There may be no wrong answers, but there are wrong questions: Avoiding pitfalls in qualitative interviewing

September 17, 2020 Leave a comment

We always tell our participants that there are no wrong answers, and it’s true. They are the experts, and if we’re not learning what we want from them, the blame is likely on us. Maybe our goals or our expectations for the research are misguided. Maybe we’re making some bad assumptions. Maybe, just maybe, we’re asking the wrong questions. The interviewer has a lot of power over what to ask and when to ask it during open-ended interviews and sometimes even the most experienced interviewer can make poor decisions. This article will cover some key interviewing pitfalls to avoid when conducting a qualitative interview. It isn’t an exhaustive list, so if you have any that I’ve forgotten or anything here that you disagree with, I’d love to hear from you!

Leading questions

Leading questions might be the first thing that comes to mind when thinking about interviews gone wrong, and researchers fall prey to asking leading questions all the time. They can come in a few, devious forms.

Leaning in on an answer. This is what most people think of when they think about leading questions: phrasing the question in a way that assumes the answer and in doing so, influences the participant to respond in a certain way. An example might be, “Do you wear your motorcycle helmet to give you a sense of security?” A better alternative might be, “Why do you wear a motorcycle helmet?” Leading questions shouldn’t be confused with mirroring questions (or “parroting” or “echoing” questions), confirming what the participant just said for clarification or to prompt additional information. The mirroring version would be something like, “What you’re saying is that wearing your motorcycle helmet gives you a sense of security?” That’s perfectly fine as long as you’re not sneaking little assumptions into your confirmations.

Narrowing the possibilities. Another way interviewers can lead a participant is by listing, and thereby limiting, potential responses. Here the interviewer may have the best intentions and funnel their participant unwittingly. Sometimes the participant is struggling with answering, and it can seem helpful to follow up with some possible direction. An example might be, “How do you use your cell phone…Do you text? Surf the web? Play games?”

These follow-up questions are unfortunate. For one, it can be helpful to know their first, top-of-mind answer, indicating it might be their most frequent or most important use. For me, if someone asked how I use my phone, my first answer might be, “I look to see if there are any good Burger King coupons.” If someone attached the list of examples to their question, I might start with “texting” instead and never even make it to my fast food addiction.

If you need specific information about their texting, you might start with an open-ended question (“What do you use your phone for?”) and if they don’t mention it on the first go around, you can follow up with questions about their texting habits.

Social influence. Social desirability bias is also an issue in quantitative research, but it can be especially potent in face-to-face, qualitative research. We often share our own experiences during our interviews and usually this is a totally harmless way to make the relationship more equitable and to build rapport. The danger is that it can key them into how we feel about whatever we’re studying and potentially steer their answers. It isn’t so much about asking the wrong questions as it is about being careful of what personal opinions to share. Studying politics? Don’t go in wearing your MAGA hat or your BLM shirt. Studying snacks? Don’t go in with orange fingers and lips, asking questions like, “I love Cheetos a lot, what do you think about them?”

Clustered questions

Another interview sin is bombarding participants with multiple questions at once. It can be a little overwhelming for the recipient of the onslaught, more like a college exam than a friendly conversation. Often the participant will answer just one of the questions, and maybe the interviewer will remember to return to the others, but maybe not.

Baffling questions

Ethnographers may be more prone to baffling questions than some other qualitative researchers. We are more likely to be looking at things like culture, social structures, and semiotics, and if we’re not careful, our questions can be overly abstract. Sometimes, we make the error of asking participants the same sort of “how the world works” questions that we’re asking ourselves in our analysis.

Questions might baffle participants when we use terms or concepts that only social scientists or marketers would understand. We can get so used to our jargon that we forget that it is jargon. Our questions also might be so removed from our participants’ experiences that they might seem absurd or even laughable to them. Market researchers are always asking people to think deeply about products and behaviors they normally don’t give much thought. “What kind of unmet needs do you have with your sour cream?” “How does taking your pills in the morning impact your sense of self?” Whatever package the baffling question comes wrapped in, the confused look of participants is always the same. Time to rephrase or move on.

 Giant leap questions

Sometimes interviewers will change subjects so abruptly that it can throw off the pace and rapport of the interview. A segue can usually save the day but making a major shift in the interview’s direction can signal that you weren’t all that interested in what the participant just said. There will be times when leaps are necessary, e.g., if you have a participant who is bound and determined to talk about everything except what you’re there to talk about. There will also be times where a conversation line will be exhausted, and a new direction will seem natural. For the most part, however, questions should move the conversation along in a steady stride and not giant leaps.

Poorly-timed questions

Sometimes it isn’t about what you ask but about when you ask it. For one, interrupting participants is obviously in bad form, but interviewers might not even realize they’re doing it if they’re used to having to talk over their chatty friends and family. Not only must we wait our turn to talk, but we have to learn to embrace silence. It is a common technique to wait just a bit longer than seems natural to ask your next question with the idea that the discomfort from the silence will prompt the participant to elaborate further. It works, but at the very least, interviewers should give their participants plenty of breathing room to say what they please. 

Another example of bad timing is going too deep or too personal with participants too fast. You have to build a little trust before you start asking about sensitive subjects. This includes asking for a home tour too early. Bedrooms and bathrooms can be just as private and personal as talking about your embarrassing health issues or your deepest feelings.

“Normally” questions

It is better to ask someone what they actually do than what they normally do. For example, instead of asking someone, “What do you usually eat for dinner?” You might ask them, “What did you have for dinner last night?” Or, “What’s on the menu for next week?” Afterwards, you might follow up with a question on how that compares to their typical dinners, but this approach promotes detailed answers and specific examples that can give color to your understanding. Or, better yet, skip the questions altogether and ask to join them for dinner or have them record their meals on a video diary!

Questions with one-word answers

Finally, when you’re doing open-ended interviewing, it is good practice to avoid questions that can be answered with one-word replies (unless you’re looking for very specific information). Instead, questions should be framed in a way that prompts as much elaboration as possible. For example, a better option to, “Did cost factor into your purchase?” might be, “Tell me how cost factored into your purchase?” Alternatively, you can follow up your more close-ended questions with something open-ended like, “Tell me more about that.” 

In fact, asking someone to “tell me more” is the ultimate open-ended prompt. It isn’t really a question at all but a simple invitation to talk and share. This is the sweet spot of the ethnographic interview, where the interviewer simply provides the fuel for the participant to share themselves and their stories. It’s unrealistic to avoid questions that seek specific information entirely, but the participant exploring their relationship with the research subject while the ethnographer is there only as a delicate guide is at the heart of all good ethnographic interviews. As long as you are conducting your research in that spirit, all of your questions, more likely than not, will be good questions.

Categories: Ethnography, Process

What Margaret Mead thought about tripods and why it matters for ethnographic filmmakers

August 17, 2020 Leave a comment

Should ethnographers use tripods or not? The question may seem trivial, but thanks to Margaret Mead, tripods signify two very distinct approaches to ethnographic filmmaking.

In terms of practicality, tripods can be cumbersome in the field. There’s plenty of sit-down interview time where a tripod is nice to have, but as the self-proclaimed “world’s clumsiest ethnographer,” I know that tripping over tripod legs while you’re following participants around isn’t a good look. In terms of the resultant video, using a tripod has its pros and cons. Using a tripod results in cleaner footage, and, of course, a more stable shot, while handheld footage can be livelier and more vibrant.

They each have their merits, but how does Margaret Mead, one of our very first ethnographic filmmakers, factor into the discussion? What did she think about this pressing issue of tripods? We get some insight from an article from 1976, “For God’s Sake, Margaret,” a transcript of the banter between her, at 75 years old, and her ex-husband, Gregory Bateson, with whom she filmed “Trance and Dance in Bali” almost forty years earlier. In the article, Bateson expressed his own position, arguing, “If you put the damn thing on a tripod, you don’t get any relevance.” To which Mead said, “No, you get what happened.”

Essentially, Mead argues that filming handheld gives the ethnographer too much power to choose what and what not to film, whereas with a tripod, you can leave the camera be and simply record whatever goes on for later analysis. This argument echoes the early “salvage ethnography” days where a primary motive of ethnographic filmmaking, and ethnography itself, was to document and preserve cultures that were in danger of disappearing. It also speaks to the inductive approach of ethnography where everything is data and the goal of filming is to capture as much of that data as possible, a position held by other anthropologists like Karl Heider. Filming, for Mead, was more about capturing evidence than creating art. She asks, “Why the hell should it be art?” She continues:

I mean an artistic film maker can make a beautiful notion of what he thinks is there, and you can’t do any subsequent analysis with it of any kind. That’s been the trouble with anthropology, because they had to trust us… [Before film] there was no way of probing further [into] material. So, we gradually developed the idea of film and tapes.

Her ex-husband, Bateson, in contrast, contends that you can only record one percent of what goes on anyway, whether you’re using a tripod or not, so you might as well get the best one percent. He values film more as a means of storytelling or conveyance and complains that without the ethnographer playing an active role in what to film, the end result will be dull and lifeless. He says, that, with a tripod, “You’re stuck. The [camera] grinds for twelve hundred feet. It’s a bore.” To which Mead retorts that he gets bored too easily.

Bateson is not alone in his preference for handheld. Jean Rouch, anthropologist and documentarian, found his filmmaking groove after losing his tripod in the rapids of the Niger River, forcing him to adopt the handheld, Cinema Verité style he pioneered:

For me, then, the only way to film is to walk about with the camera, taking it to wherever it is the most effective, and improvising a ballet in which the camera itself becomes just as much alive as the people it is filming.

By losing the tripod, Rouch is gaining himself, embracing reflexivity and the role of the researcher in the process. Through this embrace, he was able to create powerful, very human films. Rather than a tool for documenting culture, like in the Mead model, for Rouch, the camera is a medium for interpreting and expressing culture, ideally in creative, entertaining ways.

In the end, the choice to use a tripod or not is a personal preference that comes down to how practical it is in the field and the look you want from your footage. The real lesson from Mead is that we not go so “handheld” that we miss all the great data that surrounds us. The beauty of the camera is that it can collect data that we might not think to collect were we just armed with pen and paper. We also don’t want to be so devoted to the “tripod” approach that we’re collecting lifeless video—for most of us, we still use our videos for storytelling. A balanced approach may be best. The ideal may be to collect all the data we can with our cameras while acknowledging that all the while, we’re making choices and are influencing the world and our recording of it, tripod or not.

So they’re talking about much more than just tripods. With a tripod you still pick and choose what to film, and likewise with a handheld camera, you can still capture as much data as possible. Even if you compare a Mead film like “Trance and Dance” with a similar Rouch film, like “Horendi,” the differences are there, but they are not monumental. Still, the different approaches to ethnographic filmmaking have practical applications. You can take the “tripod” approach, where you’re focused on data collection, and it can impact how you film a context. Whether or not you actually have a tripod, you might tend towards long shots with the goal of capturing all of the actors and their actions with your camera. Taking a “handheld” approach, whether or not you are actually filming handheld, might mean focusing more on capturing what you find insightful in the moment, like the expression on someone’s face or the hands of someone using a tool. Most ethnographers have likely had times where they see something they find incredibly interesting and fight the urge (or succumb to the urge) to zoom in like a lunatic.

If you’re interested, you can find the whole conversation between Mead and Bateson at: http://www.oikos.org/forgod.htm

Categories: Uncategorized

Old school ethnographers moving to online research

August 3, 2020 Leave a comment

In early 2019, one of our clients asked us to do an interview and video diary study for them entirely online. We were open to the idea but a little skeptical. We had never done online research before and it seemed almost sacrilege to go against the long tradition of ethnographers immersing themselves, physically, in the research setting. We wondered exactly how far removed it would it be from our typical work. The interviews would lack much of the context of an in-person interview, and that is a real sacrifice. Still, we reasoned that if we weren’t getting much contextual, observational data from the interviews, we’d still be getting it through online video diaries. We had done similar video diaries for years where we send our participants cameras and ask them to document their lives, and we never doubted the soundness of these diaries. After all, Sol Worth and his colleagues were doing similar work over 50 years ago, handing their film cameras over to their participants to make movies. It isn’t much of a stretch to argue that video diaries, whether you’re using film, a camcorder, or a mobile phone, is an established ethnographic method.

After a little hemming and hawing, we decided that although nothing beats doing research in context, we could still get great data online by approaching it ethnographically. Once we actually got the project up and running, we were pleasantly surprised at just how good that data could be. This article will explore some of the practical and methodological challenges we experienced during our first foray into online research, and why we believe that ethnography online is a great option when in-person research may not be practical.

Diving in

Diving into this new way of doing research was a little stressful. With ethnography you want to feel like you’re at least in control of the process since what we’re studying, real life, is often so chaotic. Some of the transition to online research was easy. Participants typically go through a screener prior to the research so we can make sure they’re a good fit for the project. With our in-person research, we do this over the phone and often, at least parts of it, through an online questionnaire. Moving this screener entirely online was just a matter of learning the ins and outs of this new platform’s questionnaire tool. Transitioning to online interviewing was fairly easy too. Some nonverbal cues are different when talking to someone online, but being longtime users of Facetime, Skype, and the like, we adapted quickly.

Other aspects of moving our process online proved a little more challenging. Creating the video diary guide required a reset in our thinking. Where we typically could ask anything in a video diary guide, we had to be a little choosier—the particular platform we were using allowed only a certain number of open-ended video questions so we had to design the questions carefully make sure our data was as rich and as ethnographic as possible. We could fill in the blanks with text-based questions for the more straightforward data, but it took some consideration to construct the guide in a way that produced data that was as full of the vitality we’re accustomed to and that our clients expect from us.

There was a learning curve with the technology too. The vast majority of our sample had never used the platform and despite its general ease of use, tech issues did arise. When participants ran into a snag, they tended to come to us and not the platform’s official support channels. This was fine, but it caused a shift in our communication with participants. Typically, our interactions with diary participants are mostly about what they should be recording and when they should be sending back their memory cards. Although we were still having conversations about content and timing, we also were spending more time providing tech support. We relied on our contact at the platform to help with tech issues at first, but after a while we were able to address most questions ourselves.

The limitations

With the platform we used, each video that participants recorded could only be two minutes long. This limitation can be problematic and was a main reason we had strayed from online video diaries in the past. Our video diaries typically include activities like, “Show us every time you do this,” and this project was no exception. Luckily doing “this” was using our client’s device—something that would typically take less than two minutes to do. In contrast, if we wanted them to show us how they prepare dinner, we might have had an issue (unless a frozen pizza was on the menu). Other online platforms allow you to record more than two minutes at a time, but if we needed a diary that included long stretches of recording whole acts, sending participants camcorders might be the better option.

The other major limitation with doing research online is obvious—you’re not there. Here, having the observational data from the video diaries is a life saver, but if you are just doing online interviews? You can still collect a little contextual data by having your participant do a “show and tell” or take you on a house tour if you’re using a platform that supports mobile devices. There’s also no harm in just relying more on interview data. It’s hard to argue against the value of observational research, but there is a lot of insight to be gained through interviews alone.

The benefits

After getting past the learning curve and getting a handle on some of the limitations, we believe online research provides incredible value. Here are a few of its advantages.

Speed. In theory you could decide to do research in the morning and have data coming in by that afternoon, compared to a traditional, camcorder diary where it takes a participant a couple of days to get a camera, they record for a period of time and then we only get their recordings back a couple of days after they drop their memory cards off at FedEx. Online research is much faster.

Participant progression. Since you can see data as it comes in, you can give participants direction if they aren’t recording the quantity or types of entries you need. You can send them a friendly note offering advice and reminding them to stay on track. Online research also allows for in-the-moment follow-ups on their recordings to dig deeper.

Although ethnographers aren’t inclined to like set, structured questions, the structure of online research is another way that ensures that participants are progressing and recording the kinds of data you need them to. These platforms typically have a series of questions for the participants to complete, and the researcher can tell exactly what they’ve done and what they still need to do. It might lead the participant to mentally tick off a box and not record more than they might have otherwise, but it also ensures they tick off that box to begin with.

Client involvement. Clients can be more involved in online studies. Attending in-person research might not always be practical, but online research is more accessible since no travel is required. The data from online video diaries is also immediately available to clients, and they can interact directly with diary participants if that’s something they want to do. As insiders to their business, they’ll have different perspectives and questions than we do as ethnographers. They might see participants use their products in ways or contexts they’ve never seen before and want to learn more about their motives and rationales. Online research makes that easy.

Although nothing can replace in-person research for us, old school ethnographers, we see tremendous value in doing research online. You can still meet real people, hear their stories, and observe them going about their daily lives, even if it might come in shorter snippets. We always say that ethnography is more of an approach to understanding than a specific method, and if online platforms allow us to get a real-life, inductive glimpse into people’s lives, isn’t that the point?

Categories: context, Ethnography, Process

Keeping your cool when things get hot

July 23, 2020 Leave a comment

After more than a couple of decades of being a professional ethnographer, I think it’s safe to say that I’ve seen it all. And I don’t mean that in a bad way. I mean it in an authentic way. I’ve been present to share in the good, the bad, the joyful, the heartbreaking, the beginning, the end, the scary, the exciting, the uncomfortable, and the easy. During each of these moments, my craft has required that I maintain a focus that allows me to stay firmly grounded in the experience at hand and to stay the course, no matter how awkward. Although sometimes this can be difficult, I’ve found that there are a couple of strategies that help me to do good fieldwork no matter what comes my way.

Authenticity

Oscar Wilde said it best when he said, “Be yourself, everyone else is taken.” I don’t think it is possible to do good fieldwork unless you are willing to be authentically yourself. This doesn’t mean that you have to bare your soul or uncover your blemishes with participants, but it does mean that you behave and speak in a way that is normal for you. This is important for a lot of reasons, but it often becomes especially important when fieldwork is more intense or when it departs, more than usual, from the standard. We are usually asking people to share so much of their lives that it is not unusual for them to end up sharing things that we didn’t anticipate or maybe weren’t fully prepared to discuss. When this happens, the process is just quicker, easier, and more fluid when the ethnographer is her/himself. That is because going off script is easier to navigate inside the skin in which you are most familiar.

One time, I spent about three weeks following families on vacation at a theme park. Originally I had planned to keep my intense fear of roller coasters to myself. I knew that I had a pretty good poker face and that I would be able to manage riding along with families, even if it wasn’t very pleasant. After my first day of fieldwork, however, I realized that sharing my fear with families actually opened up an interesting dialogue and surprisingly seemed to help build a more intimate rapport. I stumbled upon this when one of my participants, an 8 year old boy, asked me if I liked scary rides as we were standing in line to board said scary ride. I knew I couldn’t lie so I told him the truth, which sparked a heated discussion amongst the family about just how scary the ride was and about the definition of “scary.” It also resulted in the son holding my hand on the ride and moving me into a deeper participant role with that family. Several days later, the family had a collective meltdown as I was shadowing them. It was not pretty and was uncomfortable for everyone present, but I think that having shown them my authentic self (and weakness), made them more comfortable to share this event with me. The rapport we had built over the last few days made it more comfortable for me to witness.     

Flexibility

I wish I had a quarter for each time my job required me to do something I didn’t know I would have to do. A deep commitment to flexibility is really the price of entry for being a good ethnographer. We take an inductive approach to our work which means that we never really know what is going to happen. It is best to show up with a sense of adventure and a wiliness to experience and do whatever helps us better understand who our participants are and what it is like to be them. This means that I have consumed lots of delicious food over the years, but also tons of things that I would have rather not eaten or drank. I’ve stayed longer than expected and sometimes even returned for an additional visit. I’ve spent hours and hours waiting patiently (or lending a helping hand) while my participants had to deal with or manage a crisis that was unexpected and (at least on the surface) unrelated to the reason for my visit. One time my colleague and I helped clean up a very serious water spill when our participant’s washing machine emptied out onto her floor. I’ve helped feed hungry kids, put babies to sleep, carried boxes, moved furniture, given rides, helped fill out forms, searched for lost items, helped fold laundry, sat outside in 100-degree weather for a visit with a cancer patient who was always cold. At every venture, I’ve been given the opportunity to learn additional context that helps me to better understand my participant’s lives and often their challenges.

One time I was doing fieldwork on how families with young kids used their minivans, so I was riding along while they did errands. When we called to arrange one of the visits, the dad had mentioned that I was welcome to join, but that I would have to enter the minivan from the hatch back. The third row was not accessible from the sliding door because of the child car seats. Although this didn’t sound like much fun, I figured it would be okay—I’m a practitioner of yoga after all. But once I arrived and saw just how little room there was between the top of the third-row seat and the ceiling of the minivan, I started to panic. For a minute, I considered asking if there was an alternative, but then I remembered that they had mentioned that this was how grandpa got in when he rode with them and so I hopped into the trunk area and threw myself over with abandon! Not only did my colleagues get a good laugh, I developed a keen appreciation for the need to create a different solution for grandpa! 

Empathic Curiosity 

Obviously being curious is an important skill for an ethnographer, but it is a particular type of curiosity that ensures fieldwork inquiry leads to understanding and not just a macabre documentation. Our work requires not just the observation and recording of data, but an attempt to better understand the challenges, experiences, and feelings that our participants have, from their perspective.  This can be really, really hard, especially when the topic at hand is a difficult one. It requires that the ethnographer open themselves up in a way that is sometimes painful. We have conducted a lot of fieldwork with people who are seriously ill or who are caring for someone who is seriously ill, and in both cases, the day-to-day experience is often excruciatingly difficult and the discussion of that experience can be equally difficult. In these kinds of situations, people often stop talking to their loved ones about what they are experiencing since it is just too painful for both parties, and so when we visit them, there is sometimes a little bit of a watershed moment when our participant understands that we really are there to learn from them and to hear their story. This can be exceedingly emotional for the participant and sometimes for the ethnographer.

One time I was visiting a woman who had a very serious chronic lung disease that had left her socially isolated. Her home was the majority of her world. She rarely got out and maintained very few relationships outside of her husband, her doctors, and the woman who came in to clean for her a few times a week. She had been a powerful and social executive prior to her diagnosis, and the transformation had been devastating. As we spent our final hour together, I was exhausted. She had walked me through her life in a way that left me feeling like I could truly understand what it must be like to be her. In order for this to happen, I had to be not only curious and willing to listen, but also be willing to let her lead and to be open to seeing the world from her point of view.

Holism

After a particularly frustrating round of fieldwork, a colleague once reminded me that there are no mistakes with ethnography. By definition, ethnography is all about real life and real life is messy, and therefore ethnographic fieldwork is often messy. Sometimes ethnographers forget this when butting up against deadlines or when working with clients that prefer a more tactical approach, but it is really, really true. Things tend to be connected in ways that we don’t always understand, especially at first blush. Sometimes when we are doing fieldwork, we can get distracted by our fieldguides and forget what we are really there to do—which is to learn about the social and cultural context of our participants’ lives and then and only then to dig into the specific topic that our client has hired us to learn about. It is understanding our specific topic in the context of our more general learnings about who people are and how they live that creates the much deeper insights that our clients are looking for. But sometimes the social and cultural context of people’s lives are complicated or thorny. Over the years, I’ve found myself witnessing a variety of illegal or unsafe activities. Once when we did fieldwork with people who had chronic pain and found ourselves in the middle of some sticky pharmacological situations. One participant, an elementary school teacher, asked me to ride with her to finish packing up her classroom for the year. After a few minutes on the road, it became clear that she was impaired. Luckily the drive was not that far and after spending some time moving things into a storage shed, she seemed to be less impaired than before. When touring another participant’s medicine cabinet, it became clear that they received prescriptions for pain medications from a variety of different doctors. Naively, I had not anticipated either of these situations and neither were covered on the official fieldguide for the project, but a quick re-grounding in the project objectives made it clear that understanding the context in which both of these events happened would provide me with a much more holistic, accurate, and real understanding of what it is like to live with chronic pain.

Ethnographic fieldwork isn’t always easy, but it is almost always interesting. Maintaining authenticity, flexibility, empathetic curiosity and a commitment to holism goes a long way towards ensuring that even when fieldwork is difficult, insights are trustworthy and even deeper and more real.

Categories: Uncategorized

Forming connections in the field: Three case studies on the bonds that ethnography builds

July 21, 2020 Leave a comment

The bonds ethnographers make with their participants can come in unexpected ways. Years ago I was in Australia studying hair loss, and my participant’s apartment looked like it would be walkable from the hotel. This was back when we used paper maps, and I would measure distance by how many thumb-widths point A was from point B. What I thought might be a twenty-minute walk turned out to be more like an hour jog in the Sydney heat, so I showed up late, sweaty, and panting like a dog. Fortunately, the guy was as nice as could be, and it ended up being very rich, surprisingly intimate fieldwork. As much as I’d like to, I can’t really attribute that to my highly refined skills and astute questions. Rather, I think that by arriving a disheveled mess, by showing this very human side of myself, it gave him free rein to do the same.

That day we connected over dripping sweat and blistered toes, but often our bonds with participants are deeper and longer lasting. It’s only natural that ethnographers in academia who spend years with the people they’re studying might build these bonds, but it can happen in business ethnography too, where we might only have a few hours with participants. You don’t always develop intimacy with participants, and it isn’t always necessary in order to walk away with good data, but it’s still great when it happens.

All ethnographers, including my co-workers at Ethnographic Research, Inc. will likely have similar stories of the connections they’ve made in the field. Here are a few of mine, along with a few ideas of how the methods and contexts of ethnography might have fueled the bond-building.

Watching fireworks with the Wilsons

A travel and leisure company hired us to understand families on vacation—a fun topic for sure. We did all of the fieldwork in Orlando, going to both the lesser-known attractions, like the Titanic Museum and the Holy Land Experience (a religious theme park), to the bigger names like Universal and Disney World. Our job was to become ethnographic tourists and temporary members of the families in the sample, popping in for participant observation multiple times throughout their trips. I was “Uncle Steve, the one that keeps staring at us.”

Each family was great, but I really bonded with one in particular, the Wilsons. The mom, Marianne, has a personality that can light up a room and is one of the funniest people I’ve met. The dad, Paul, is much more reserved, the “strong and silent” type. He had fun, but I always got the sense that his biggest joy was seeing his family have a good time. Marianne and Paul have two teenage daughters: both good, smart kids who share their parents’ love of all things Disney. They are the kind of people who would have gotten along with anybody, but we really hit it off. On our last day, together we hung out for hours longer than we were slotted for so they could show me Epcot’s fireworks show, and we’ve kept in touch ever since. We still send each other Disney-themed Christmas cards every year.

Why did we get on well? The Wilsons were very friendly and that’s certainly helpful, but there’s probably more to it. We got along well with all of the families in the sample, probably more so than a typical project. Some of it might have been transference: we were observing one of the happiest times of the year for the families, and those good feelings about their vacations became good feelings about us ethnographers along the way.

The context also provided the families an ideal “looking glass self,” a way of gauging how they think they appear to others. With an ethnographer at your side, you might be more self-reflective, more aware of how this outsider is perceiving you and your kids. Sometimes this can be a good thing, sometimes not so good. On vacation, your family might put aside its typical troubles for a few days, everyone might stop quibbling for a minute. Seeing the ethnographer there, observing you and your family in all of its glory, can feel great. You might think, “Yeah, we are pretty awesome.” Still, not all of the trips were as fun and fancy-free as the Wilson’s trip. Some continued to quibble and some didn’t leave their problems at home—those families don’t send me Christmas cards.

Gaining mana in game shops

A games company wanted to learn about teenage boys who were into collectible card games (CCGs) like Pokémon and Magic the Gathering so we dove headfirst into the fascinating world of the local game shops they hung out at. More than just retail stores, these shops were gathering places where people played all varieties of games: mainly CCGs, strategy games like Warhammer, and tabletop roleplaying games like Dungeons and Dragons. The shops served as many players’ core social hubs, where they went to be with their friends, chill out, and have fun.

Although I didn’t keep in touch with the participants I met during the study, they welcomed me into their world with open arms, and I became a part of their groups remarkably fast. I did the weekly Friday Night Magic events with my pedestrian starter decks and won a game or two. I competed in a Pokémon tournament and lost miserably. Dungeons and Dragons is hard for a newcomer to jump into without grinding everything to a halt, so we just sat in on those sessions. All in all, they enjoyed us being there, and we enjoyed it too, the culture and the games themselves—I still play Magic to this day.

But why did we have these synergies? Simply showing interest went a long way. Collectible card games serve a niche audience and CCG players don’t have many people outside of their inner group willing to talk about games with them. I know I’d be thrilled if someone asked me how my Ooze deck was coming along.

The research was also a great example of something we talk about a lot: the value of letting the participant know they’re the expert. There was a distinct hierarchy at the shops. There were the adults and older teenagers who had been playing these games for years and were often more skilled and had more expendable income to spend on the best cards. The old timers often mentored the younger kids (our primary participants), teaching them the ropes, raising the next generation of CCG players. Our arrival meant that the younger kids could turn the tables. The students became the masters, and we became their students. That sort of role switching can be fun and empowering for a kid.

Henry and his chauffeur

A pharmaceutical company hired us to learn about the experiences of people living with schizophrenia. The plan was to see each participant four times times over the course of a year, but I ended up hanging out with one participant, Henry, for several years (until he passed away). When we met Henry, he was living in a transitional home in a rough part of Kansas City. His thoughts could be hard to follow at times, so we never really did any sort of formal interviewing with him. Instead we learned through observation, experiencing his very unique life alongside him.

Henry was a character: charismatic, a 24/7 Lothario, kind of a hustler, but an all-around good guy. Henry walked most places out of necessity, so when we first showed up, we weren’t so much researchers to him, we were a ride. I couldn’t count how many times I drove him to Dollar General and the smoke shop so he could resupply. As time went by, our destinations expanded, and I never knew what I was in store for when he invited me out to lunch. Cigarettes and snacks continued to be on the docket, but we might go to sell some stuff at the pawn shop. We might go to see one of his girlfriends (who had interesting stories too). One time I even took him to vote (and saw how problematic voter access can be).

With Henry, the bonds of fieldwork might have had an economic origin (I had a car and paid for lunch), but he developed a genuine fondness for not only for me but my co-workers, Melinda and Shalonda too. It was probably a rare treat for someone to be as attentive to him as we were, for someone to really listen and care about what he had to say.

Henry’s situation was unique but regardless of who you are or where you’re from, it is unusual for people to show you the sort of genuine interest that’s central to an ethnographer’s work. Whether we’re asking someone about their life story or how they do their laundry, the “it’s all about you” focus of an ethnographer is refreshing and makes fieldwork wide open to these kinds of bond-building moments. Ethnographers don’t necessarily remove themselves from the environments they work in, rather they work to help others shine, to share themselves in ways they often do not. Part of it is simply people “clicking” with other people, but there is also some special magic in the ethnographic context—our methods produce a setting ripe for the kinds of deep connections that develop between us and the people we learn from.

Categories: Ethnography, Process

Analysis at Ethnographic Research, Inc.

July 13, 2020 Leave a comment

Analysis is a sacred and labor-intensive element of our work at Ethnographic Research, Inc. Sometimes we hear about ethnography timelines that have reporting slotted just a couple of days after the end of fieldwork and we aren’t sure how that is even possible. Ethnography is about bringing people and culture to life; it gets to the heart of what’s really going on with a depth that is simply impossible to achieve in a couple of days. Good ethnography offers what Clifford Geertz called “thick descriptions.” More than just reporting some top of mind ideas, it goes much deeper into context and culture. To get there, we rely on (1) analytical rigor, (2) theory, and finally, (3) years and years of experience.

1.    Analytical rigor

Doing analysis right takes a lot of work and a lot of time. We spend around six hours doing analysis for every hour of video we collect, and we collect tons of video. We often provide some “early insights” to clients who need something to work from immediately, but to do a complete analysis that makes the most of the data? That takes time.

Still, it doesn’t matter how much time you spend doing analysis if you don’t spend it wisely, so we use methods like Glaser and Strauss’s Grounded Theory, an inductive approach to analysis where data is coded and categorized until insights begin to emerge. People tend to picture analysis as this magical process where a wild-eyed, crazy-haired social scientist is thumbing through notes and watching video until some brilliant idea pops in their head. And yes, there are “Eureka!” moments (and sometimes crazy hair), but in reality, we follow fairly structured steps. If we didn’t, those big ideas might never show up and if they did, we wouldn’t be sure that they were trustworthy.

2.    Theory

Our team is academically trained in ethnography, and we learned that using theory to help inform research is not only helpful, it is required. It just makes sense. Brilliant minds have been wrestling with similar topics for years. It would be silly not to take advantage of that, and although we’re all sociologists by training, we also use theory from anthropology, psychology, and sometimes economics and philosophy.

Our use of theory has a meaningful impact on our results. It is vital in making sense of data, and it helps so much in understanding the social and cultural drivers behind the behaviors we observe. Research that ignores culture comes out flat. For social scientists, by definition, if you want to understand people, you have to look at the society and culture they live in: the people they interact with, the institutions they are a part of, the information they consume, and any other outside influence that shapes the way they see the world. Theory provides the scaffolding for organizing and understanding all of that data.

3.    Years of experience.

Ethnographic Research, Inc. opened its doors back in 2001, long before the iPhone, long before Facebook. Back when we started, ethnographers didn’t do in-homes, they did in-caves.

We’ve been observing people in-context for nearly twenty years, and we’ve picked up a few things along the way. This gives us a leg up whenever we start a new project—we go in with a strong understanding of how households have evolved over the last couple of decades and can use this to give projects an analytical jumpstart. We can approach new topics with a certain maturity and sophistication that would have been impossible were we just starting out. For instance, we do a lot of work studying how illnesses impact people’s daily lives. We’ve studied the daily lives of people with cancer, heart disease, arthritis, chronic pain, lupus, epilepsy, and many others. When someone comes to us wanting to learn about the patient experience of a condition we haven’t studied, like multiple sclerosis, we have all of this past work to help us learn, right away, what is unique and different about living with MS.

This experience is just as helpful for our other projects too. We have years of experience watching people shop, work, cook, groom, clean, play, parent, travel, and more. This allows us to place our research topic into a much larger database of insights into daily life habits and rituals. It helps us in every aspect of the journey that is ethnography. We can avoid common pitfalls in sampling and recruiting, we can get the most out of our in-home visits, and our analytical processes are refined and streamlined. We have also learned that it is our analytical processes that add the most value for our clients. All of the time and rigor we give to analysis are absolutely necessary when your research aims for deep, rich insights.

Oh the people we have met!

July 7, 2020 Leave a comment

We never really know what to expect when we roll up to do ethnographic fieldwork. Even though we’ve been doing ethnography for more than 30 years, arriving at a participant’s home or workplace always feels a little like our first day on the job. We’re anxious and hopeful that everything will go okay but are never really sure what is going happen when we walk through the front door and into someone’s life. Some contexts are more exciting or more unnerving than others, but we have to be prepared for almost anyone or anything. And boy-o-boy, have we not been disappointed. We have met so many interesting people and heard so many interesting stories over the years.

If we’ve said it once, we’ve said it 1,000 times—we’ve got the best job in the world. One reason it is such a great job is that it gives us the opportunity to meet so many interesting people. As sociologists, we believe that people are inherently interesting and what we’ve discovered as professional ethnographers is that EVERYONE has a story to tell that is uniquely captivating. If you take time to learn about someone, you discover that they are way more multi-dimensional than they appear at first blush. Although our job is usually to focus on the patterns that tie people together, we generally get there by first listening to and trying to understand each individual and what makes them who they are.

Over the years we have met thousands of people. We have been invited into their homes and into their lives and have found ourselves entertained and inspired by most of them. Here are some of the people who have stuck out as being particularly impressive, entertaining, or inspiring.

  • Alma from Missouri was 85 years old, played the organ, and kept a refrigerator stocked with six different kinds of soda (she lived alone). She had a Facebook page and texted before either were mainstream and recorded herself reading books so that her kids could listen to her homemade books on tape.
  • Dina from Pennsylvania was a twenty-something year old mother of two diagnosed with stage 4 colon cancer. We met her when we conducted a study on chronic pain. She had one of the most positive attitudes and brightest smiles of anyone we’ve ever met.
  • Robert from Georgia was a postal worker we met during a study on diabetes. He had hardly traveled outside Atlanta except for a tour of Korea while in the army. He was soft-spoken and exceedingly polite and spent a lot of time wondering how scientific theories intersected with philosophy and religion.
  • Rene from Kansas single-handedly cared for her husband with dementia even though she was in her 70s. She was amazing and truly inspiring and gave us a new appreciation for unconditional love.
  • Chubby from Georgia was a really thin man receiving treatment for cancer but was far more concerned about his wife’s happiness and comfort than his own.  
  • Dr. Anderson from Minnesota was a primary care doctor who had been treating most of his patients for several decades. He moonlighted as the primary fundraiser, organizer, and healthcare provider for massive shipments of medical supplies and treatment of patients in the Philippines.
  • Deanna from Arizona was a young mom who had spent a few years in a prison where she worked as a firefighter, then met her husband at a Narcotics Anonymous meeting and together they built the kind of suburban life for their kids that they never had.  
  • Edwin from Georgia was a barber who delivered a homily with every trim, complete with a bible that he encouraged patrons to open to the page of their choice from which he would extemporaneously preach in a strong baritone.
  • Fanny and Lloyd from rural Louisiana owned and ran a booming roadside fish restaurant, in their retirement.
  • Annie from Missouri was a single woman with no kids, until she met and married a widower with eight kids, after which she became a stay-at-home mom.
  • Brenda, a physician’s assistant from Oregon, had a treatment style that combined science, tough love, and a bohemian philosophy to motivate her patients to get healthy.
  • Sheila from California was diagnosed with a serious chronic lung disease that caused her to be fatigued and winded virtually all of the time but refused to take on the role of “sick person” no matter what came her way.
  • Samantha a restaurant manager and bartender from Illinois highlighted her love of cats and witches in her talented artwork.
  • Angela in Tennessee, after meeting her husband on an oldie’s music cruise, decided to quit her job as an architect in Washington and move cross-country to live with him and start a second career as an uber driver.
  • Candace and Dean from the Upper Peninsula in Michigan were in their 70s but still shoveled their own rooftops (we didn’t know people did that either!). Dean has decided to donate his body to science and has been getting medical trivia tattooed on his body for the last several years to make it more interesting and educational for whoever does his autopsy.
  • Dr. Monroe, a veterinarian in rural Kansas, treated every kind of animal under the sun and did professional ballroom dancing on the side.  

Our research over the years has included more interesting characters than the Marvel Universe. They might not be able to fly or bend metal with their minds, but they’re all superheroes to us—doing their own things and making their own, unique life stories. We are just thankful that they have been kind and generous enough to share their rich experiences with us. We are so excited to see who we get to meet and learn from during the next 20 years!  

Categories: Uncategorized

Developing empathy and understanding with ethnography

July 6, 2020 Leave a comment

The political divide in the United States has been a stark reminder of how people can experience and interpret the world in very different ways. No matter what side you are on, it can be hard to see where the other side is coming from, what they’re feeling, and what drives them to think and do what they do. Developing this sort of empathy is essential to ethnography and to each part of our research process. We need empathy to ensure that we gather data that is deep and trustworthy. We need empathy to help us organize and sort that data in a way that accurately reflects the experiences and viewpoints of our participants. We need empathy to hold ourselves and our clients accountable and grounded during the reporting phases of our work. Still, maintaining empathy is sometimes easier said than done. Although most of the time we can connect with people and their stories right away, sometimes we just can’t relate to their experiences and viewpoints. Let’s explore some ways that ethnographers can develop empathy and understanding, especially in contexts where those might be hard to come by.

History, physical space, and relationships

Spending time with people is obviously the first step for ethnographers. Developing empathy is typically just a matter of really listening and hanging out with participants, trying to walk in their shoes as much as we can. Usually this goes a long way towards gaining insight into their perspectives. Even if it isn’t directly related to what we’re studying, investing time to learn a little bit about where they come from and about the context of their daily life pays dividends in helping us walk away with an empathetically grounded understanding of our research topic.

Touring a participant’s home or workspace provides another great opportunity to build empathy. Going room to room, sharing stories about their recent purchases and favorite belongings, there’s a good chance that we will run into something that will help us understand what their life is like and what’s really important to them.

We also try to involve our participants’ friends and families in the process whenever we can. They may show a different side of themselves when they’re playing with their kids or when they’re talking shop with a colleague. This can help us see them in a whole new light. People play many different roles in their lives, and the more roles we can observe, the more complete our understanding will be.

Public discourse, media, and marketing

We can also build empathy if we step back and look at the impact of the larger cultural context on our participants’ attitudes and actions. Macro sources of behaviors and beliefs are often ignored, but they can be quite powerful in molding and shaping individuals. Tracing the influences of marketing messages, information sources, government systems, religious structures, and social media all help us gain a better understanding of who our participants are.

We usually do this through “contextual mapping.” This means we examine how what we’re studying is represented in public discourse. If we want to understand cat owners, for example, we’ll dive into social media to see how cat care is discussed. We’ll survey ads about cat care, looking at the messages they convey and the symbols they use. We’ll explore the world of cat care influencers, like Jackson Galaxy, to see what they’re teaching others. We’ll also watch lots of cute cat videos just for the heck of it, but the goal is to understand how all of this background noise impacts and shapes people with cats in their lives. Contextual mapping would help even the most die-hard “dog person” empathize with their cat-loving neighbors.

Colleagues and theory

When we’re having trouble getting our heads around what’s going on with our participants, sometimes it helps to get another perspective. Getting a colleague’s input is great. Sometimes we need someone else to remind us to be more empathetic and to stop letting our own baggage get in the way. Social science theory also helps us reposition our thinking and see our data and our participants from a different angle. As odd as it may seem, reading theory can even help when the theory has nothing to do with the research topic. You can read Foucault when you’re studying paper towels, and it still might spark a big idea. Theory is an ethnographer’s yoga—it resets your mind and leads you straight towards empathy and enlightenment.

Induction and reflexivity

A good ethnographer is always working inductively, but sometimes we put the cart before the horse and start making assumptions. This can prevent us from developing empathy and getting at the heart of what’s going on with our data. If this happens, we need to take a deep breath and brush off those assumptions as quickly as we can.

The whole process requires self-reflection. When what someone thinks or does seems a little confusing, we try to remind ourselves that our thoughts or actions would probably be just as confusing to them. If we continue to have trouble understanding someone’s behaviors or motives, there’s a decent chance that we might be our own roadblock; a prejudice of one sort or another might be standing in our way. It helps to take an inventory of our own beliefs and practices, being critical of their origins and how they shape our viewpoints. This is a key step in developing empathy. If we want to walk in the shoes of the people we’re trying to learn from, we’ve got to take our own shoes off first.

Five challenges ethnographers face in health care settings and how to overcome them

June 22, 2020 Leave a comment

It’s not our imagination—observing health care provider/patient interactions was simpler when Ethnographic Research, Inc. opened its doors in 2001. This was before HIPAA’s Privacy Rule, its Security Rule, and its HITECH Rule all went into effect, and although these are all important and necessary, the required processes and paperwork can be intimidating for our clients, for the HCPs we meet, and for us too.

This article will highlight some of the challenges involved in doing observational research in health care spaces and provide some insights into how we have adapted and continue to do work in these settings. Whether you’re a researcher or you are thinking about hiring ethnographers to observe health care in action, we hope these provide you with some food for thought.

1.    Getting your foot in the door is difficult.

HIPAA regulations can make recruiting an enormous challenge; the HCPs have to trust that we, complete strangers, will treat their patient data as sacredly as they do. Even without HIPAA, HCPs would likely be uncomfortable with the idea of folks showing up at their work with cameras. That’s true of any workplace, particularly customer-facing workplaces. By letting us in, they’re vouching for us and that’s a risk for them.

Compounding the challenge are gatekeepers, usually office managers, whose job it is to filter the calls that make it to the decision-makers, usually physicians. This is another uphill battle, a kind of modern-day gauntlet. Finally, these are busy places, and they simply don’t have time for us. We have to convince them that we’ll be as little of a bother as possible and that their practice can function almost as efficiently as it normally does.

What is the secret sauce to recruiting health care providers? Persistence and an indestructible will. Also, although it isn’t always practical, we have found that recruiting in-person can go a long way in showing sincerity and resolve. When dealing with a tight timeline, getting the help of a third party recruiter can also be a viable option.

2.    Incentives can be complicated.

HIPAA isn’t the only regulatory barrier we contend with doing healthcare research. There’s also the Sunshine Act, and although it sounds very pleasant, it can make incentives for participants a little tricky. The Physicians Payments Sunshine Act is anti-bribery legislation designed to keep pharmaceutical companies and others from incentivizing physicians to prescribe their products. It seems totally removed from ethnography, but we have to make sure that any incentives we pay health care providers don’t top fair market value.

As a result, our incentives are never so much that they will really drive HCPs’ participation. So, again, we need to make sure that participating in our research causes as little inconvenience as possible and that their time with us is, if not loads of fun, at least mildly interesting.

3.    Be careful what data you collect.

Once we’re in the door, keeping the data we collect safe and sound is always our top priority. It is essential for everyone involved: the patient, the practice we are observing, our client, and our company. The first step is to only collect patient data when necessary. This can be hard if we’re videotaping the research. Here, video’s greatest strength, that it records everything, becomes its biggest weakness, that it records everything. Like a vacuum cleaner inhales random coins, hairpins, and the occasional sock, the camera is going to record off-camera conversations, random patients walking in front of the camera, and computer screens displaying patient data. We minimize this by:

  • Not recording in hallways and waiting rooms whenever possible (where other patients tend to roam).
  • Being far enough away from computer screens that they aren’t legible on the recording.
  • Only having the camera on and recording when necessary. 
  • Being careful not to record patient data unnecessarily (e.g., if we don’t really need to record a patient’s face, we don’t record their faces).

Also, we get informed consent from anyone whose data we collect so they know what we’re collecting and how it is going to be used.

4.    Be careful how you store and transmit your collected data.

After we’re done with data collection, that data needs to stay safe. It is important to have solid security policies ahead of time—multiple layers of protection in place to prevent unauthorized access. It helps to enlist a professional with a background in information security to make sure that everything is airtight.

5.    You may need to take a few extra steps to protect your clients.

All of our clients have different needs when it comes to regulatory compliance, and it is best to discuss their needs from the start. Again, we make sure our planned incentive won’t cause our client any unnecessary hassle. We also see whether our client needs the study to be blinded or double-blinded. Like other industries, it is common for health care clients to want their identity withheld from participants. That might make recruiting more difficult, but it is fairly routine. If they need the research to be double-blinded, for whatever reason, we need to take a few additional steps. We will need to remove names and other information that may identify the practices in anything we give to the client, including initial sample spreadsheets and final reporting. We’ll also need to mask all of the video in the video deliverable. This includes participant faces, ID tags, and any paperwork with the practice’s name on it—it is always surprising how many identifiers need blurring. Understanding a client’s needs from the start is extremely helpful in preventing bumps down the road as the research unfolds.

So those are five things to be thinking about when undertaking in-context research in health care settings. It can be a challenge for sure, but there are ways you can navigate the challenges and get the job done. The insights possible from seeing health care providers in action are very much worth the effort.

Categories: Ethnography

Some of our favorite theories for doing ethnography in health care spaces

June 16, 2020 Leave a comment

At Ethnographic Research, Inc., we always emphasize the value of social theory in ethnography and its ability to add depth and nuance to our results. It is like having the ghosts of sociology’s past prodding us to consider looking at our data this way or that way, just in case there might be a big insight around the corner. Research for the health care industry is no exception. In fact, given how challenging in-context observations of health care settings can be, it’s a crying shame not to make the most out of that data. That’s where theory lend a hand. There is a ton out there, but here are a few theories we tend to use the most:

Stigma: Emile Durkheim, Erving Goffman. Stigma is an essential variable to consider when we do projects on living with an illness. Sometimes the stigma is the result of the physical effects of an illness, its accompanying behaviors (like injecting insulin in public), or by just having the illness (like a sexually transmitted disease). The impact of stigma can be as traumatic as the physical effects of the illness itself, and Durkheim and Goffman helped us understand these dynamics.

The sick role: Talcott Parsons. Talcott Parsons’ functionalism hasn’t necessarily stood the test of time, but we still use his idea of the “sick role.” The basic notion is that when we’re deemed “sick” and take on the “sick role,” we’re excused from normal responsibilities while also being required to work towards getting better. For us, we often use it more broadly in examining how having a specific illness impacts a person’s social roles and their engagement with the world around them. Given our long history of studying different conditions, we can then compare the “sick role” of X illness with the many other illnesses we’ve studied in the past.

Gender theory: Simone de Beauvoir. We always make sure to attend to how gender roles impact the interactions and behaviors we observe. You could pick many influential gender theorists, but de Beauvoir was one of the first to draw the line between sex and gender, and this idea of the social construction of gender is arguably the fundamental starting point of most or even all current gender theory.

She also wrote that women and their bodies were the “inessential other,” deemed both alien to and lesser than men and men’s bodies. We can see this in women’s experiences of health care. In a study we did on a rare, difficult to diagnose illness, women, in trying to find out what was going on with them, weren’t taken seriously by the HCPs. Their physicians downplayed their symptoms as “just stress” or “just needing to lose some weight” when they had a condition that would be fatal if left untreated. 

Presentation of the self: Erving Goffman. Goffman is back for a second round! For Goffman, when we interact with others we act, as if in a play, and our choice of words and our body language are designed to convey a certain image to the person we’re interacting with. This concept is essential when trying to decipher the interactions that patients have with their health care providers. It helps us make sense of how both sides communicate and how those communications are interpreted, which ultimately shapes treatment decisions and patient outcomes.

These interactions usually play out in the exam room, what Goffman would call the “front stage,” the stage that our clients tend to be most interested in. We always argue that we should also observe the “backstage,” their offices, labs, and break rooms, to see what HCPs are doing outside of direct patient care, to see how they interact with other staff members, and to get the entire picture of what’s involved in their day’s work.

This front stage and backstage distinction of Goffman’s is also important when we study the experiences people have with their illnesses away from the doctor’s office. It’s our job to understand how the public face of someone’s experience of an illness might differ from the private, backstage experience they keep to themselves or just share with their closest friends and family. It is often only in this backstage space where we can see what’s really going on.

The quantified self: Deborah Lupton. Just so we can include something from this century, the quantified self has become a more influential theory in the last couple of years in both our health care research and our technology research. It basically explores how we are increasingly measuring the wellbeing of our bodies with numbers. The most common example is fitness tracking (e.g., FitBits and Apple Watches), but you can see it elsewhere, like assessing diabetes status through the numerical output of a glucometer.

The quantified self can be considered a kind of extension or offshoot of the “medicalization of society,” another valuable theory from the previous century, the 70’s. It contends that more and more aspects of our lives are falling under the umbrella of medicine. A classic example of medicalization is giving birth. Where once done with family in the comfort of the home, now having babies in hospitals is the norm. Medicalization comes up periodically in our research too, like a project we did on Restless Legs Syndrome (RLS). Our participants’ friends and family didn’t take RLS seriously; they didn’t believe it was a real condition (rather the result of the medicalization of society). This led our participants to feel the stigma of having a “fake” condition and it impeded their ability to take on the sick role.

Often we combine these theories in our quest to understand and organize our fieldwork, our analysis and our reporting. What are some theories you love to use in your work?