Chapter 9: Ethnography

What is ethnography?

The key concept in ethnography is culture.

Ethnography studies emerged from the discipline of anthropology. They aim to understand the meanings and behaviours associated with the membership of groups, teams, organisations and communities.¹ The focus of ethnographic research is on the lived culture of groups of people; ethnographers have studied systems of belief, religious frameworks, worldviews and structures that form the social world. There are many definitions of culture. In ethnography, culture is defined as the group norms and expectations that allow members of the group to communicate and work together. This includes attributes, beliefs, customs, behaviours, knowledge, capabilities and habits. Examples of cultural groups include people from a particular region or race, religious groups, organisational groups, workplaces and social groups (for example, friendship groups, and mothers groups). Note that culture is dynamic and socially constructed and it is normal for there to be sub-cultures within cultural groups.²

Multiple methods can be used in ethnographic research, but participant observation is a hallmark method.^1,3 To explore culture requires a ‘triangulation’; that is,  the use of multiple methods, such as observations and interviews, to develop a comprehensive understanding of culture through observing people and listening to what they have to say about (or within) the culture.

Several approaches to data analysis lend themselves to ethnography, including the identification, study and analysis of patterns. The process of analysis follows a typically unstructured and iterative path consisting of description (describing data), analysis (examining relationships and linkages) and interpretation (explanations beyond analysis).⁴

There are other key concepts in ethnographic research, which are outlined below.

Additional key concepts in ethnographic research

• Fieldwork and field notes – the time spent engaging in primary data collection, which is predominantly participant observation, and the mode of data collection. Fieldwork is the time spent immersed in the culture under study, while field notes are the written reflections, observations and ideas documented during or soon after fieldwork.⁵
• Participant observation – the main method of data collection in ethnography involves the researcher participating as a member of the community or culture, to gain first-hand experience of daily life in the research setting.⁵
• An emic perspective – ethnography seeks to understand the worldview of the participant; it thus follows that the researcher can have an emic perspective (insider) or an etic perspective (outsider). This is not a binary category. Rather, researchers might be considered on a continuum, from emic to etic⁶ (see Chapter 28 for an overview of insider and outsider research), and therefore reflexivity (Chapter 30) and researcher positionality (Chapter 28) are important elements of the research process. Implementing ‘insider’ ethnography: lessons from the Public Conversations about HIV/AIDS project in rural South Africa describes an ethnography project involving insider community members and outsider investigators reflecting on the advantages and challenges of this approach.⁷
• Thick description – the researcher creates detailed observational field notes with references to the social actions and behaviours of participants. The field notes include anecdotes, observations about the language used and quotes to illustrate the activities of the cultural group being observed. The researcher then integrates theoretical frameworks to help create meaning for the observations.⁸
• Holism – ethnography focuses on studying all aspects of a culture, including religious practices, politics, institutions, family structures and cultural traditions. Using the analogy of the structure of the human body, Bronislaw Malinowski, one of the founders of the functionalist school of anthropology, described survey research as the skeleton and ethnography as the flesh and blood.⁴

How long researchers spend conducting observations in the field depends on the research question and context. For example, in research to observe and characterise the behaviours and processes of antimicrobial decision-making in two surgical units of an acute hospital setting, researchers spent 58 hours in participant observation at three points of care: pre-admission clinic, surgery and on the ward following surgery. These three points of care were chosen as key moments in the patient’s experience of surgery. The observations were conducted in an acute hospital where medical practice is process-driven and protocol-driven. Hence, it did not take extensive time to observe the typical process and protocol in this setting. Researchers used an observation audit sheet (see Chapter 15) and informed participants that the study was focused on clinical decision-making, rather than specifically antimicrobial prescribing. This was done to minimise the ‘Hawthorne effect’, whereby people are said to change their behaviour because they know they are being observed. Following participant observations, six semi-structured interviews were conducted with two surgeons and four anaesthetists to clarify and discuss the findings of the observations. Interview data were analysed thematically, using inductive and deductive coding.⁹

In contrast, an ethnographic study of homecare workers supporting people living with dementia involved 100 hours of participant observations of 16 homecare workers who were supporting 17 people living with dementia. Interviews were conducted with 82 people, including people living with dementia, family carers, homecare managers and support staff, homecare workers, and health and social care professionals.¹⁰

Advantages and challenges of ethnography

The immersive approach to ethnography enables a nuanced understanding of the cultural group under study. Unlike other research designs, the prolonged engagement with the research setting provides an opportunity to refine and iterate research questions leading to a deeper understanding of the phenomenon. Participant observation provides a first hand of the behaviours and interactions of people within a cultural group which can be triangulated with interviews and documents to increase the rigour of the research.⁹

There are many challenges in conducting ethnographic research. The time required to undertake ethnographic fieldwork can range from short sessions of observations over months or years, to the researcher living in the community for a period of time. The resources and time required may be substantial. When a researcher is embedded within a community, their departure can cause anxiety and distress for both the researcher and the community members. This experience was described by Paolo Franco, who spent 18 months conducting fieldwork in a retirement village, as a volunteer technology supporter for the residents. Franco described how the participants became dependent on his technology service as well as socially and emotionally connected to him as the researcher. To mitigate problems occurring with a researcher withdraws from a research setting, the researcher should let participants know as early as possible about their estimated time in the community, and should have a plan for their exit.¹¹

Another key challenge in ethnography is gaining access to ‘the field’ and enlisting the support of gatekeepers. Careful planning and engagement are required to ensure communication channels are open and positive relationships are established. Managing ethical conduct is another important consideration in ethnography. Researchers need to consider how much they will disclose to participants about the purpose of the research, and whether they will be covert (undercover) or overt (open and transparent) in their approach to fieldwork. For the most part, researchers are overt about their research, hoping that participants will ‘forget’ that they are being studied and will revert to natural behaviours.⁵

Table 9.1 provides two examples of ethnography from health and social care.

Table 9.1. Ethnographic examples

Summary

Ethnography focuses on understanding culture and the behaviours, experiences and meanings at the group level. The main method of data collection is participant observation, which can be combined with interviews, focus groups and field notes to inform interpretations of the research topic.

References

1. Reeves S, Kuper A, Hodges BD. Qualitative research methodologies: ethnography. BMJ. 2008;337:a1020. doi:10.1136/bmj.a1020
2. Hudelson PM. Culture and quality: an anthropological perspective. Int J Qual Health Care. 2004;16(5):345-346. doi:10.1093/intqhc/mzh076
3. Strudwick RM. Ethnographic research in healthcare – patients and service users as participants. Disabil Rehabil. 2020;43(22):3271-327. doi:10.1080/09638288.2020.1741695
4. Reeves S, Peller J, Goldman J, Kitto S. Ethnography in qualitative educational research: AMEE Guide No. 80. Med Teach. 2013;35(8):e1365-e1379. doi:10.3109/0142159X.2013.804977
5. O’Reilly K, Bone JH. Key Concepts in Ethnography. The SAGE Key Concepts Series. SAGE; 2009.
6. Eriksson P, Kovalainen A. Qualitative Methods in Business Research. SAGE; 2008.
7. Angotti N, Sennott C. Implementing ‘insider’ ethnography: lessons from the Public Conversations about HIV/AIDS project in rural South Africa. Qual Res. 2015;15(4):437-453. doi:10.1177/1468794114543402
8. Clark L, Chevrette R. Thick Description. In: Matthes J, Davis CS, Potter RE, eds. The International Encyclopedia of Communication Research Methods: John Wiley & Sons; 2017.
9. Jackson J. Ethnography. In: Hua Z, ed. Research Methods in Intercultural Communication. John Wiley & Sons; 2015.
10. Leverton M, Burton A, Beresford-Dent J, et al. Supporting independence at home for people living with dementia: a qualitative ethnographic study of homecare. Soc Psychiatry Psychiatr Epidemiol. 2021;56(12):2323-2336. doi:10.1007/s00127-021-02084-y
11. Franco P, Yang YN. Existing fieldwork ‘with grace’: reflections on the unintended consequences of participant observation and researcher-participant relationships. Qualitative Market Research. 2021;24(3):358-374. doi:10.1108/QMR-07-2020-0094
12. Johnson EK. The costs of care: an ethnography of care work in residential homes for older people. Sociol Health Illn. 2023;45(1):54-69. doi:10.1111/1467-9566.13546
13. Kitson C, Haines M, O’Byrne P. Understanding the perspectives of women who use intravenous drugs and are experiencing homelessness in an urban centre in Canada: an analysis of ethnographic data. Glob Qual Nurs Res. Published online March 20, 2022. doi:10.1177/23333936221080935