Arguments for 'British Pluralism' in qualitative health research

AIMS OF THE STUDY: This paper examines the argument that certain qualitative research methods can be used in 'pure' forms. Whilst rigid adherence to particular published procedures might be possible, we argue that in many cases this is neither necessary nor more likely to increase the validity of the research outcome. METHODOLOGICAL PURITY: In examining the works of well-known claimants to particular research approaches such as grounded theory and phenomenology we show that purity of method is uncommon. In particular it is possible to demonstrate that all published qualitative methods are subject to their own underlying relativist philosophy. The implication of this is that all are social constructions and that their execution will necessarily be negotiated in time and context. CONCLUSION: We conclude that analysis of varied examples of qualitative research shows methods to be more flexible than is often admitted. What we describe as 'British Pluralism' is an attempt to accept this reality whilst maintaining rigour through integrity, clear accounts, reflexivity and constructive critique of one's own work and that of others.     

'Patient satisfaction': knowledge for ruling hospital reform--an institutional ethnography

Driven by funding restraint, Canadian health-care has undergone over a decade of significant reform. Hospitals are being restructured, as text-based practices of accountability bring a new business-orientation into hospital and clinical management. New forms of knowledge, generated through records of various sorts, are a necessary resource for managing care in the new environment. This paper's research uses Canadian sociologist Dorothy E. Smith's institutional ethnographic methodology to critically analyse one instance of text-based management. I analyse information about 'patient satisfaction' as it is generated through a patient survey (in which I was implicated through my involvement with a hospitalized family member). Subsequently, I have studied the management environment into which that information would be entered. I argue that in the instance analysed, the information becomes part of a dominant consumer oriented healthcare discourse that subordinates concerns about 'what actually happened' as a professional caregiver would have known it. On this basis, I contend that this sort of taken-for-granted approach to making decisions about quality care in hospitals may be seriously, even dangerously, flawed.     

A journey to becoming: the student nurse in transition

The study reported in this paper explored the nature of the transition experienced by student nurses in their journey to becoming qualified nurses. In keeping with the developing relationship between the disciplines of anthropology and nursing, the methodology of choice was ethnography. Data were collected by open-ended questionnaires and interviews with key informants from one English College of Nursing undertaking Diploma level Project 2000 Adult Branch Studies. Thematic analysis of the data revealed an ill-defined transition for the student nurse and this lack of clarity was being perpetuated for many by their dual role as both student nurse and worker. This was also creating a potential role conflict and a blurring of the boundaries between professional nursing and skilled health care work. The data also revealed two 'in limbo' states, a ritualized transition phase, and that the rationale for 'learning to become a nurse' retains the idealized and vocational imagery of nursing as helping and caring for sick people.     

The researcher's personal responses as a source of insight in the research process

Drawing on accounts of the author's personal responses while undertaking a qualitative study on the norms governing the relationship between nurses and mothers, it is argued that such responses, rather than being seen as a source of bias, have the potential to be a source of insight and interpretation in the research. This paper tells the 'inside' story of previously published research that was 'sanitized' by the omission of any reference to die researcher's subjective responses. The recognition of such researcher responses has implications for how research is supervised and presented.     

Medical practice and anthropological bias

The purpose of this article is twofold: to describe some of the biases common to anthropological investigations of healing, particularly Biomedical healing; and to suggest that the physician-anthropologist is uniquely positioned to avoid some of these biases and to make valid contributions to the understanding of the practice of healing. Biases described are methodological (the tendency to formal-symbolic analyses rather than practical-instrumental understandings of behavior, transference and the observer effect), ontological (due to the estrangement of the anthropologist from his culture, other disciplines and his subjects, romanticization of the Other and celebration of the exotic over the mundane), and conventional or stylistic (the minimal importance given to emotional or psychological aspects of behavior, the emphasis on visual and linguistic understanding over other forms of investigation, unsophisticated use of medical texts as an indicator of clinical practice, a characteristic mode of reductionism, and the failure to elicit the responses of the subjects to interpretations made by anthropologists). As native-ethnographer, the M.D./Ph.D. physician-anthropologist may avoid some of these biases and offer complementary interpretations of healing.     

Effects of social and spatial contexts on young latinas’ methamphetamine use initiation

ABSTRACT

In this article, we examine methamphetamine (meth) use initiation as influenced by Latinas’ social positions within institutions (e.g., family and economy). We conducted ethnographic fieldwork in five women’s residential substance use treatment facilities in Los Angeles County with women who considered meth to be their primary drug of choice. Using an urban ethnographic framing, we demonstrate the effects of low-income young Latinas’ spatial- and social-context rendered vulnerability to abuse and neglect, and the resulting emotional distress, on meth use initiation. When considering pathways to substance use intervention for vulnerable Latina girls and women, clinicians, researchers, and policy makers need to understand substance use pathways as dynamic processes to cope with psychosocial stress while living in communities with easy access to illicit substances such as methamphetamine.     

Anatomy of the Alzheimer's Respite Care Program (ARCP)

The Alzheimer's Respite Care Program is an innovative project designed to serve caregivers of Alzheimer's clients. This unique model offers both in-home and instilutionally based respite care. Two community organizations which offer Adult Day Care respite forged a partnership to coordinate and expand their continuum of care, bringing many of the benefits of a day care setting into the home. This paper compares the original project conceptualization with its current design today. Factors affecting this evolution are explored together with program modifications incorporated to more appropriately respond to local needs. Key marketing strategies are discussed coupled with a presentation of program successes and recommendations for the future.     

An institutional ethnography of prevention and treatment services for substance use disorders in the Dominican Republic

ABSTRACT

The Dominican Republic is thought to have significant epidemics of illicit drug use but lacks surveillance and formal analyses of the policy context of drug prevention and treatment services. We conducted an institutional ethnography of 15 drug service organisations in Santo Domingo and Boca Chica, Dominican Republic, to explore barriers and resources for drug abuse prevention and treatment. Here, we present a typology of drug service organisations based on their services, methods, and approach. We then draw on interviews with representatives of drug service institutions to describe the primary barriers to drug treatment and prevention services for drug users. We conclude with a focus on the policy priorities that could improve the conditions of health care for marginalised drug users in the Dominican Republic.     

‘They’re doing surgery on two people’: a meta‐ethnography of the influences on couples’ treatment decision making for prostate cancer

Background Current orthodoxy suggests that patients need to be provided with full information about their care and that treatment options should be discussed with patients and family members. This imperative is especially challenging when there is a lack of consensus about treatment effectiveness and equivocacy over different types of interventions. In the case of prostate cancer, evidence is contested as to the efficacy of different treatments. Thus, involving patients and their family members in treatment choices is complex and little is known about how patients and their partners process these decisions when there is uncertainty about different outcomes. This paper has reviewed the literature on the way couples approach such decision making in relation to treatment for prostate cancer. Objective A meta‐ethnographic synthesis of published qualitative papers that focused on the influences on patients’, and their partners’ treatment decision making for prostate cancer, was conducted in order to identify and understand barriers and facilitators which impact on this process. Results Our synthesis indicates that the couples’ relationship ‘dynamic’ provides a contextual background against which treatment decisions are negotiated and made. Discussion and conclusions We propose that the findings from this synthesis can enhance the potential for shared decision making for patients, and their partners, when facing a treatment decision for prostate cancer. By understanding the couples’ relationship dynamic pre‐diagnosis, clinicians may be able to tailor the communication and information provision to both patients and their partners, providing a personalized approach to treatment decision making.