pan out’ to the larger picture. How does this sort of episode fit into the broader life of the ward, the hospital and the community?

Another aid to considering what to observe is through the use of the idea of rules. Arguably, nations, communities, families and even individuals are governed by rules. There are written and unwritten rules for just about everything. There are, for example, rules about how to behave at funerals that are quite different from the rules governing weddings. There are rules about how to be a student radiographer as well as rules about how to be a radiography lecturer. There are rules about living with another person and about living in a street and in a town. The effective ethnographic researcher can often structure his or her observation by fairly frequently asking the question – in any context – ‘what are the rules at work here?’ This is a variant on the questions: ‘why does this happen?’ and ‘what is going on here?’ Attempting to codify or record the rules governing the way in which people work and live together, in this particular context, at this particular time, is often a fruitful way to proceed in ethnographic research.

Analysis

Once back home, the ethnographer is charged with analysing the data and organising it into readable passages of text. Perhaps the most usual way of doing this is to employ a form of content analysis – an umbrella term for a range of ways of organising textual data. Examples of how to do this are elaborated in Chapter 11, which explores qualitative data analysis in detail.

Once the data have been analysed, the (almost) final stage of the process is to write the research report (the final stage of any research project being the publication of findings in a journal or as a book). There are various styles of reporting. Some ethnographic accounts leave out details of previous literature and even of the methods used to collect and analyse the data. Most recently, however, the tendency has been for ethnographers to report their findings, more formally, in the style adopted by most other researchers.

As is the case with other types of qualitative research, there are two options in writing up the findings. One is to link the new findings from the study with other people’s research and theories. The other is to present only the findings of the new study and relate them to other research only in the discussion. Here are two examples. The first is a reporting (of a fictitious project), with references to other people’s work. The second is ‘straight’ reporting.

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