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Qualitative research: Qualitative research methodologies: Ethnography

  • Kingston University & St George's, University of London


The previous articles (there were 2 before this 1) in this series discussed several methodological approaches commonly used by qualitative researchers in the health professions. This article focuses on another important qualitative methodology: ethnography. It provides background for those who will encounter this methodology in their reading rather than instructions for carrying out such research. Ethnography is the study of social interactions, behaviours, and perceptions that occur within groups, teams, organisations, and communities. Its roots can be traced back to anthropological studies of small, rural (and often remote) societies that were undertaken in the early 1900s, when researchers such as Bronislaw Malinowski and Alfred Radcliffe-Brown participated in these societies over long periods and documented their social arrangements and belief systems. This approach was later adopted by members of the Chicago School of Sociology (for example, Everett Hughes, Robert Park, Louis Wirth) and applied to a variety of urban settings in their studies of social life. The central aim of ethnography is to provide rich, holistic insights into people’s views and actions, as well as the nature (that is, sights, sounds) of the location they inhabit, through the collection of detailed observations and interviews. As Hammersley states, “The task [of ethnographers] is to document the culture, the perspectives and practices, of the people in these settings. The aim is to ‘get inside’ the way each group of people sees the world.”1 Box 1 outlines the key features of ethnographic research. #### Box 1 Key features of ethnographic research2
Qualitative research methodologies: ethnography
Scott Reeves,
Ayelet Kuper,
Brian David Hodges
The previous articles in this series discussed several
methodological approaches commonly used by
qualitative researchers in the health professions. This
article focuses on another important qualitative meth-
odology: ethnography. It provides background for
those who will encounter this methodology in their
reading rather than instructions for carrying out such
What is ethnography?
Ethnography is the study of social interactions,
behaviours, and perceptions that occur within groups,
teams, organisations, and communities. Its roots can be
traced back to anthropological studies of small, rural
(and often remote) societies that were undertaken in the
early 1900s, when researchers such as Bronislaw
Malinowski and Alfred Radcliffe-Brown participated
in these societies over long periods and documented
their social arrangements and belief systems. This
approach was later adopted by members of the
Chicago School of Sociology (for example, Everett
Hughes, Robert Park, Louis Wirth) and applied to a
variety of urban settings in their studies of social life.
The central aim of ethnography is to provide rich,
holistic insights into peoples views and actions, as well
as the nature (that is, sights, sounds) of the location they
inhabit, through the collection of detailed observations
and interviews. As Hammersley states, The task [of
ethnographers] is to document the culture, the
perspectives and practices, of the people in these
settings. The aim is to get insidethe way each group of
people sees the world.
Box 1 outlines the key features
of ethnographic research.
Examples of ethnographic research within the health
services literature include Strausss study of achieving
and maintaining order between managers, clinicians,
and patients within psychiatric hospital settings; Taxis
and Barbers exploration of intravenous medication
errors in acute care hospitals; Costellos examination
of death and dying in elderly care wards; and
Østerlunds work on doctorsand nursesuse of
traditional and digital information systems in their
clinical communications.
Becker and colleagues
Boys in White, an ethnographic study of medical
education in the late 1950s, remains a classic in this
Newer developments in ethnographic inquiry
include auto-ethnography, in which researchersown
thoughts and perspectives from their social interactions
form the central element of a study
; meta-ethnogra-
phy, in which qualitative research texts are analysed
and synthesised to empirically create new insights and
; and online (or virtual) ethnography,
which extends traditional notions of ethnographic
study from situated observation and face to face
researcher-participant interaction to technologically
mediated interactions in online networks and
What should I be looking for in an ethnographic study?
Ethnographers typically gather participant observa-
tions, necessitating direct engagement and involve-
ment with the world they are studying. Owing to the
complex nature of social life, ethnographers need to
record a variety of elements in their field notes
(box 2).
This is the third in a series of six
articles that aim to help readers to
critically appraise the increasing
number of qualitative research
articles in clinical journals. The
series editors are Ayelet Kuper and
Scott Reeves.
For a definition of general terms
relating to qualitative research,
see the first article in this series
Box 1 Key features of ethnographic research
A strong emphasis on exploring the nature of a
particular social phenomenon, rather than setting out
to test hypotheses about it
A tendency to work primarily with
unstructured data
that is, data that have not been coded at the point of
data collection as a closed set of analytical categories
Investigation of a small number of cases (perhaps
even just one case) in detail
Analysis of data that involves explicit interpretation of
the meanings and functions of human actions; the
product of this analysis primarily takes the form of
verbal descriptions and explanations
Box 2 Nine observational dimensions and their
Physical layout of the place(s)
Range of people involved
A set of related activities that occur
The physical things that are present
Single actions people undertake
Activities that people carry out
The sequencing of events that occur
Things that people are trying to accomplish
Emotions felt and expressed
Department of Psychiatry, Li Ka
Shing Knowled ge Institute, Centre
for Faculty Development, and
Wilson Centre for Research in
Education, University of Toronto,
200 Elizabeth Street, Eaton South
1-565, Toronto, ON, Canada
M5G 2C4
Department of Medicine,
Sunnybrook Health Sciences
Centre, and Wilson Centre for
Research in Education, Univer sity
of Toronto, Toronto, ON, Canada
M4N 3M5
Department of Psychiatry, Wilson
Centre for Research in Education,
University of Toronto, Toronto,
ON, Canada M5G 2C4
Correspondence to: S Reeves
Cite this as:
doi:10.1136/ bmj.a1020
512 BMJ |30 AUGUST 2008 |VOLUME 337
During their observations, ethnographers routi-
nely use informal or conversational interviews,
which allow them to discuss, probe emerging issues,
or ask questions about unusual events in a naturalistic
manner. Because of the casualnature of this
type of interview technique it can be useful in
eliciting highly candid accounts from individuals.
Ethnographers also gather formal in-depth inter-
views and documentary data such as minutes of
meetings, diaries, and photographs.
Participants or situations are sampled on an oppor-
tunistic or purposive basis. It is also usual for
ethnographers to focus upon specific features (for
example, medical ward rounds) that occur within a
research setting.
Analysis of ethnographic data tends to be under-
taken in an inductive thematic manner: data are
examined to identify and to categorise themes and
key issues that emergefrom the data. Through a
careful analysis of their data, using this inductive
process, ethnographers generate tentative theoretical
explanations from their empirical work.
Reflexivity (that is, the relationship a researcher
shares with the world he or she is investigating) is a
central element of ethnographic work, owing to the
relationship the ethnographer shares with participants
and the ethical issues that flow from this close relation-
ship. Within research reports, reflexivity is presented in
the form of a description of the ethnographers ideas
and experiences, which can be used by readers to judge
the possible impact of these influences on a study.
To enhance the quality of their work, ethnographers
will often provide a detailed or thick descriptionof
the research setting and its participants, which will
typically be based on many hours of direct observation
and interviews with several key informants.
Box 3 Triangulation in ethnography
Triangulation is a term linked to navigation or surveying:
people discover their position on a map by taking bearings
on landmarks, and where the lines intersect is where they
are positioned. As well as methodological triangulation,
outlines three other types:
Data triangulation, which uses different sources of data to
examine a phenomenon in several different settings and
different points in time or space
Investigator triangulation, which uses multiple
researchers to generate a complex range of perspectives
on the data
Theory triangulation, in which researchers approach data
with different concepts and theories to see how each
helps to understand the data
Box 4 An ethnographic studyof professional relationships
This ethnographic study took place in a large general
hospital in the United Kingdom.
It aimed to understand,
in depth, the nature of hospital based nurse-doctor
relationships in the wake of changes to health policy and
to the delivery of professional education.
The author, a nurse, undertook participant observations
for 10 months, during which she worked as a nurse (on an
unpaid basis) with doctors, nurses, managers, and
auxiliary staff on both a surgical and a medical ward. To
gain a candid insight into these professionals
views, she
undertook informal interviews with staff while they worked
together. She also collected 57 tape recorded interviews,
each lasting 60 to 90 minutes, with nurses, doctors,
auxiliaries, and managers. These explored in more depth
views of their interprofessional
relationships. Documentary data were also generated
through analysis of organisational documents and
through attendance at professional and managerial
The author undertook an inductive approach to data
analysis, in which meanings emerged from the data
through exploration of all data sets. In addition, she used
data from different sources (observations, interviews,
documentary data) to generate a more comprehensive
understanding in the emerging analysis. The author drew
upon negotiated order perspective
a sociological theory
developed by Strauss to frame and illuminate the findings
from her analysis. She also discussed her reflexive role in
the study, and as a nurse, how that helped her secure
access into this clinical setting, and how it helped her
attain richer insights into the nature of nurse-doctor
relationships in relation to how they negotiate
professional boundaries in their clinical work.
Further reading
Atkinson P, Coffey A, Delamont S, Lofland J, Lofland L, eds.
Handbook of ethnography. London: Sage, 2001.
Fetterman D. Ethnography: step by step.2nded.London:
Sage, 1988.
Fielding N. Ethnography. In: Researching social life.
London: Sage, 1993:155-71.
Hammersley M, Atkinson P. Ethnography: principles in
practice. 2nd ed. London: Routledge, 1995.
Spradley J. The ethnographic interview. New York: Holt,
Journal articles
Atkinson P, Pugsley L. Making sense of ethnographic
research in medical education. Med Educ
Charmaz K, Oleson V. Ethnographic research in medical
sociology: its foci and distinctive contributions. Sociol
Methods Res 1997;25:452-94.
Fine G. Ten lies of ethnography. J Contemp Ethnogr
Jeffrey B, Troman G. Time for ethnography. Br Educ Res J
Savage J. Ethnography and health care. BMJ
BMJ |30 AUGUST 2008 |VOLUME 337 513
In addition, ethnographic work commonly uses
methodological triangulation
a technique designed
to compare and contrast different types of methods to
help provide more comprehensive insights into the
phenomenon under study. This type of triangulation
can be very useful, as sometimes what people say about
their actions can contrast with their actual behaviour.
Box 3 provides further information about triangulation
and the different types that can be employed within
ethnographic research.
Ethnographers often draw upon social sciences
for example, interactionism, feminism, and
postmodernism, to strengthen their research focus and
analyses. (The use of theory within qualitative research
is examined in more depth in another paper in this
series.) See box 3 for an example of an ethnographic
Why choose ethnography?
Ethnographic research offers several advantages. For
example, the use of participant observation enables
ethnographers to immersethemselves in a setting,
thereby generating a rich understanding of social
action and its subtleties in different contexts.
Participant observation also gives ethnographers
opportunities to gather empirical insights into social
practices that are normally hiddenfrom the public
gaze. Additionally, since it aims to generate holistic
social accounts, ethnographic research can identify,
explore, and link social phenomena which, on the
surface, have little connection with each other.
Ethnographic research can be problematic. Owing
to the relatively long periods of time ethnographers
spend talking to participants and observing actions, it
can be difficult to secure repeated access, especially if
institutional gatekeepers are concerned that the
research may cast their organisation in a poor light.
Obtaining formal approval from research ethics
committees can be complicated. The direct inter-
action that occurs between ethnographers and
patients or clinicians during fieldwork can be
regarded with suspicion, as traditional notions of
health services research rest on researchersdetach-
ment rather than involvement. Comprehensively
recording the multifaceted nature of social action
that occurs within a clinic or ward is a difficult task, as
a range of temporal, spatial, and behavioural
elements need to be documented (see box 1). In
addition, the unpredictability of social (and clinical)
life often means that ethnographers have to be
flexible, patient, and persistent in their work, as
data collection activities can be disrupted or access
withdrawn as local circumstances and politics
Ethnography is a highly useful methodology for
addressing a range of research questions within the
health professions. In particular, it can generate rich
and detailed accounts of cliniciansprofessional and
interprofessional relationships, their interactions with
patients, and their approaches to delivering care, as
well as in-depth accounts of patientscare experiences.
Understanding the foundations of ethnography and its
key elements will help readers when they come across
reports that use this methodology. A later article in this
series will provide readers with a more formal frame-
work to use when critically appraising qualitative
research papers, including ethnographies. Readers
interested in undertaking such research should refer
to the works listed in box 4.
Funding: None.
Competing interests: None declared.
Provenance and peer review: Commissioned; externally peer reviewed.
s wrong with ethnography? Methodological
explorations. London: Routledge, 1992.
2 Hammersley M, Atkinson P. Ethnography: principles in practice. 2nd
ed. London: Routledge, 1995
3 Strauss A, Schatzman D, Ehrlich R, Bucher M, Sabshin C. The hospital
and its negotiated order. In: Freidson E, ed. The hospital in modern
society. New York: Free Press, 1963:147-69.
4 Taxis K, Barber N. Causes of intravenous medication errors: an
ethnographic study. Qual Saf Health Care 2003;12:343-7.
5 Costello J. Nursing older dying patients: findings from an ethnographic
study of death and dying in elderly care wards. JAdvNurs
sterlund C. Genre combinations: a window into dynamic
communication practices. J Manage Inf Syst 2007;23:81-108.
7 BeckerH,GeerB,HughesE,StraussA.Boys in white: student culture
in medical school. Chicago: University of Chicago Press, 1961.
8Reed-DanahayD.Auto-ethnography: rewriting the self and the social.
London: Berg, 1997.
9 Britten N, Campbell R, Pope C, Donovan J, Morgan M, Pill R. Using
meta-ethnography to synthesise qualitative research: a worked
example. J Health Serv Res Policy 2002;7:209-15.
10 Hine C. Virtual ethnography. London: Sage, 2000.
11 Spradley J. Participant observation. New York: Holt, 1980
12 Geertz C. The interpretation of cultures: selected essays.NewYork:
Basic Books, 1973.
13 Strong P.The ceremonial order of the clinic. London: Routledge, 1977.
14 Denzin N. The research act in sociology. London:Butterworth, 1970.
15 Allen D. The nursing-medical boundary: a negotiated order? Sociol
Health Illn 1997;19:498-520.
Ethnography is the study of social interactions, behaviours,
and perceptions that occur withinteams, organisations,and
Ethnographic studies typically gather participant
observations and interviews; through using these methods
ethnographers can immerse themselves in settings and can
generate rich understanding of the social action that occurs
Owing to the relationship the ethnographer shares with
research participants, reflexivity (whereby ethnographers
describe the relationship they shares with the people and
world they are studying) occupies a central element of this
type of research
Ethnographers commonly triangulate (that is, compare and
contrast)interview and observation methods to enhance the
quality of their work; this technique is important as what
people say about their behaviour can contrast with their
actual actions
514 BMJ |30 AUGUST 2008 |VOLUME 337
... Rationale for selecting focused ethnography for the qualitative phase Ethnography can be described as the study of social interactions, behaviours and perceptions that occur within groups, teams, organisations and communities (Reeves and Hodges 2008). Traditional or classical ethnography originates from anthropological studies in the early 1990s, whereas focused ethnography has emerged more recently (Knoblauch 2005). ...
Background: Urinary tract infection is a leading cause of healthcare associated infection in hospitals with around half of these being attributable to indwelling urinary catheters. Overuse of urinary catheters in healthcare settings is a known problem yet the extent to which it is possible to avoid catheter use is unclear. Urine output monitoring is one of the main indications for short-term catheter use, with acute kidney injury (AKI) and sepsis as key drivers to detect oliguria (low urine output). However, published guidance lacks clarity on when a catheter is needed for urine output monitoring, fueling uncertainty and potential for overuse in clinical practice. Aim: The aim of this research is to explore how and why urine output is monitored in acute medical environments. Methods: A sequential, explanatory mixed methods study was designed. Two approaches to data collection were used: a point prevalence survey of 17 medical wards, using the whole source population as the sample and analysed using descriptive statistics, followed by a focused ethnography in an acute medical unit and a medicine for older people ward using a purposive sample and reflexive thematic analysis. Findings: The prevalence survey identified 107/389 (27.5%) patients had an indwelling urinary catheter. Almost half (n=49/107; 46%) were placed solely for the purpose of urine output monitoring. Most (n=87/107; 81%) catheters had a urine meter attached to enable 1-2 hourly measurements, but only 12% (n=7/60) were utilised for this purpose outside of critical care. The focused ethnography revealed how clinicians were influenced both by clinical and non-clinical rationales when justifying the need for a urinary catheter to monitor urine output. Distrust in the use of non-invasive collection methods was a significant contributing factor to catheter use. Conclusion: Urinary catheters are thought to champion the accuracy of urine output monitoring, but it is debatable whether the drive for accuracy is jeopardising rather than improving patient safety. The redundancy of most urine meters outside of critical care in one hospital reveals considerable potential for reduction in urinary catheters and thereby in catheter-associated infections. However, uncertainty about the reliability and practical application of non-invasive approaches for urine output monitoring is likely to hinder such reduction and requires further investigation.
... knowledge is relative to differences in perception, and is mind-dependent) and epistemological constructivism (i.e. knowledge is constructed) were used to provide rich qualitative understandings of the social dynamics within a community PA exercise setting (Reeves, Kuper, and Hodges 2008). Ethnography is rooted in anthropology, and involves the application of fieldwork, including various methods, such as participant observation, for understanding and making sense of cultural and social life (Coffey 2021). ...
... To explore the influence of IPE on students' perceptions and experiences in clinical practice, we conducted a qualitative interview study. Using a constructivist paradigm, the data were collected/produced and analyzed based on experiences of participants and through interaction between participants and researchers [20]. ...
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Background Interprofessional education (IPE) aims to improve students’ collaborative competencies and behaviour. The effect of classroom IPE on students’ perceptions of collaboration in clinical practice, and how knowledge is possibly transferred, has yet to be investigated. The research question of this study was: How does IPE in a classroom setting influence students’ perceptions of collaboration in clinical practice? Social capital theory is used as the theoretical lens. Social capital theory describes how social relationships generate benefits for the individuals involved. Social capital can be divided into three forms of social cohesion: bonding, bridging and linking social capital. Bonding refers to connections that are close and strong, such as family. Bridging social capital occurs in more distant relationships. Linking social capital refers to relationships between individuals with different power or social status. Methods A qualitative study with semi-structured face-to-face interviews was conducted to explore students’ perceptions and experiences. Nursing and medical students who had participated in four classroom IPE-sessions were asked about the perceived influence of the IPE-sessions they had attended on their interprofessional collaboration. Thematic analysis was conducted, with sensitising concepts of ‘bonding’, ‘bridging’ and ‘linking social capital’ from the social capital theory. Results Twenty-two interviews were conducted. Students experienced: 1) exchange of discipline specific knowledge, 2) general knowledge about each other’s responsibilities, 3) reduction of hierarchy, and 4) improvement in patient care. The first two themes reflect bridging social capital, since students experience that the other student is from a different group. The third theme reflects linking social capital, since students experience a difference in (social) status. The fourth theme most explicitly reflects ‘getting ahead’ or doing better, what is referred to as an effect of increased social capital. Conclusion This study reveals new insights regarding how increased social capital of undergraduate students after IPE-sessions in a classroom setting influences the way they conceptualise and experience interprofessional collaboration in clinical practice. These insights contribute to the understanding of the effectiveness of IPE in undergraduate curricula. Further research on long-term effects is underway.
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This study sought to investigate the role of ICTs in democratizing public information access. It was guided by four objectives: To determine digital options for capturing and recording parliamentary proceedings; to assess the utilization of information communication technologies in parliament; to find out the attitudes of MPs to digital media resources as well as their perception to its use and value; and to establish the extent to which use of digital platforms by parliament facilitate interactive public discussion. The study used a descriptive survey research design. The target population of this study was all Members of Parliament and Parliamentary Service Commission employees. There are 416 MPs and 532 employees of PSC according to Parliamentary Service Commission Strategic Plan 2008 – 2018 that was revised in 2012. The study sampled 10% of the MPs and Parliamentary Service Commission employees which translated into 98 respondents. Quantitative data from structured questionnaires was analyzed using descriptive statistics such as mean scores, frequencies and percentages. The results of quantitative data analysis were presented in charts and tables.
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The usability of Mobile commerce (M-commerce) websites is a key parameter in determining the success of M-commerce businesses. Literature shows that numerous M-commerce websites have failed to attract customers due to the poor usability of user interfaces. In order to offer superior quality shopping experiences to consumers, it is thus essential to determine the appropriate attributes of successful user interfaces as well as the evaluation methods which should be employed to measure them. The available research resources consulted contained few references to usability evaluation, the identification of appropriate attributes as well as evaluation methods to be used for M-commerce applications. Consequently, the researcher proposes a new usability model for M-commerce websites to determine the suitability of attributes to be included in the proposed model for M-commerce websites. This research work aims to address the imbalance in literature by determining the appropriate attributes of the proposed usability model for usability evaluations of M-commerce applications. In an effort to validate the proposed usability model, an appropriate method to assess usability was formulated to evaluate existing M-commerce websites. The inappropriate application of usability methods will result in major usability problems which will, in turn, negatively impact users’ experiences. To facilitate improved M-commerce user experiences, this study set out to determine appropriate attributes of usability model as well as formulate a domain-specific usability evaluation method to ascertain the usability of said websites. The research work applied a combination of a user-based evaluation method and the proposed domain-specific evaluation method to evaluate the usability of four selected M-commerce websites. The outcomes of the study, which aided in the development of a framework for the usability evaluation of M-commerce websites, highlighted the effectiveness of the methods. Therefore, the proposed framework will prove useful to both new, and well-established M-commerce providers, as it will help guide usability professionals as to which evaluation method to choose for a specific usability problem area when evaluating the usability of M-commerce websites.
Ecosystem governance is a highly contested issue where competing human stakeholder groups wield unequal power over nonhuman species. Pluralistic approaches to ecosystem governance consider a diversity of voices and disciplines to apply translational ecological knowledge to policy. However, the rights, agency, and welfare of nonhuman species – at the abstract (macro) and individual (micro) levels – are rarely considered, distancing nonhumans from human interests. This ‘othering’, results in nonhumans being treated as subservient to humans in power relations, which can result in poor welfare and even death. This study draws on multispecies ethnography, posthumanism, multispecies livelihoods, decolonial ecology, and translational ecology literature to critically review current paradigms in ecosystem governance and questions how to represent nonhumans equitably in ecosystem governance. This essay also considers qualitative data collected during 15 months of a multi-sited, multispecies ethnographic study that explored wolf-human (Canis lupus) relations in the western United States during the Trump Administration. A pluralistic posthumanist wildlife-human coexistence framework for translational ecology is presented that emphasizes nonhumans’ rights, welfare, and agency in ecosystem governance.
Purpose The purpose of this study Artificial intelligence (AI) is one of the important emerging trends in information technology and is slowly being implemented in libraries. The researchers have presented a brief strengths, weaknesses, opportunities and threats (SWOT) analysis of the application of AI in Pakistani university libraries. Design/methodology/approach This study uses an ethnographic approach for data retrieval. Five chief librarians were interviewed by phone, during which they were asked to identify one key strength, weakness, opportunity and threat in terms of introducing AI technologies. The researchers have used a standard SWOT matrix to report the respondents’ comments. Findings AI is already slowly being introduced into Pakistani university libraries. While commenting on ways in which AI could help their libraries deliver more innovative services and better meet user needs, respondents expressed concern about the investment required in funding, time and staff. Research limitations/implications Further study is indicated to identify existing AI implementations in Pakistani university libraries and to assess relevant library users’ perspectives. This study is limited to brief, qualitative data; its main purpose is to validate the use of a SWOT analysis. Practical implications Given that AI-based tools are already being used in libraries to some degree regardless of location, now is an opportune time to develop strategies for implementing AI technologies more widely. A SWOT analysis can be used to identify and categorize challenges and risks specific to AI in a logical way to support strategic decision-making. Originality/value To date, no SWOT analysis has been conducted in the context of AI applications in libraries, let alone specifically university libraries in Pakistan.
Background Structural vulnerabilities for people who use drugs (PWUD) were exacerbated by the COVID-19 pandemic. In this context, federal lawmakers in the United States (U.S.) invoked an exemption to the 2008 Ryan Haight Act requiring in-person evaluation to prescribe buprenorphine for treatment of opioid use disorder (OUD), which allowed for the initiation and maintenance of buprenorphine via telehealth. Despite the potential for telehealth to address some of the geographic disparities in OUD treatment access, recent research has suggested that significant barriers to buprenorphine also exist at the pharmacy level. The purpose of this study was to qualitatively assess how efforts to increase access to buprenorphine via telehealth are implemented by prescribers and pharmacists and experienced by patients. Methods Participant observation and semi-structured interviews focused on telehealth for OUD treatment and buprenorphine prescribing and dispensing were conducted with patients (n = 19), prescribers and clinic staff (n = 24), and pharmacists (n = 10) in Pennsylvania and California between May 2020 - May 2021. Findings While participants stated that telehealth for OUD treatment was a welcome option, pharmacy-level barriers to buprenorphine persisted. Geographical distance from patient to provider or pharmacist continued to serve as “red flags” for pharmacists, leading to pharmacy-level “red tape:” gatekeeping measures including geographic restrictions, telephone prescription “confirmations,” prescription cancellations and refusals. Patients’ unmet expectations of buprenorphine access in some cases led to unanticipated risks including a return to injection drug use. Conclusion Challenges to increasing buprenorphine access persist in the U.S. even in settings where telehealth is implemented, and telehealth may inadvertently produce new barriers for some patients. Despite national support for policies aimed at increasing access to treatment for substance use disorders rather than punishment, policy shifts from punishment to treatment have not permeated evenly across all geographic areas and populations. Perceived threats of Drug Enforcement Administration (DEA) enforcement, and self-defensive institutional practices in pharmacies, reinforce ideologies of drug law enforcement, leading to poor patient outcomes including lack of buprenorphine access.
The aging population means that health systems rely on informal carers to meet the physical, psychological, and emotional needs of older people. In this context, it is particularly important to know the perceived quality of life of informal carers. Health studies highlight the close relationship between care work and the carer's objective health. Through a qualitative ethnographic methodology, by means of open interviews with carers from rural areas of Extremadura (Spain), this study deepens the knowledge of the emotional costs to which the figure of the informal carer is subjected. The authors approach the social-emotional dimension in places where it is not always possible for public health policies to be fully developed. In this situation, moreover, some moral characteristics of these environments take on special importance.
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Auto/Ethnography: Rewriting the Self and the Social. Deborah E. Reed-Danahay. ed. New York: Berg, 1997. xiv. 277 pp., contributors, notes, bibliography, index.
Medical sociology ranges from studies of formal medical care to those of health, healing, and caring practices outside the health care system. This field has had a history of ethnographic and qualitative research since its beginnings. Because few studies in medical sociology derive from immersion in a setting, the authors examine those qualitative works in which researchers and subjects had sustained contact. They focus only on major areas in which ethnographic contributions have clustered: (1) disability, chronic illness, and terminal illness; (2) caring and curing; (3) medical sociology in aging research; (4) socialization into health care professions; and (5) the ethnography of ethics. Throughout this review, the added value of ethnographic research to each specific area is noted. Ethnographic research has enriched medical sociology with its emphasis on descriptive detail, meanings, ongoing processes, and concepts. The article ends with a discussion of methodological considerations for conducting research and a summary statement.
For an occupational therapist unfamiliar with a culturally diverse treatment population, ethnographic interview is described as an appropriate method for assessing client group needs. This study describes the use of ethnographic interview as a tool which was culturally sensitive to the occupational behaviors of American Indians and Alaska Natives of the Northwest involved in drug and alcohol treatment. Results of the interviews helped the researcher identify sociocultural factors in the acquisition and maintenance of maladaptive behaviors. Recurring themes of the extended family network, the strength and complexity of social norms and codes, and the pervasiveness of alcohol use among this population are described in review of the literature and results of the interviews. Results of the Tennessee Self-concept Scale revealed an overall measure of self-esteem significantly lower than that of the normed population, and enerally supported rehabilitation issues originally identified by the f iterature and expanded on in the interviews. Implications for treatment discuss acceptance of the therapist by members of the culture, the concept of nonmterference, the role of purposeful activity, cultural identification and assimilation, and the use of group work.
In a recent paper in Sociology of Health and Illness, Svensson (1996) makes the case for adopting the negotiated order perspective as the most appropriate theoretical framework for understanding patterns of doctor-nurse interaction. Analysing interview data with nursing staff from surgical and medical wards in five Swedish hospitals, Svensson identifies key changes in the health care context which he suggests have created ‘negotiation space’ for nurses, leading to the evolution of new working relationships with doctors. In examining the relationship between negotiation processes and the wider structural context, Svensson addresses a theme that has remained an enduring interest of critics and supporters of the negotiated order perspective alike. Drawing on data generated on a surgical and a medical ward in a UK District General Hospital, this paper attempts to make a further contribution to this debate and also to sociological understanding of doctor-nurse relationships, by analysing some features of hospital work which inhibited face-to-face inter-occupational negotiations but which nevertheless resulted in the modification of the formal division of labour between nursing and medicine. The implications of these findings for the negotiated order perspective are considered, and the question is raised as to what researchers working within this tradition understand by ‘negotiation’ and how it can be studied.