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Qualitative research methodologies: ethnography

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• Scott Reeves , associate professor 1 ,
• Ayelet Kuper , assistant professor 2 ,
• Brian David Hodges , associate professor and vice chair (education) 3
• 1 Department of Psychiatry, Li Ka Shing Knowledge 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
• 2 Department of Medicine, Sunnybrook Health Sciences Centre, and Wilson Centre for Research in Education, University of Toronto, Toronto, ON, Canada M4N 3M5
• 3 Department of Psychiatry, Wilson Centre for Research in Education, University of Toronto, Toronto, ON, Canada M5G 2C4
• Correspondence to: S Reeves scott.reeves{at}utoronto.ca

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.

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 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 research 2

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 …

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Methodology

• What Is Ethnography? | Definition, Guide & Examples

What Is Ethnography? | Definition, Guide & Examples

Published on March 13, 2020 by Jack Caulfield . Revised on June 22, 2023.

Ethnography is a type of qualitative research that involves immersing yourself in a particular community or organization to observe their behavior and interactions up close. The word “ethnography” also refers to the written report of the research that the ethnographer produces afterwards.

Ethnography is a flexible research method that allows you to gain a deep understanding of a group’s shared culture, conventions, and social dynamics. However, it also involves some practical and ethical challenges.

Table of contents

What is ethnography used for, different approaches to ethnographic research, gaining access to a community, working with informants, observing the group and taking field notes, writing up an ethnography, other interesting articles.

Ethnographic research originated in the field of anthropology, and it often involved an anthropologist living with an isolated tribal community for an extended period of time in order to understand their culture.

This type of research could sometimes last for years. For example, Colin M. Turnbull lived with the Mbuti people for three years in order to write the classic ethnography The Forest People .

Today, ethnography is a common approach in various social science fields, not just anthropology. It is used not only to study distant or unfamiliar cultures, but also to study specific communities within the researcher’s own society.

For example, ethnographic research (sometimes called participant observation ) has been used to investigate  football fans , call center workers , and police officers .

Advantages of ethnography

The main advantage of ethnography is that it gives the researcher direct access to the culture and practices of a group. It is a useful approach for learning first-hand about the behavior and interactions of people within a particular context.

By becoming immersed in a social environment, you may have access to more authentic information and spontaneously observe dynamics that you could not have found out about simply by asking.

Ethnography is also an open and flexible method. Rather than aiming to verify a general theory or test a hypothesis , it aims to offer a rich narrative account of a specific culture, allowing you to explore many different aspects of the group and setting.

Disadvantages of ethnography

Ethnography is a time-consuming method. In order to embed yourself in the setting and gather enough observations to build up a representative picture, you can expect to spend at least a few weeks, but more likely several months. This long-term immersion can be challenging, and requires careful planning.

Ethnographic research can run the risk of observer bias . Writing an ethnography involves subjective interpretation, and it can be difficult to maintain the necessary distance to analyze a group that you are embedded in.

There are often also ethical considerations to take into account: for example, about how your role is disclosed to members of the group, or about observing and reporting sensitive information.

Should you use ethnography in your research?

If you’re a student who wants to use ethnographic research in your thesis or dissertation , it’s worth asking yourself whether it’s the right approach:

• Could the information you need be collected in another way (e.g. a survey , interviews)?
• How difficult will it be to gain access to the community you want to study?
• How exactly will you conduct your research, and over what timespan?
• What ethical issues might arise?

If you do decide to do ethnography, it’s generally best to choose a relatively small and easily accessible group, to ensure that the research is feasible within a limited timeframe.

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There are a few key distinctions in ethnography which help to inform the researcher’s approach: open vs. closed settings, overt vs. covert ethnography, and active vs. passive observation. Each approach has its own advantages and disadvantages.

Open vs. closed settings

The setting of your ethnography—the environment in which you will observe your chosen community in action—may be open or closed.

An open or public setting is one with no formal barriers to entry. For example, you might consider a community of people living in a certain neighborhood, or the fans of a particular baseball team.

• Gaining initial access to open groups is not too difficult…
• …but it may be harder to become immersed in a less clearly defined group.

A closed or private setting is harder to access. This may be for example a business, a school, or a cult.

• A closed group’s boundaries are clearly defined and the ethnographer can become fully immersed in the setting…
• …but gaining access is tougher; the ethnographer may have to negotiate their way in or acquire some role in the organization.

Overt vs. covert ethnography

Most ethnography is overt . In an overt approach, the ethnographer openly states their intentions and acknowledges their role as a researcher to the members of the group being studied.

• Overt ethnography is typically preferred for ethical reasons, as participants can provide informed consent…
• …but people may behave differently with the awareness that they are being studied.

Sometimes ethnography can be covert . This means that the researcher does not tell participants about their research, and comes up with some other pretense for being there.

• Covert ethnography allows access to environments where the group would not welcome a researcher…
• …but hiding the researcher’s role can be considered deceptive and thus unethical.

Active vs. passive observation

Different levels of immersion in the community may be appropriate in different contexts. The ethnographer may be a more active or passive participant depending on the demands of their research and the nature of the setting.

An active role involves trying to fully integrate, carrying out tasks and participating in activities like any other member of the community.

• Active participation may encourage the group to feel more comfortable with the ethnographer’s presence…
• …but runs the risk of disrupting the regular functioning of the community.

A passive role is one in which the ethnographer stands back from the activities of others, behaving as a more distant observer and not involving themselves in the community’s activities.

• Passive observation allows more space for careful observation and note-taking…
• …but group members may behave unnaturally due to feeling they are being observed by an outsider.

While ethnographers usually have a preference, they also have to be flexible about their level of participation. For example, access to the community might depend upon engaging in certain activities, or there might be certain practices in which outsiders cannot participate.

An important consideration for ethnographers is the question of access. The difficulty of gaining access to the setting of a particular ethnography varies greatly:

• To gain access to the fans of a particular sports team, you might start by simply attending the team’s games and speaking with the fans.
• To access the employees of a particular business, you might contact the management and ask for permission to perform a study there.
• Alternatively, you might perform a covert ethnography of a community or organization you are already personally involved in or employed by.

Flexibility is important here too: where it’s impossible to access the desired setting, the ethnographer must consider alternatives that could provide comparable information.

For example, if you had the idea of observing the staff within a particular finance company but could not get permission, you might look into other companies of the same kind as alternatives. Ethnography is a sensitive research method, and it may take multiple attempts to find a feasible approach.

All ethnographies involve the use of informants . These are people involved in the group in question who function as the researcher’s primary points of contact, facilitating access and assisting their understanding of the group.

This might be someone in a high position at an organization allowing you access to their employees, or a member of a community sponsoring your entry into that community and giving advice on how to fit in.

However,  i f you come to rely too much on a single informant, you may be influenced by their perspective on the community, which might be unrepresentative of the group as a whole.

In addition, an informant may not provide the kind of spontaneous information which is most useful to ethnographers, instead trying to show what they believe you want to see. For this reason, it’s good to have a variety of contacts within the group.

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The core of ethnography is observation of the group from the inside. Field notes are taken to record these observations while immersed in the setting; they form the basis of the final written ethnography. They are usually written by hand, but other solutions such as voice recordings can be useful alternatives.

Field notes record any and all important data: phenomena observed, conversations had, preliminary analysis. For example, if you’re researching how service staff interact with customers, you should write down anything you notice about these interactions—body language, phrases used repeatedly, differences and similarities between staff, customer reactions.

Don’t be afraid to also note down things you notice that fall outside the pre-formulated scope of your research; anything may prove relevant, and it’s better to have extra notes you might discard later than to end up with missing data.

Field notes should be as detailed and clear as possible. It’s important to take time to go over your notes, expand on them with further detail, and keep them organized (including information such as dates and locations).

After observations are concluded, there’s still the task of writing them up into an ethnography. This entails going through the field notes and formulating a convincing account of the behaviors and dynamics observed.

The structure of an ethnography

An ethnography can take many different forms: It may be an article, a thesis, or an entire book, for example.

Ethnographies often do not follow the standard structure of a scientific paper, though like most academic texts, they should have an introduction and conclusion. For example, this paper begins by describing the historical background of the research, then focuses on various themes in turn before concluding.

An ethnography may still use a more traditional structure, however, especially when used in combination with other research methods. For example, this paper follows the standard structure for empirical research: introduction, methods, results, discussion, and conclusion.

The content of an ethnography

The goal of a written ethnography is to provide a rich, authoritative account of the social setting in which you were embedded—to convince the reader that your observations and interpretations are representative of reality.

Ethnography tends to take a less impersonal approach than other research methods. Due to the embedded nature of the work, an ethnography often necessarily involves discussion of your personal experiences and feelings during the research.

Ethnography is not limited to making observations; it also attempts to explain the phenomena observed in a structured, narrative way. For this, you may draw on theory, but also on your direct experience and intuitions, which may well contradict the assumptions that you brought into the research.

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

• Normal distribution
• Degrees of freedom
• Null hypothesis
• Discourse analysis
• Control groups
• Mixed methods research
• Non-probability sampling
• Quantitative research
• Ecological validity

Research bias

• Rosenthal effect
• Implicit bias
• Cognitive bias
• Selection bias
• Negativity bias
• Status quo bias

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Ethnographic Research -Types, Methods and Guide

Table of Contents

Ethnographic Research

Definition:

Ethnographic research is a qualitative research method used to study and document the culture, behaviors, beliefs, and social interactions of a particular group of people. It involves direct observation and participation in the daily life and activities of the group being studied, often for an extended period of time.

Ethnographic Study

An ethnographic study is a research method that involves the detailed and systematic study of a particular group, culture, or community. Ethnographic studies seek to understand the beliefs, values, behaviors, and social dynamics of a group through direct observation and participation in their daily life.

Ethnographic Research vs Ethnographic Study

here’s a table comparing ethnographic study and ethnographic research:

While there are some differences between the two, they are similar in that they both use qualitative research methods to study a particular group, culture, or community. The main difference is that an ethnographic study involves the researcher spending an extended period of time within the community being studied in order to develop a deep understanding, while ethnographic research is focused on documenting and analyzing the culture, beliefs, behaviors, and social interactions of the group being studied.

Ethnographic Research Types

Ethnographic research can be divided into several types based on the focus of the study and the research objectives. Here are some common types of ethnographic research:

Classic Ethnography

This type of ethnographic research involves an extended period of observation and interaction with a particular community or group. The researcher aims to understand the community’s culture, beliefs, practices, and social structure by immersing themselves in the community’s daily life.

Autoethnography

Autoethnography involves the researcher using their own personal experiences to gain insights into a particular community or culture. The researcher may use personal narratives, diaries, or other forms of self-reflection to explore the ways in which their own experiences relate to the culture being studied.

Participatory Action Research

Participatory action research involves the researcher working collaboratively with members of a particular community or group to identify and address social issues affecting the community. The researcher aims to empower community members to take an active role in the research process and to use the findings to effect positive change.

Virtual Ethnography

Virtual ethnography involves the use of online or digital media to study a particular community or culture. The researcher may use social media, online forums, or other digital platforms to observe and interact with the group being studied.

Critical Ethnography

Critical ethnography aims to expose power imbalances and social inequalities within a particular community or culture. The researcher may use their observations to critique dominant cultural narratives or to identify opportunities for social change.

Ethnographic Research Methods

Some common ethnographic research methods include:

Participant Observation

This involves the researcher directly observing and participating in the daily life and activities of the group being studied. This technique helps the researcher gain an in-depth understanding of the group’s behavior, culture, and social dynamics.

Ethnographic researchers use interviews to gather information about the group’s beliefs, values, and practices. Interviews may be formal or informal and can be conducted one-on-one or in group settings.

Surveys can be used to collect data on specific topics, such as attitudes towards a particular issue or behavior patterns. Ethnographic researchers may use surveys as a way to gather quantitative data in addition to qualitative data.

Document Analysis

This involves analyzing written or visual documents produced by the group being studied, such as newspapers, photographs, or social media posts. Document analysis can provide insight into the group’s values, beliefs, and practices.

Field Notes

Ethnographic researchers keep detailed field notes of their observations and interactions with the group being studied. These notes help the researcher organize their thoughts and observations and can be used to analyze the data collected.

Focus Groups

Focus groups are group interviews that allow the researcher to gather information from multiple people at once. This technique can be useful for exploring shared beliefs or experiences within the group being studied.

Ethnographic Research Data Analysis Methods

Ethnographic research data analysis methods involve analyzing qualitative data collected from observations, interviews, and other sources in order to identify patterns, themes, and insights related to the research question.

Here are some common data analysis methods used in ethnographic research:

Content Analysis

This involves systematically coding and categorizing the data collected from field notes, interviews, and other sources. The researcher identifies recurring themes, patterns, and categories in the data and assigns codes or labels to each one.

Narrative Analysis

This involves analyzing the stories and narratives collected from participants in order to understand how they construct and make sense of their experiences. The researcher looks for common themes, plot structures, and rhetorical strategies used by participants.

Discourse Analysis

This involves analyzing the language and communication practices of the group being studied in order to understand how they construct and reproduce social norms and cultural meanings. The researcher looks for patterns in the use of language, including metaphors, idioms, and other linguistic devices.

Comparative Analysis

This involves comparing data collected from different groups or communities in order to identify similarities and differences in their cultures, behaviors, and social structures. The researcher may use this analysis to generate hypotheses about why these differences exist and what factors may be contributing to them.

Grounded Theory

This involves developing a theoretical framework based on the data collected during the research process. The researcher identifies patterns and themes in the data and uses these to develop a theory that explains the social phenomena being studied.

How to Conduct Ethnographic Research

To conduct ethnographic research, follow these general steps:

• Choose a Research Question: Identify a research question that you want to explore. It should be focused and specific, but also open-ended to allow for flexibility and exploration.
• Select a research site: Choose a site or group that is relevant to your research question. This could be a workplace, a community, a social movement, or any other social setting where you can observe and interact with people.
• Obtain ethical clearance: Obtain ethical clearance from your institution or organization before beginning your research. This involves ensuring that your research is conducted in an ethical and responsible manner, and that the privacy and confidentiality of participants are protected.
• Conduct observations: Observe the people in your research site and take detailed notes. This involves being present and engaged in the social setting, participating in activities, and taking note of the behaviors, interactions, and social norms that you observe.
• Conduct interviews : Conduct interviews with people in the research site to gain deeper insights into their experiences, perspectives, and beliefs. This could involve structured or semi-structured interviews, focus groups, or other forms of data collection.
• Analyze data: Analyze the data that you have collected, looking for themes and patterns that emerge. This involves immersing yourself in the data and interpreting it within the social and cultural context of the research site.
• Write up findings: Write up your findings in a clear and concise manner, using quotes and examples to illustrate your key points. This may involve creating narratives, tables, or other visual representations of your findings.
• Reflect on your process: Reflect on your process and methods, thinking about what worked well and what could be improved for future research.

When to Use Ethnographic Research

Here are some situations where ethnographic research may be particularly appropriate:

• When exploring a new topic: Ethnographic research can be useful when exploring a topic that has not been well-studied before. By engaging with members of a particular group or community, researchers can gain insights into their experiences and perspectives that may not be visible from other research methods.
• When studying cultural practices: Ethnographic research is particularly useful when studying cultural practices and beliefs. By immersing themselves in the cultural context being studied, researchers can gain a deeper understanding of the ways in which cultural practices are enacted, maintained, and transmitted.
• When studying complex social phenomena: Ethnographic research can be useful when studying complex social phenomena that cannot be easily understood through quantitative methods. By observing social interactions and behaviors, researchers can gain insights into the ways in which social norms and structures are created and maintained.
• When studying marginalized communities: Ethnographic research can be particularly useful when studying marginalized communities, as it allows researchers to give voice to members of these communities and understand their experiences and perspectives.

Overall, ethnographic research can be a useful research approach when the goal is to gain a deep understanding of a particular group or community and their cultural practices, beliefs, and experiences. It is a flexible and adaptable research method that can be used in a variety of research contexts.

Applications of Ethnographic Research

Ethnographic research has many applications across a wide range of fields and disciplines. Some of the key applications of ethnographic research include:

• Informing policy and practice: Ethnographic research can provide valuable insights into the experiences and perspectives of marginalized or underrepresented groups, which can inform policy and practice in fields such as health care, education, and social services.
• Developing theories and concepts: Ethnographic research can contribute to the development of theories and concepts in social and cultural anthropology, sociology, and other disciplines, by providing detailed and nuanced accounts of social and cultural phenomena.
• Improving product design and marketing: Ethnographic research can be used to understand consumer behavior and preferences, which can inform the design and marketing of products and services.
• Studying workplace culture: Ethnographic research can provide insights into the norms, values, and practices of organizations, which can inform efforts to improve workplace culture and employee satisfaction.
• Examining social movements: Ethnographic research can be used to study the practices, beliefs, and experiences of social movements, which can inform efforts to understand and address social and political issues.
• Studying healthcare practices: Ethnographic research can provide insights into healthcare practices and patient experiences, which can inform efforts to improve healthcare delivery and patient outcomes.

Examples of Ethnographic Research

Here are some real-time examples of ethnographic research:

• Anthropological study of a remote indigenous tribe: Anthropologists often use ethnographic research to study remote indigenous tribes and gain insights into their culture, beliefs, and practices. For example, an anthropologist may live with a tribe for an extended period of time, observing and participating in their daily activities, and conducting interviews with members of the community.
• Study of workplace culture: Ethnographic research can be useful in studying workplace culture and understanding the dynamics of the organization. For example, an ethnographer may observe and interview employees in a particular department or team to gain insights into their work practices, communication styles, and social dynamics.
• Study of consumer behavior: Ethnographic research can be useful in studying consumer behavior and understanding how people interact with products and services. For example, an ethnographer may observe and interview consumers as they use a particular product, such as a new smartphone or fitness tracker, to gain insights into their behaviors and preferences.
• Study of health care practices: Ethnographic research can be useful in studying health care practices and understanding how patients and providers interact within the health care system. For example, an ethnographer may observe and interview patients and providers in a hospital or clinic to gain insights into their experiences and perspectives.
• Study of social movements: Ethnographic research can be useful in studying social movements and understanding how they emerge and evolve over time. For example, an ethnographer may observe and interview participants in a protest movement to gain insights into their motivations and strategies.

Purpose of Ethnographic Research

The purpose of ethnographic research is to provide an in-depth understanding of a particular group or community, including their cultural practices, beliefs, and experiences. This research approach is particularly useful when the research question is exploratory and the goal is to generate new insights and understandings. Ethnographic research seeks to understand the experiences, perspectives, and behaviors of the participants in their natural setting, without imposing the researcher’s own biases or preconceptions.

Ethnographic research can be used to study a wide range of topics, including social movements, workplace culture, consumer behavior, and health care practices, among others. The researcher aims to understand the social and cultural context of the group or community being studied, and to generate new insights and understandings that can inform future research, policy, and practice.

Overall, the purpose of ethnographic research is to gain a deep understanding of a particular group or community, with the goal of generating new insights and understandings that can inform future research, policy, and practice. Ethnographic research can be a valuable research approach in many different contexts, particularly when the goal is to gain a rich, contextualized understanding of social and cultural phenomena.

Advantages of Ethnographic Research

Ethnographic research has several advantages that make it a valuable research approach in many different fields. Here are some of the advantages of ethnographic research:

• Provides in-depth and detailed information: Ethnographic research involves direct observation of the group or community being studied, which allows researchers to gain a detailed and in-depth understanding of their beliefs, practices, and experiences. This type of information cannot be obtained through other research methods.
• Offers a unique perspective: Ethnographic research allows researchers to see the world from the perspective of the group or community being studied. This can provide unique insights into the ways in which different cultural practices and beliefs are constructed and maintained.
• Promotes cultural understanding: Ethnographic research can help to promote cultural understanding and reduce stereotypes by providing a more nuanced and accurate picture of different cultures and communities.
• Allows for flexibility: Ethnographic research is a flexible research approach that can be adapted to fit different research contexts and questions. Researchers can adjust their methods based on the needs of the group being studied and the research goals.
• Generates rich and diverse data: Ethnographic research generates rich and diverse data through a combination of observation, interviews, and other methods. This allows researchers to analyze different aspects of the group or community being studied and identify patterns and themes in the data.
• Supports theory development: Ethnographic research can support theory development by providing empirical data that can be used to test and refine theoretical frameworks.

Limitations of Ethnographic Research

Ethnographic research has several limitations that researchers should consider when selecting this research approach. Here are some of the limitations of ethnographic research:

• Limited generalizability: Ethnographic research typically involves studying a small and specific group or community, which limits the generalizability of the findings to other contexts or populations.
• Time-consuming: Ethnographic research is a time-consuming process that requires a significant investment of time and resources. Researchers must spend time observing and interacting with the group being studied, which may not be feasible in all research contexts.
• Subjectivity: Ethnographic research relies on the researcher’s interpretation and analysis of the data collected, which may introduce subjective bias into the research findings.
• Limited control: Ethnographic research involves studying a group or community in their natural setting, which limits the researcher’s control over the research context and the behavior of the participants.
• Ethical concerns: Ethnographic research can raise ethical concerns, particularly when studying marginalized or vulnerable populations. Researchers must be careful to ensure that they do not harm or exploit the participants in the research process.
• Limited quantitative data: Ethnographic research typically generates qualitative data, which may limit the types of analysis that can be conducted and the types of conclusions that can be drawn.

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Ethnography In Qualitative Research

Saul McLeod, PhD

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Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

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What is Ethnography?

Ethnography is a qualitative research method that emphasizes studying what people do and say in particular contexts. Ethnographers typically spend considerable time observing and interacting with a social group to understand how the group develops cultural constructions and relations.

Ethnography is used anthropology and other social sciences to systematically study people and cultures.

The goal of ethnography is to explore cultural phenomena from the perspective of the subjects being studied.

They aim to uncover the reasons for particular behaviors and practices within a specific cultural context. For example, an ethnographic study might examine why certain communities use specific child-rearing techniques or how cultural values influence emotional expression.

This often involves immersing oneself in a community or organization to observe their behaviors and interactions up close.

Ethnographic research is often open-ended and exploratory. Researchers may enter the field with a research question in mind, but they remain open to unexpected findings and allow the social order of the community to guide their observations.

This openness to discovery helps researchers develop a deeper understanding of the cultural phenomena they study.

How does an ethnographic perspective view psychological knowledge?

Ethnography considers the social context of psychological phenomena to be critical to the field of psychology.

An ethnographic perspective argues that psychological knowledge is not complete unless it examines how communal practices, economic and political structures, shared values, histories, aspirations, and other life dimensions shape human experiences.

The interaction of identity and self-definition is dynamic and shaped by an individual’s social contexts.

Ethnography is primarily used in the following situations:

• Cultural anthropology : Ethnography is the primary research method used by cultural anthropologists to study and understand different societies and cultures around the world. Margaret Mead conducted ethnographic research among the Arapesh, Mundugumor, and Tchambuli people of New Guinea, which resulted in her book Sex and Temperament in Three Primitive Societies (1935). In this work, she explored the ways in which gender roles and personality traits varied across cultures.
• Sociology : Ethnographic methods are used in sociology to study subcultures, communities, and social groups within a larger society, such as urban neighborhoods, religious communities, or professional groups. Paul Willis conducted an ethnographic study of working-class youth culture, presented in his work Learning to Labo r. Willis sought to understand why working-class youth often ended up in working-class jobs. His research involved a series of interviews and observations, focusing on a school setting to gain insight into the connection between working-class backgrounds and career trajectories. Willis concluded that working-class children often develop a counter-school culture, characterized by opposition to academics and authority figures.
• Education : Ethnography is used in educational research to study classroom dynamics, student-teacher interactions, and the impact of cultural factors on learning.
• Healthcare : Ethnography is used in healthcare research to study patient experiences, healthcare provider practices, and the cultural factors that influence health behaviors and outcomes.
• Social work : Ethnographic research helps social workers understand the lived experiences of marginalized or vulnerable populations, informing the development of more effective interventions and support services.
• Policy and development : Ethnography is used in policy research and international development to assess the impact of policies and programs on local communities and to ensure that development initiatives are culturally appropriate and sustainable.

What distinguishes ethnography from other qualitative methods?

While ethnography shares commonalities with other qualitative methods, these distinctions highlight its unique capacity to provide rich, nuanced insights into the complexities of human behavior and culture.

• Immersive Fieldwork: Unlike other qualitative methods that might rely solely on interviews or surveys, ethnography necessitates the researcher to be directly involved in the community or group they are studying, often for extended periods. This immersive approach allows for a depth of understanding unattainable through less participatory methods.
• Unstructured Data Collection: Ethnographers typically begin their research with a more exploratory approach rather than testing predetermined hypotheses. They embrace unstructured data collection, allowing patterns and theories to emerge from their observations and interactions rather than imposing pre-existing frameworks.
• Emphasis on Observation Over Interviews: Although interviews are a common tool in ethnographic research, the core of the method lies in observing what people do rather than solely relying on what they say . This focus on action allows ethnographers to identify discrepancies between stated beliefs and actual practices, providing a richer understanding of the complexities within a social group.
• Interpretative and Reflexive Analysis: Ethnographers acknowledge the inherent subjectivity involved in interpreting social phenomena. They embrace reflexivity, acknowledging that their own backgrounds and perspectives shape how they observe and interpret data.
• Focus on Process, Meaning, and Place: Ethnography seeks to uncover the dynamic processes, shared meanings, and influence of place that shape social life. It investigates how individuals make sense of their world and how these understandings influence their actions and interactions within specific geographical and social contexts.
• Thick description : Thick description, a concept by Geertz, is an ethnographer’s in-depth and nuanced representation of social life that goes beyond simple observation, exploring the meanings and motivations behind behaviors. This nuanced understanding illustrates how ethnographers use thick description to reveal what is “at stake” in people’s lives.

Gaining Access to a Community for Ethnographic Research

Negotiating access to a community for research can be a delicate process, requiring sensitivity and understanding of local social practices.

There is no one-size-fits-all approach; instead, researchers must adapt their approach to the specific community and setting they wish to study.

• Initial Contact: Start by identifying potential participants and settings relevant to the research question. Initial contact can be made remotely through emails, calls, or social connections. Reaching out to researchers who have previously worked in the field can be beneficial. Physical visits to the field can also be helpful in the initial stages.
• Building Trust and Understanding Local Norms: Establishing trust is paramount in ethnographic research. Researchers should prioritize initiating contact in a manner that aligns with the community’s social practices. For example, directly emailing community centers in a culture that values personal introductions might be ineffective. Introducing the researcher through a trusted community member, like a friend or neighbor, can foster trust and facilitate acceptance. Researchers should remain mindful of their position in relation to the community’s cultural norms and how their presence might be perceived.
• Addressing Challenges and Maintaining Access: Unexpected challenges and setbacks are common in ethnographic research. Embracing methodological agility allows researchers to adapt their methods to the contingencies of the field site and view setbacks as opportunities for refining research design. Flexibility is key, and researchers should be open to exploring alternative settings or communities if access to the initial choice proves difficult.
• Ethical Considerations and Reciprocity: Ethnographic research involves a responsibility to the community being studied. Ethnographers must be aware of the power dynamics inherent in research and strive to minimize harm by respecting participants’ privacy and cultural norms. Researchers should consider how their work can benefit the community, for instance, by offering insights, providing resources, or advocating for positive change.

Working with Informants in Ethnography

Informants are crucial to ethnographic research, acting as primary points of contact and facilitating the researcher’s understanding of the group being studied.

Identifying the right informants is vital, and a “friend-of-a-friend” approach, leveraging existing social networks, can be advantageous.

This method can grant access to otherwise inaccessible aspects of social life and provide a unique, embedded perspective on the community’s language use and attitudes.

However, over-reliance on a single informant can skew the researcher’s perspective, potentially leading to biased or unrepresentative findings.

An informant may consciously or unconsciously shape their interactions with the researcher to align with what they believe is expected, hindering the collection of spontaneous and authentic data.

Therefore, it’s essential to cultivate relationships with a diverse range of informants within the community. This approach helps ensure a more comprehensive understanding of the group’s dynamics and mitigates the risk of individual bias influencing the research findings.

While the sources don’t provide detailed steps on managing relationships with multiple informants, they emphasize the importance of ethical considerations, open communication, and building trust throughout the research process.

Data Sources in Ethnographic Research

Ethnographers often employ a  multi-method approach , combining data from these various sources to create a rich and comprehensive understanding of the group being studied.

They may also utilize audio and video recordings to capture interactions and analyze nonverbal communication.

The choice of specific data collection methods depends on factors like the research question, available resources, and ethical considerations

• Participant observation involves the researcher immersing themselves in the daily life of a community to gain an understanding of the actions, activities, rituals, routines, and daily practices. The ethnographer might participate in activities to learn through experience or observe from the sidelines. There are varying levels of participation in this method. Some researchers fully adopt the social role they are studying, like a factory worker or police officer, to better understand the group’s worldview. Others maintain a more detached relationship, observing from the sidelines, while acknowledging that some interaction is inevitable.
• Field notes  are a primary data source, meticulously recording observations, conversations, and preliminary analyses made during immersion in the research setting3.
• Interviews  play a significant role, providing insights into individuals’ perspectives and experiences within the group. Interviews provide a source of witness accounts about settings and events in the social world that the ethnographer may or may not have been able to observe.
• Documents , both official and personal, can offer valuable contextual information and supplement observational data

When conducting ethnographic research, researchers should be mindful of their ontological and epistemological stances, their research questions, and the context of their research.

Ethnographers must also consider ethical implications, the type of data they are collecting, and how their findings will be used.

What are the limitations of solely relying on interviews in ethnographic research?

While interviews are a common element of ethnographic research, relying on them solely as a source of data has some significant limitations.

• Discrepancies Between Words and Actions : Interviews primarily capture what people say about their lives, beliefs, and practices. However, what people say and what they actually do can differ. Observing participants in their natural environment can reveal these discrepancies and provide a more complete understanding of their lived experiences.
• Influence of Interviewer and Context : The interview itself is a constructed situation that can influence participants’ responses. Participants may modify their language or opinions to align with perceived expectations or power dynamics, particularly when discussing sensitive topics.
• Limited Insight into Meaning-Making : While interviews can provide information about perspectives and beliefs, they may not fully capture the subtle ways cultural meanings are embedded in everyday practices and interactions. Ethnographic observation allows researchers to witness these meaning-making processes firsthand.
• Difficulty in Capturing Complexity : Interviews, especially structured ones, often rely on pre-determined questions and response categories. This approach can oversimplify complex cultural phenomena and miss nuances that emerge through observation of natural interactions.

Supplementing Interviews with Observation

To mitigate these limitations, sources emphasize the importance of combining interviews with other ethnographic methods, primarily participant observation .

• Observing participants in their natural environment provides a more holistic and nuanced understanding of their practices, interactions, and the cultural meanings embedded within them.
• This immersive approach allows researchers to go beyond self-reported accounts and gain insights that might not be revealed through interviews alone.

Skills Required for Ethnographic Studies

• High Degree of Interpretative Agility: Understanding the intricacies of ethnographic studies necessitates a high degree of interpretative agility to make sense of the diverse range of issues and facts gathered.
• Cultural Sensitivity: Sensitivity towards the culture, values, and norms of the social setting is paramount for conducting ethical and meaningful research. This is essential for building trust and rapport with research participants and understanding their perspectives.
• Reflexivity : Ethnographers must be self-aware and reflective about their own positionality, biases, and impact on the research process, and be transparent about these factors in their writing.

The Role of Reflexivity in Ethnography

Reflexivity in ethnographic writing involves thoughtfully examining how the researcher’s background, beliefs, and position influence their observations, interpretations, and the final ethnographic account.

It’s a crucial aspect of producing responsible and insightful ethnographic work.

• Acknowledging Subjectivity: Ethnographers who practice reflexivity understand that their accounts are not objective truths, but rather interpretations shaped by their own experiences and perspectives. They acknowledge that other researchers, with different backgrounds and positions, might interpret the same data differently.
• Positioning the Researcher: Reflexivity encourages ethnographers to explicitly consider and articulate how their personal and cultural background, as well as their social position relative to the community being studied, might influence their understanding of the observed phenomena. This includes acknowledging any preconceived notions or biases they bring to the research.
• Examining Power Dynamics: Ethnographic research often involves power imbalances between the researcher and the researched, especially when studying marginalized groups. Reflexivity encourages researchers to critically examine these power dynamics and to consider how their work might perpetuate or challenge existing inequalities. This involves being transparent about the research process and engaging in ethical practices that protect participants.
• Enhancing the Validity of Findings : Ultimately, reflexivity aims to strengthen the ethnographic account by making the researcher’s interpretive process more transparent and by providing a more nuanced and accountable representation of the community being studied. This can involve explicitly discussing the researcher’s positionality and reflecting on how their presence might have influenced the data collected.

It is important to note that while reflexivity is widely recognized as crucial in ethnography, there are different understandings of its application and implications.

Some argue for a more radical approach that emphasizes the subjective nature of ethnographic knowledge and the limitations of representation.

Others advocate for a more moderate stance that acknowledges the importance of reflexivity while still striving for rigorous and insightful accounts of social reality.

Importance of Local Context in Ethnography

Understanding the local context is crucial for ethnographic research because it allows researchers to accurately interpret the meanings behind people’s actions and perspectives within their specific social and cultural environment.

Ethnography examines the intricate relationships between human agency and the structures of society within the everyday experiences of a particular place. This method aims to understand the processes and meanings that underpin social life, recognizing that these processes and meanings vary across locations.

Here’s why local context is so important for ethnographic research:

• Connecting Macro and Micro Levels of Analysis: Ethnography aims to reveal the link between large-scale societal structures and the everyday experiences of individuals. The local context provides the specific setting where these connections are made visible and understandable. For instance, studying violence statistically cannot capture the contextual factors that lead to it, but ethnographic research can uncover the specific social dynamics and meanings within particular places that contribute to such behavior.
• Uncovering Meaning Systems: The meanings people assign to events and actions are often deeply embedded within their local culture and not always explicitly stated. Ethnographers, by immersing themselves in the local context, can gradually understand these meaning systems through prolonged observation, interaction, and analysis of daily practices.
• Context-Sensitivity of Behavior: People’s actions and accounts of their actions are highly context-dependent, meaning they can vary significantly across different settings. Ethnographic research acknowledges this by emphasizing firsthand observation and understanding of the local context to ensure accurate interpretation of behavior and perspectives.
• Avoiding Misinterpretation: Without a deep understanding of the local context, researchers risk misinterpreting observations or imposing their own cultural biases on the data. Immersing oneself in the local context allows ethnographers to develop cultural competence and sensitivity, which helps them arrive at more accurate and insightful interpretations of the group’s actions and beliefs.

In essence, understanding the local context is not just about knowing where something occurs, but about comprehending the intricate web of cultural meanings, social dynamics, and historical factors that shape people’s lives and experiences in that specific location.

This understanding is fundamental to the ethnographic approach and its ability to generate meaningful insights into human behavior and social life.

Challenges in Conducting Ethnographic Research

Ethnography, a qualitative research method focusing on the study of people and cultures, presents a unique set of challenges for researchers:

• Time Commitment : Ethnography is a time-consuming endeavor. Researchers need to spend significant time immersed in the community or organization they are studying to build relationships, observe interactions, and gain a deep understanding of the culture. This long-term immersion requires careful planning and can be personally demanding. For instance, some research may necessitate a “focused” or “mini” ethnography lasting a few weeks or months, while others require a year or more.
• Observer Bias : Ethnographers are at risk of introducing their own biases into the research. Writing an ethnography involves subjective interpretation, and it can be difficult to remain objective when analyzing a group in which the researcher is deeply involved. The researcher’s background, beliefs, and experiences can influence their observations and interpretations.
• Representing Culture : Writing about other people is inherently complicated, and ethnographers must consider how to describe people in a manner that is informative, honest, sensitive, and ethical.
• Ethical Issues : Recognize that ethnographers often hold a position of power relative to the communities they study, particularly when working with marginalized groups. Ensure participants are volunteers who understand the study’s purpose and their right to withdraw.
• Gaining Access : Getting access to a community or organization for research can be a delicate process. Researchers need to establish trust with gatekeepers and negotiate their role within the community. This can be particularly difficult in settings that are closed or suspicious of outsiders. For instance, researchers may face resistance from organizations concerned about negative publicity stemming from the study’s findings.
• Data Analysis and Interpretation : Ethnographic research often generates large amounts of data in various forms, such as field notes, interviews, and documents. Analyzing this data and developing meaningful interpretations can be challenging and time-consuming. Researchers must develop systematic ways to manage, analyze, and interpret their data while staying true to the experiences and perspectives of the participants.
• Generalizability : The findings of ethnographic research, which typically focuses on a specific case or setting, can be challenging to generalize to other populations or contexts. The in-depth, context-specific nature of ethnographic research, while a strength in understanding a particular group, poses challenges for drawing broader conclusions about human behavior and social phenomena.
• External Pressures : Ethnographers may face pressure from funding agencies or institutions to conduct research that aligns with specific agendas or produces immediate, tangible outcomes. This pressure can create ethical dilemmas and compromise the integrity of the research. For example, ethnography may be perceived as an inefficient research method due to its reliance on long-term engagement.

Strategies for Ethical Representation

Any ethnographic account of another cultural group risks engaging in what Edward Said (1978) called the “politics of othering,” potentially distorting the lives of those being studied in support of “scientific racism and projects of colonial domination and exploitation”.

The ethnographer should chronicle the community’s experiences, including their struggles, aspirations, losses, and stagnation, with compassion

Thick Description

Provide a nuanced perspective on social life, connecting observed behaviors to underlying meanings, emotions, and decision-making strategies, while avoiding simplistic or reductive accounts of complex experiences.

For example, instead of simply stating that Alzheimer’s carries a social stigma, an ethnographer might connect this observation to the community’s beliefs about family and social change.

Respect and Dignity

Represent individuals with respect and dignity, appreciating their values within the context of their lives.

The ethnographer should chronicle the community’s experiences, including their struggles, aspirations, losses, and stagnation, with compassion.

Reflexivity and Collaboration

Acknowledge the historical legacy of ethnography, including its role in colonialism and the potential for exploitative research practices.

Ethnographers should strive for a more equitable and collaborative approach by:

• Recognizing participants as “epistemic agents and interlocutors” who contribute theoretical interpretations, not merely data points2.
• Involving community members in shaping research questions, data analysis, and the dissemination of findings.
• Considering co-authorship with community members

Strengths of Ethnography

• Ethnography offers a nuanced understanding of cultural phenomena by directly observing behaviors and interactions within a specific community or organization. This immersive approach allows researchers to gain firsthand knowledge of shared culture, conventions, and social dynamics. Ethnography is particularly useful for studying complex social phenomena like football fans, call center workers, and police officers.
• Flexibility, allowing researchers to adapt their research strategy and direction based on their observations and developing understanding. Rather than aiming to confirm a hypothesis or test a general theory, ethnographic research prioritizes providing a comprehensive and detailed narrative of a specific culture. This open-ended approach enables the exploration of various aspects of the group and setting being studied.
• Ethnographers can uncover authentic information and observe spontaneous dynamics that might not surface through direct questioning. By becoming immersed in the social environment, researchers gain access to a deeper understanding of the lived experiences of the group under study. For example, ethnographers can examine discrepancies between what people say and their actual actions, providing insights that other methodologies might miss.
• Ethnography enables researchers to understand the meanings behind social actions by revealing the knowledge and meaning structures that guide them. Through prolonged engagement and observation, ethnographers gain insight into the cultural systems of meaning that shape individuals’ perceptions and actions. Unlike surveys or interviews with pre-determined questions, ethnography allows for an emergent understanding of the cultural competencies within a social setting.
• Ethnographic research relies on a comprehensive approach to data collection, incorporating observations, conversations, and preliminary analysis through detailed field notes. This rigorous documentation helps ensure the accuracy and representativeness of the findings. Moreover, ethnography goes beyond simply describing behaviors; it strives to provide a structured explanation of the observed phenomena, drawing on the researcher’s direct experiences, intuitions, and relevant theoretical frameworks.

However, it’s important to note that ethnography, while valuable, has limitations. It is a time-consuming method requiring significant planning and careful consideration of ethical issues.

Additionally, maintaining objectivity and minimizing observer bias can be a challenge due to the researcher’s immersive role.

Further Information

• Brewer, J. (2000).  Ethnography . McGraw-Hill Education (UK).
• Hammersley, M. (2006). Ethnography: problems and prospects .  Ethnography and education ,  1 (1), 3-14.
• Herbert, S. (2000). For ethnography .  Progress in human geography ,  24 (4), 550-568.
• Lew-Levy, S., Reckin, R., Lavi, N., Cristóbal-Azkarate, J., & Ellis-Davies, K. (2017). How do hunter-gatherer children learn subsistence skills? A meta-ethnographic review. Human Nature,  28 (4), 367–394.  https://doi.org/10.1007/S12110-017-9302-2
• Mead, M. (1963). Sex and temperament in three primitive societies (Vol. 370). New York: Morrow.
• Said, E. W. (2013). Orientalism reconsidered. In  Literature Politics & Theory  (pp. 230-249). Routledge.
• Willis, P. (1977). Learning to Labor: How Working-class Kids Get Working-class Jobs . New York: Colombia University Press

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Chapter 9: Ethnography

Darshini Ayton

Learning outcomes

Upon completion of this chapter, you should be able to:

• Identify the key terms and concepts used in ethnography.
• Discuss the advantages and disadvantages of ethnography.

What is ethnography?

The key concept in ethnography is culture .

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

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

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

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

Additional key concepts in ethnographic research

• Fieldwork and field notes – the time spent engaging in primary data collection, which is predominantly participant observation, and the mode of data collection. Fieldwork is the time spent immersed in the culture under study, while field notes are the written reflections, observations and ideas documented during or soon after fieldwork. 5
• Participant observation – the main method of data collection in ethnography involves the researcher participating as a member of the community or culture, to gain first-hand experience of daily life in the research setting. 5
• An emic perspective – ethnography seeks to understand the worldview of the participant; it thus follows that the researcher can have an emic perspective (insider) or an etic perspective (outsider). This is not a binary category. Rather, researchers might be considered on a continuum, from emic to etic 6 (see Chapter 28 for an overview of insider and outsider research), and therefore reflexivity (Chapter 30) and researcher positionality (Chapter 28) are important elements of the research process . Implementing ‘insider’ ethnography: lessons from the Public Conversations about HIV/AIDS  project in rural South Africa describes an ethnography project involving insider community members and outsider investigators reflecting on the advantages and challenges of this approach. 7
• Thick description – the researcher creates detailed observational field notes with references to the social actions and behaviours of participants. The field notes include anecdotes, observations about the language used and quotes to illustrate the activities of the cultural group being observed. The researcher then integrates theoretical frameworks to help create meaning for the observations. 8
• Holism – ethnography focuses on studying all aspects of a culture, including religious practices, politics, institutions, family structures and cultural traditions. Using the analogy of the structure of the human body, Bronislaw Malinowski, one of the founders of the functionalist school of anthropology, described survey research as the skeleton and ethnography as the flesh and blood. 4

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

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

Advantages and challenges of ethnography

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

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

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

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

Table 9.1. Ethnographic examples

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

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

Qualitative Research – a practical guide for health and social care researchers and practitioners Copyright © 2023 by Darshini Ayton is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

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12 Ethnography

Anthony Kwame Harrison, Department of Sociology, Virginia Tech

• Published: 04 August 2014
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Embracing the trope of ethnography as narrative, this chapter uses the mythic story of Bronislaw Malinowski’s early career and fieldwork as a vehicle through which to explore key aspects of ethnography’s history and development into a distinct form of qualitative research. The reputed “founding father” of the ethnographic approach, Malinowski was a brilliant social scientist, dynamic writer, conceited colonialist, and, above all else, pathetically human. Through a series of intervallic steps—in and out of Malinowski’s path from Poland to the “Cambridge School” and eventually to the western Pacific—I trace the legacy of ethnography to its current position as a critical, historically informed, and unfailingly evolving research endeavor. As a research methodology that has continually reflected on and revised its practices and modes of presentation, ethnography is boundless. Yet minus its political, ethical, and historical moorings, I argue, the complexities of twenty-first-century society render its future uncertain.

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The Ultimate Guide to Qualitative Research - Part 1: The Basics

• Introduction and overview
• What is qualitative research?
• What is qualitative data?
• Examples of qualitative data
• Qualitative vs. quantitative research
• Mixed methods
• Qualitative research preparation
• Theoretical perspective
• Theoretical framework
• Literature reviews
• Research question
• Conceptual framework
• Conceptual vs. theoretical framework
• Data collection
• Qualitative research methods
• Focus groups
• Observational research
• Case studies
• Introduction

Defining ethnographic research

What are the methods in ethnographic research, how do i conduct an ethnography.

• Ethical considerations
• Confidentiality and privacy
• Power dynamics
• Reflexivity

What is ethnographic research?

An ethnographic study is one of the most ambitious endeavors a researcher can pursue in qualitative research . It involves using several ethnographic methods to observe and describe social life, social relations, or human society as a whole. Time-consuming and arduous as the data collection and data analysis might be, conducting an ethnography can be one of the most rewarding challenges in cultural anthropology, social anthropology, and similar qualitative research areas.

Let's look at the fundamentals of ethnographic research, examples of ethnographic studies, and the fundamentals of ethnography as a qualitative research method.

"Culture" is an ambiguous term that resists an easy definition. What defines a culture? What takes place inside a culture? What cultures does a particular individual belong to? Who decides who belongs to any specific culture?

Even within a particular context, there are several layers of cultures. Take the United States, for example. Given how diverse and as big as it is, how can one define American culture in as brief an explanation as possible? What are the different social groups within this one country, and how do those groups interact with each other?

Quantitative research is often incapable of capturing such detail, especially because it is extremely difficult to adequately capture a culture in quantitative terms. As a result, researchers often conduct traditional ethnographic research when they want to understand a culture. A credible, written account of a social group is challenging to produce. It requires looking at participant experiences, interviews , focus groups , and document collection, which are different ways to collect data for ethnographic research.

Ethnography belongs squarely in the realm of observational research . In other words, writing culture and cultural critique cannot be based on experiments performed in controlled settings. Ethnography aims to provide an immersive experience in a culture for audiences who are unfamiliar with it. In that case, the researcher must observe the intricate dimensions of social interaction in its natural environment. In ethnographic research, this observation is active and involves being part of the culture to understand the dimensions of cultural norms from the inside.

That said, even observation alone cannot capture concepts such as social relationships or cultural practices. Researchers conducting ethnographic studies acknowledge that simply observing and describing actions are insufficient to grasp social interaction fully. The concept of thick description, or the description of perspectives and beliefs informing those actions in addition to the actions themselves, guides the use of various methods to capture social phenomena from multiple angles.

What is the purpose of ethnographic research?

Ethnographic studies are heavily used in social and cultural anthropology disciplines to generate and expand theory. Outside of anthropology, the insights uncovered by ethnography help to propose or develop theories that can be verified by further qualitative or quantitative research within the social and human sciences.

In simple terms, ethnographic studies relate what a culture is to audiences who are otherwise unfamiliar outsiders. Armed with this understanding, researchers can illustrate and persuade audiences about patterns that emerge from a community or group of people. These patterns are essential to generating theory and pioneering work.

What are examples of ethnographic research?

Ethnographic research aims to reach a deep understanding of various socially-constructed topics, including:

• Rituals and other cultural practices in everyday life
• Social interaction among people of different cultures
• People's interactions with their natural environment
• Creation of and tensions in social relationships

Ethnography as a qualitative method is common in social and cultural anthropology and any scholarly discipline concerned with social interaction. The traditional role of ethnography is to inform scholars interested in cultures they wouldn't otherwise have contact or experience with. Various topics that have been explored by such research with ethnography include:

• health care workers interacting with patients
• teachers and students constructing classroom dialogue
• workplace relations between employees and managers
• experiences of refugees in conflict zones

Other disciplines, especially in the social sciences, employ ethnographic research methods for varied reasons, including understanding:

• effective teaching practices
• socialization processes
• intercultural cohesiveness
• company-customer relations

The range of inquiries that ethnography can answer is vast, highlighting the importance of ethnographic methods in studies where the researcher seeks a deep understanding of a particular topic.

Even within anthropology, there is a lack of consensus on the particular processes for conducting research through ethnography. Interaction among people is unpredictable to the extent that the researcher might encounter unexpected issues with research participants not foreseen at the outset of a study. Because no observational research can be conducted in a fully controlled setting, it is a challenge to define an exact process for an ethnography beyond the general principles guiding an ethnographic approach.

In broad terms, ethnographic data collection methods are varied. Still, all such methods carry the assumption that a single research method cannot fully capture a thorough understanding of a cultural phenomenon. A systematic study that employs ethnographic research methods collects data from observations, participant observations, and interviews . The researchers' reflections also contribute to the body of data since personal experiences are essential to understanding the unfolding ethnography.

Participant observation

At the core of field research is a method called participant observation . Scholars in contemporary ethnography have long acknowledged the importance of active participation in understanding cultural life. This method allows the researcher to experience activities and interactions alongside participants to establish an understanding they wouldn't otherwise achieve by observing from afar. In active participant observation, the ethnographic researcher takes field notes of what they see and experience. They are essential during fieldwork as they create a record that the researcher can look at later on to structure their analysis and recall crucial developments useful to data analysis .

During participant observation, the researcher may also collect other forms of data, including photographs and audio and video recordings . Sensory data is beneficial to ethnography because it helps the researcher recall essential experiences with vivid detail and provides potentially abundant supporting evidence for the arguments in their findings.

Interviews and focus groups

Participant observation provides data for seeing what people say and do in their natural environment. However, observation has its limits for capturing what people think and believe. As a result, an ethnographic researcher conducts interviews to follow up on what they saw in fieldwork with research participants.

A common type of interview in an ethnography is the stimulated recall interview. In a stimulated recall interview, research participants are asked questions about the events the researcher observed. These questions help research participants remember past experiences while providing the researcher with their way of thinking about those experiences.

A focus group involves interactions between the researcher and multiple research participants. Suppose the researcher is interested in the interpersonal dynamics between research participants. In that case, they might consider conducting focus groups to elicit interactions that are markedly different from one-on-one exchanges between a single research participant and the researcher. Interviews and focus groups also help uncover insights otherwise unfamiliar to the researcher, who can then use those insights to guide their theoretical understanding and further data collection .

Document collection

Documents often make up an essential aspect of cultural practices. Think about these examples:

• student homework
• medical records
• newspaper articles
• informational posters

The visual elements uncovered during an ethnography are potentially valuable to theoretical insights, and a researcher might find it important to incorporate documents in their project data.

Reflections

In any ethnography, the researcher is the main instrument of data collection. Their thoughts and beliefs are consequential to the data analysis in that any theoretical insights are filtered by their interpretations . As a result, a researcher should take field notes during participant observation and reflection notes about any connections between what they saw and what it might mean for generating theory during data analysis.

As with taking field notes, a researcher might not remember all the different things that transpire during an ethnography without being able to refer to some sort of record later on. More importantly, reflecting on theory during participant observation may be challenging. A useful practice involves sitting down after observations or interviews and writing down potential theoretical insights that come to mind.

Reflections guide participant observations during an ethnography and theoretical analysis afterward. They point the researcher toward phenomena that are most relevant to theory and guide discussion of that theory when the time comes to write a description of their ethnographic study.

Organizing data

With a research approach as complex as ethnography, you will likely collect abundant data that require organization to make the analytical process more efficient. Researchers can use ATLAS.ti to store all their data in a single project. Document groups allow you to categorize data into different types (e.g., text, audio, video), different contexts (e.g., hospital room, doctor's office), or even different dates (e.g., February 17th observation, March 21st observation).

Moreover, researchers can integrate text with multimedia in ATLAS.ti, which is ideal for analyzing interviews, because you can look at transcripts and their video or audio recordings simultaneously. This is a valuable feature in ethnographic studies examining how people speak and what they say. Photos and other visual documents can also easily be incorporated and analyzed, adding further valuable dimensions to your research.

Choose ATLAS.ti for analysis of all forms of data.

Download a free trial of ATLAS.ti to put your project data to work.

Now that we have established a foundational understanding of the various methods associated with ethnography, let's look at what an ethnographic approach to research might look like.

Defining your research questions

As with any research study, ethnographic studies begin when researchers want to know more about something unfamiliar. Do you want to understand how a particular group of people interact with their natural environment? What about how group members decide on a social structure? How is daily life affected by changing economic conditions over a long period of time?

Ethnographic research may also be appropriate for conducting a comparative study of multiple cultures. For example, consider the different groups of soccer fans in several parts of the world: fans in South America might act differently from fans in Europe or Asia. Teaching and learning in high school are bound to look different than teaching and learning in university settings. Emergency room medicine and hospice care have distinct purposes that affect the nature of interactions between doctors and patients.

Whatever the inquiry, the researcher benefits from defining a focus for their ethnography. A clear research question can help the researcher narrow their field of perception during participant observation . Suppose the research question has to do with doctor-patient interactions. In that case, the ethnographer can lend more focus to those conversations and less emphasis on ancillary developments within their research context. With a more specific view, they can examine how doctors speak to their patients while being less concerned about the hospital executives in earshot or the orderlies passing by unless and until they are relevant to the research inquiry.

Choosing theoretical perspectives

To further narrow the focus of the ethnography, a theoretical lens can direct the ethnographer toward aspects relevant to theory. Continuing with the example regarding doctor-patient interactions, let's imagine that the ethnographic study explores the role of reassuring language in situations regarding dire medical conditions. Are there relevant theories about what people can say to give peace of mind to others?

Typically, theories in qualitative research consist of a framework with discrete indicators you can use to organize knowledge. For example, let's suppose that there exists a concept of reassurance that can be broken down like this:

empathy - understanding and affirming other people's emotions evidence - providing examples of favorable results in similar situations responsiveness - actively listening to and validating others' concerns

With this sort of theory in mind, an ethnography can focus on listening for instances of these particular indicators during participant observation and recording these examples in field notes . Naturally, a theory is more credible if it's grounded in previous research.

Entering ethnographic fieldwork

The next step is to choose an appropriate and accessible context for your ethnography. Ethics are an important part of contemporary research in the social sciences, requiring permission from potential participants to observe and interact with them for research purposes.

Before any meaningful data collection, make sure to obtain informed consent from the research participants you are studying. Essentially, this involves receiving permission from your participants to document what they say and do after explaining the purpose of your study and the rights they have while participating in your ethnography.

Ethnographic collection of data

With a context and theory in mind, it's now time to conduct your ethnography. In general terms, this means entering the field and capturing as much rich data relevant to your research question as possible.

Good ethnographic practice relies on pursuing multiple research methods to capture data. Participant observation can help you document what people say and do, but good ethnographies also capture what people believe about their everyday actions.

However, the research method most associated with ethnographic research is note-taking. Field notes capture the researcher's personal experience with the culture they observe, which is necessary to fully understand the captured data. With the ethnographer as the main instrument of data collection, readers of ethnographic studies can attain a sense of the possible ways they can view cultures through the researcher's eyes.

Moreover, ethnography relies on rapport with research participants. Ethnographers who want to conduct interviews later will benefit from establishing good relationships with their research participants. As a result, more involved interactions during fieldwork can generate deeper and richer data for your study.

Considerations during fieldwork

It's important to remember that the ethnographer's presence can affect how people behave. Especially in participant observation, your interactions with research participants will directly influence what they do in their daily lives. Even our natural environment is affected by what we do in it. When writing your reflections, qualifying your interactions in the field with a sufficient accounting of how your presence might change what others say and do is important.

There are also ethical questions about what to document and how to use the resulting data afterward. Within anthropology, there are issues of representing cultural groups with respect and ensuring you have their permission to use what you observe and collect from the field. Top scholarly journals and academic conferences also want to know how you observed research ethics during fieldwork, so it is necessary to use your reflection memos to document your ethics practices in addition to the data you collect.

Further development in ethnographic fieldwork

Unexpected issues in field research , especially long-term fieldwork, can help you refine your theoretical framework . Returning to the example of the concept of reassurance, you might observe a doctor's explanation of a medical procedure and find that it's similar to providing evidence. Still, it does not fully align with the established theory. In other words, studying real-world episodes of medical explanations may contribute novel insights about reassurance, helping you further develop your focus in subsequent observations.

As you continue your ethnography, refining the scope of your theoretical perspective helps you more easily gather observational data relevant to your research inquiry and thus provide a fully developed framework for your data.

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Qualitative research: Qualitative research methodologies: Ethnography

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Qualitative study design: Ethnography

• Qualitative study design
• Phenomenology
• Grounded theory

Ethnography

• Narrative inquiry
• Action research
• Case Studies
• Field research
• Focus groups
• Observation
• Surveys & questionnaires
• Study Designs Home

To describe the characteristics of a particular culture/ethnographic group. 

Ethnography is the study of culture (Taylor & Francis, 2013) it is in many ways similar to anthropology; this being the study of human societies and cultures. 

Exploration and data collection can occur in either an emic or etic approach. Emic meaning that the observation happens from within the culture. Etic meaning the observation is external looking in (Taylor et al., 2006) 

Used to explore questions relating to the understanding of a certain group's beliefs, values, practices and how they adapt to change. (Taylor & Francis, 2013) 

Ethnographic studies can be about identifying inequalities. For example exploring racial and cultural aspects of how a cultural group functions and the rules that guide behaviours. (Taylor & Francis, 2013) 

One form of ethnography is an auto-ethnography which involves exploration of the self as the topic being explored. 

The researcher places themselves as a ‘participant observer’ amidst the culture. 

The setting is a very important consideration within ethnographic studies as the exploration of the people and their behaviours must be within the context of that cultural situation. 

Methods used include, but are not limited to: observation, interviews, focus groups, review of documentary evidence and keeping field notes. (Taylor & Francis, 2013) 

Steps involved include:  

Identify the culture to be studied  

Identify the significant variables within the culture 

Review existing literature 

Gain entrance 

Immerse within the culture or observe the culture 

Acquire the informants 

Gather data 

Describe the culture 

Develop theories. 

(Taylor & Francis, 2013) 

Direct insight into the lives and experiences of the people and the group of interest. 

Allows for rich detailed data to be collected (Howitt, 2019). 

Provides an opportunity for researchers to uncover new unknown ways of thinking. Researchers may become aware of behaviors, trends and beliefs that are present within one culture although these may be previously unknown to other cultures. This enables new opportunities for improved ways of viewing and solving issues within other cultures.   

Limitations

Biases can be apparent because a researcher will always bring with them their own culture and own perspective which may impact their interpretations of the experiences they observe within this different culture. 

Genuine co-operation and engagement from the people of interest may not always be forthcoming and rapport might be difficult to establish. 

There can be a greater cost involved for this study type than others. Due to the need for transport, accommodation and researcher time that is spent in the field among the participants. This can be greater than what would be spent in a different research methodology where the engagement may be limited to a laboratory or shorter duration. 

Certain logistics can pose challenges for this type of research approach, such as travelling and gaining access to communities depending on their unique cultural values, for example there are many indigenous societies that only permit people of certain genders to have access. 

As the setting may be very specific to a particular group or community of people it may not be possible to generalise and apply the findings very broadly. 

Researchers need to be aware of the impact that their presence can have on the behaviours of the population they are investigating. 

The “Hawthorne effect” can be a limitation to observing genuine behaviours within a group. This is a situation founded by Dickson and Roethlisberger in 1966 when they reviewed previous experiments conducted at the Hawthorne factory. These experiments observed the ways that different influences, such as the level of lighting, impacted on the efficiency of factory workers. Their re-examination demonstrated that participants can behave differently to what they usually would when they are aware that they are being studied or recorded. As such, the methods selected need to counteract this effect for all study types, but for ethnographic studies especially, as authenticity of the cultural experience is quite important to ethnographic methodology. 

Example questions

What expectations and beliefs do people within specific communities hold about their healthcare options? 

What practices are being undertaken by healthcare professionals in specific settings and are these consistent with best practice? 

What barriers are certain communities experiencing in relation to different healthcare access? 

Are people within a specific community receiving the appropriate information and communication about aspects of their health for them to then make informed educated decisions? 

Example studies

Coughlin, C. (n.d.). An ethnographic study of main events during hospitalisation: perceptions of nurses and patients . Journal of Clinical Nursing, 22(15–16), 2327–2337.  

Molloy, L., Walker, K., Lakeman, R., & Lees, D. (2019). Mental Health Nursing Practice and Indigenous Australians: A Multi-Sited Ethnography. Issues in Mental Health Nursing, 40(1), 21–27. 

Rainsford, S., Phillips, C. B., Glasgow, N. J., MacLeod, R. D., & Wiles, R. B. (2018). The ‘safe death’: An ethnographic study exploring the perspectives of rural palliative care patients and family caregivers. Palliative Medicine, 32(10), 1575–1583. 

Newnham, E., McKellar, L., & Pincombe, J. (2017). ‘It’s your body, but…’ Mixed messages in childbirth education: Findings from a hospital ethnography. Midwifery, 55, 53–59 

King, P. (2019). The woven self: An auto-ethnography of cultural disruption and connectedness . International Perspectives in Psychology: Research, Practice, Consultation, 8(3), 107–123.  

Howitt, D. (2019). Introduction to qualitative research methods in psychology: putting theory into practice. Pearson Education.

Taylor, B. J., & Francis, K. (2013). Qualitative research in the health sciences: methodologies, methods and processes: Routledge.

Taylor, B. J., Kermode, S., & Roberts, K. L. (2006). Research in nursing and health care: creating evidence for practice (Third edition. ed.): Thomson. 

O’Connor, S. J. (2011). Context is everything: The role of auto‐ethnography, reflexivity and self‐critique in establishing the credibility of qualitative research findings. European Journal of Cancer Care, 20(4), 421–423. https://doi.org/10.1111/j.1365-2354.2011.01261.x 

Dickson, W. J & Roethlisberger, F. J., (1966) Counseling in an organization: a sequel to the Hawthorne researches. 1898-1974 & Western Electric Company (U.S.) Division of Research, Graduate School of Business Administration, Harvard University, Boston   

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• Ethnography: challenges and opportunities
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• Janice Jones 1 ,
• Joanna Smith 2
• 1 Institute of Vocational Learning, School of Health and Social Care, London South Bank University , London , UK
• 2 Children’s Nursing, School of Healthcare, University of Leeds , Leeds , UK
• Correspondence to Dr Janice Jones, Institute of Vocational Learning, School of Health and Social Care, London South Bank University, London SE1 0AA, UK; jonesj33{at}lsbu.ac.uk

https://doi.org/10.1136/eb-2017-102786

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• paediatrics
• paediatric surgery
• paediatric neurosurgery
• health services administration & management
• quality in health care

Introduction

Collectively qualitative research is a group of methodologies, with each approach offering a different lens though which to explore, understand, interpret or explain phenomena in real word contexts and settings. This article will provide an overview of one of the many qualitative approaches, ethnography , and its relevance to healthcare. We will use an exemplar based on a study that used participant-as-observer observation and follow-up interviews to explore how occupational therapists embed spirituality into everyday practice, and offer insights into the future directions of ethnography in response to increased globalisation and technological advances.

What is ethnography?

What research methods do ethnographic researchers adopt.

Ethnographic methods are diverse and a range of approaches can be adopted; they are based on observation, often complemented with interviews, and detailed analysis often at a micro level. Although the methods used are not exclusive to ethnography, it is the depth of fieldwork and the continuous process of engaging with participants and their natural environments that is central and adds strength to the findings of ethnographic studies. 6 Participant observation requires immersion in the setting under investigation, and observing the language, behaviours and values of the participants. 7 Consequently, paramount to undertaking an ethnographic study is the role of the researcher in data collection.

Engaging with participants in the real world poses several challenges; first the researcher must decide whether to adopt an overt or covert approach to data collection and observation. In an overt approach the participants know they are being observed, whereas in a covert approach the participants are unaware they are being observed. The rationale for undertaking covert data collection in healthcare contexts needs careful consideration because of ethical implications, and the tensions with the principles of good research governance such as the right to choice whether to participate, information provision and gaining consent. 8 Second, the researcher must consider ‘their position’ either as an ‘insider’ (emic) or ‘outsider’ (etic). 5 Broadly, an emic approach is aligned with immersing into the culture, observing and recording participants’ way of life and activity, in contrast to the etic approach that observes and describes communities and cultures ( table 1 ). Both methods produce rich, in-depth data aiming to make sense of the context or phenomena under investigation, and require the researcher to be reflexive when undertaking fieldwork, accounting for their own assumptions and presuppositions to strengthen the findings. 5

• View inline

Approaches to participant observation 7

Ethnographic approaches to data collection produce voluminous unstructured data from a range of sources, for example fieldwork notes, diary entries, memos and, where appropriate, interview transcripts. The volume of data can be challenging to analyse and we would recommend a structured approach such as the framework approach. 9 The framework approach is rigorous, logical and transparent, and is particularly suitable to manage large amounts of textual information, while remaining close to the original data. 10 Framework approach supports the process of crystallisation, where the multiple facets of an ethnographic study are iteratively analysed, and constantly reviewed to identify patterns and associations across the data. 9 While the final stage in the framework approach aims to present the data in a way that is meaningful to the reader by grouping findings into categories and themes, the role of the researcher is to offer explanations about ‘how and why’ events, actions and interactions occur. 9 10

Table 2 outlines the methods adopted, rationale for decisions made and challenges of undertaking an ethnographical study that explored how occupational therapists incorporate spiritual care into their everyday practice. 11 Data were collected through participant-as-observer, recognising JJ’s role as an occupational therapist and knowledge of the study setting, with semistructured interviews used to explore with participants their decisions and thoughts by reflection on the observational data collected. Several key findings emerged; first spirituality is more meaningfully described than defined for occupational therapy practice. Second, central to occupational therapy practice is supporting patients during times of vulnerability; addressing the spiritual constructs of practice is essential to holistic person-centred care. Finally, organisational and contextual factors influenced how the occupational therapists framed their practice, and adopted strategies to retain their commitment to holistic, person-centred practice. 11

Methods, rationale for decision and challenges undertaking ethnographical research

How flexible is ethnography to social changes, globalisation and technological advances?

Rapidly advancing technology and increased globalisation require healthcare organisations to adapt and change; similarly approaches to undertaking qualitative research must evolve. 12 The increased use of web-based platforms as a means of sharing information, offering support networks and monitoring patients is creating opportunities for health researchers to study the naturally occurring and vast amount of data generated online. The rapid advancement of online communities has resulted in the emergence of online research methodologies such as netnography. 13 Netnography is rooted in ethnographical methods that aim to explore the social interactions of online communities, and can be adapted across the spectrum of online activities. 14

The emergence of team-based ethnography, as a departure from the traditional lone researcher working ‘ in the field’ , is in part in response to the globalisation of societies, economies and ororganisations. 15 Multisite or global ethnography is a new way of conceptualising ethnography that offers opportunities to study the interconnectedness of modern society, 15 and could be appropriate to study healthcare systems globally.

In summary, it is not surprising that qualitative research has been widely adopted as a means of understanding healthcare from the patient experience, and exploring service provision, care delivery and organisational cultures. The value of focused ethnographic studies in healthcare is essential to develop an in-depth understanding of healthcare cultures and explore complex phenomenon in real world contexts.

• Ritchie J ,
• Streubert HJ ,
• Carpenter DR
• Hammersley M ,
• Edgecombe N
• McNaughton Nichols C ,
• Angrosino M
• Hammersley M
• Costello L ,
• McDermott M ,
• Kozinets RV
• Jarzabkowski P ,
• Bednarek R ,
• Cabantous L
• Monahan T ,

Competing interests None declared.

Provenance and peer review Commissioned; internally peer reviewed.

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Journal of Ethnographic & Qualitative Research (JEQR) is a quarterly, peer-reviewed periodical, publishing scholarly articles that address topics relating directly to empirical qualitative research and conceptual articles addressing topics related to qualitative. The journal has been assigned ISSN #1935-3308. It is indexed with ERIC and EBSCO (H.W. Wilson, Social Science Full Text, Psychology and Behavioral Sciences, SocINDEX, and Academic Search Complete). Additionally, we intend to pursue abstract indexing with PsychInfo and other indexing organizations. An example of a published JEQR article is Researching Violence: Conducting Risky Fieldwork in Dangerous Spaces Across Latin America and the  Caribbean .

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Ethnographic research as an evolving method for supporting healthcare improvement skills: a scoping review

Georgia b. black.

Department of Applied Health Research, UCL, London, UK

Sandra van Os

Samantha machen, naomi j. fulop, associated data.

All papers included in the review are listed in Additional file 4 and are publicly available from their publishers’ websites.

The relationship between ethnography and healthcare improvement has been the subject of methodological concern. We conducted a scoping review of ethnographic literature on healthcare improvement topics, with two aims: (1) to describe current ethnographic methods and practices in healthcare improvement research and (2) to consider how these may affect habit and skill formation in the service of healthcare improvement.

We used a scoping review methodology drawing on Arksey and O’Malley’s methods and more recent guidance. We systematically searched electronic databases including Medline, PsychINFO, EMBASE and CINAHL for papers published between April 2013 – April 2018, with an update in September 2019. Information about study aims, methodology and recommendations for improvement were extracted. We used a theoretical framework outlining the habits and skills required for healthcare improvement to consider how ethnographic research may foster improvement skills.

We included 274 studies covering a wide range of healthcare topics and methods. Ethnography was commonly used for healthcare improvement research about vulnerable populations, e.g. elderly, psychiatry. Focussed ethnography was a prominent method, using a rapid feedback loop into improvement through focus and insider status. Ethnographic approaches such as the use of theory and focus on every day practices can foster improvement skills and habits such as creativity, learning and systems thinking.

Conclusions

We have identified that a variety of ethnographic approaches can be relevant to improvement. The skills and habits we identified may help ethnographers reflect on their approaches in planning healthcare improvement studies and guide peer-review in this field. An important area of future research will be to understand how ethnographic findings are received by decision-makers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12874-021-01466-9.

Research can help to support the practice of healthcare improvement, and identify ways to “improve improvement” [ 1 ]. Ethnography has been identified particularly as a research method that can show what happens routinely in healthcare, and reveal the ‘ what and how of improving patient care [ 2 ]. Ethnography is not one method, but a paradigm of mainly qualitative research involving direct observations of people and places, producing a written account of natural or everyday behaviours and ideas [ 3 ]. Ethnographic research can identify contextual barriers to healthcare improvement. For example, Waring and colleagues suggested that hospital discharge could be improved by allowing staff to have more opportunities for informal communication [ 4 ].

There have been advances in ethnographic methods that support its role in supporting healthcare improvement. Multi-site, collaborative modalities of ethnography have evolved that suit the networked nature of modern healthcare [ 5 ]. Similarly, rapid ethnographic approaches (e.g. Bentley et al. [ 6 ];) meet the needs of improvement activities to produce findings within short timeframes [ 7 ]. However, the production of sustained ethnographic fieldwork has waned in response to demands for rapid evidence [ 6 , 8 , 9 ]. Critics of rapid ethnographic methods worry that they are diluting ethnography within applied contexts more widely [ 5 , 10 ].

The relationship between ethnography and healthcare improvement has been the subject of methodological concern [ 8 ]. The first concern is that some research identified as ethnography does not fit within the ethnographic paradigm, merely collecting observational data without a theoretical analysis, interpretation or researcher reflexivity [ 11 ]. A second concern is whether the topics of ethnographic inquiry produce findings that are seen as useful for improvement [ 12 ], particularly if they do not make explicit recommendations or produce checklists [ 8 , 13 – 15 ]. Authors fear that ethnographic findings that capture complexity [ 16 ] and expose taken-for-granted behaviours and phenomena [ 14 , 17 ] may be too abstract to be relevant to healthcare improvement [ 8 ]. However, these critiques position ethnographic research as a product which may be taken up by healthcare improvers, rather than seeing ethnographic work itself as an improvement activity. We take the view that healthcare improvement aims to change human behaviour to improve patient care, and is therefore reliant on the development of particular skills and habits (such as good communication) [ 18 ]. We would consider that engaging in ethnographic research may support skill development and habit formation that serves healthcare improvement.

In the literature of ethnography in healthcare improvement, there is not much discussion of the close relationship between methodological features of ethnographic research, and their impact on improvement skills. The aim of this paper is twofold: (1) to describe current ethnographic methods and practices in healthcare improvement research and (2) to consider how these may affect habit and skill formation in the service of healthcare improvement [ 19 ].

This is a scoping review following the methods outlined by Arksey & O’Malley and later refined by Levac et al., [ 20 , 21 ] including a systematically conducted literature review and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR; see Additional file 1 for PRISMA checklist). No protocol was published for this review. Our literature search and analyses were conducted iteratively, searching reference lists and undertaking discussions with colleagues about key lines of argument. We also held a workshop at Health Services Research UK conference in 2018 on this topic to gain a wide range of stakeholder views.

Systematic retrieval of empirical papers and purposive sampling

Our search strategy was designed to capture a wide range of approaches to ethnography from different journals, healthcare settings and types of research environment. It was not our aim to capture every study using this methodology, but to map the current field. Thus we did not search grey literature, books or monographs. The search strategy was developed and piloted in consultation with a health librarian. Medline (on OVID platform), PsychINFO, CINAHL and EMBASE databases were searched, and six journals were hand-searched, including: BMJ Quality & Safety, Social Science and Medicine, Medical Anthropology, Cochrane library, Sociology of Health and Illness and Implementation Science. These databases were searched between dates April 2013 – April 2018 and an update was performed in September 2019 using the search terms outlined in Additional file 2 . We limited the search to these dates in order to capture the most recent methodological characteristics of ethnographic studies in this field.

We screened titles and then abstracts according to the inclusion and exclusion criteria detailed in Table ​ Table1. 1 . We included studies which self-identified as using ethnography or ethnographic methods rather than using our own criteria. This is because ethnography can be hard to define, and use of criteria may risk excluding papers which exemplify the sorts of tensions and workarounds we are trying to capture.

Inclusion and exclusion criteria

The retrieved papers were screened by GB, SVO and SM based on inclusion and exclusion criteria (Table ​ (Table1). 1 ). The total number of papers after screening titles, abstracts and full texts was 274 (Fig. ​ (Fig.1 1 ).

PRISMA statement of all references retrieved, screened and included in the scoping review

Numerical charting

Characteristics of each paper, such as title, authors, journal, year, country and healthcare subject area were extracted (see Table ​ Table2 2 ).

Characteristics of studies in review

a some studies have been allocated to more than one region

Thematic analysis and development

We coded all 274 papers using NVivo software for stated aims and recommendations. This included close reading, and retrieval of key ideas and quotations from the papers that exemplified key ideas in relation to healthcare improvement, methodology and the authors’ reflections on these. The coded extracts of aims and recommendation in conjunction with the closer reading of the sub-sample were used to inductively develop conceptual ideas, such as how the corpus of papers explicitly aimed to contribute to healthcare improvement, and if not, how this affected the types of conclusions drawn. Some papers were read in greater depth to understand how the authors’ methods related to their findings and conclusions. In order to consider how ethnography supports habits and skills associated with healthcare improvement, we drew on a framework which identifies five habits of ‘improvers’: creativity, learning, systems thinking, resilience and influencing [ 19 ]. Applying this model to our selected papers, we mapped traits or approaches to the ethnographic studies that exemplified these habits either in the authors, or as part of developing these habits in others (e.g. healthcare decision-makers and professionals). Thematic interpretations and lines of argument were generated and discussed by all the authors.

Overview of study characteristics

The included studies covered a wide range of ethnographic methodologies and healthcare subjects, published internationally (Table ​ (Table2) 2 ) in predominantly social science and clinical journals (see Additional file 3 ). The full list of the 274 included studies is available in Additional file 4 .

Most studies described themselves as an ‘ethnography’ or ‘ethnographic’, although some described their methodology as ‘mixed methods’ including ethnographic components. For example, Collet et al. conducted a mixed methods participatory action research study using observations to produce an “ethnographic description” [ 22 ].

Almost all studies relied on observation and interviews as the main data sources. It was not always specified whether researchers took a participant or non-participant approach to observation. There were some examples of other data sources e.g. video data, surveys, documents, field notes, diaries, and artefacts. A few examples contained a paucity of data, such as only video data [ 23 ], limited fieldwork [ 24 ], a small number of interviewees [ 25 ], or reliance on focus group data alone [ 26 ]. Methods associated with qualitative methodology (but not necessarily ethnographic) were also used, such as data ‘saturation’ to denote that additional data did not provide new insights into the topic [ 27 ].

There were a number of minority or unusual ethnographic variations:

• Quantitative ethnography [ 23 ]: temporal coding of physicians' workflow and interaction with the electronic health record system, and their patient.
• Cognitive ethnography [ 28 ]: “identifying and elaborating distributed cognitive processes that occur when an individual enacts purposeful improvements in a clinical context”.
• Street-level organizational ethnography [ 29 ]: intensive case study methods to explore the implications of healthcare policy at a street level.
• Phenomenological ethnographies [ 30 ]: focussing on the lived experience and meanings associated with a phenomenon.
• Geo-mapping [ 31 ]: geomapping of selected service data to define Latino immigrant community before conducting interviews and observations.

Use of different types of ethnography to support healthcare improvement

We found that many studies used methods that could identify issues relating to power and vulnerability, with potential relevance to how healthcare improvement problems are defined and solved, and by whom [ 1 ]. For example we noted a significant minority of studies using institutional and critical ethnography, mostly in vulnerable populations (see Table ​ Table3). 3 ). These studies were explicitly attentive to systems and power relations, rather than on individual practices. We suggest that the use of geographically-oriented methods such as geo-mapping and street-level organisational ethnography are also attentive to the power structures inherent in place and space, and could be relevant to other geographical healthcare improvement topics such as networked healthcare systems, care at home and patient travel for treatment.

Ethnographic methodology and its relevance to healthcare improvement

The high prevalence of ethnographic studies with vulnerable populations (e.g. psychiatry, end of life care) suggests that ethnography is also being conceptualised as an emancipatory method, reversing healthcare power structures in its focus. This has been a traditional focus of ethnography since social changes in power and representation in the 1970s, incorporated into the development of healthcare research methodology [ 40 , 41 ]. Some methods used were calculated to maximise the potential for supporting vulnerable groups, for example, Nightingale et al. [ 42 ] used focused ethnography (prolonged fieldwork in a small number of settings) to look at patient-professional interactions in paediatric chronic illness settings. The authors suggested that focussed ethnography is particularly suited to settings where fostering trust is essential. We would also suggest that ethnography may be particularly suited to settings in which participants are less able to verbalise their experiences.

The reviewed studies suggested that video ethnography can support healthcare improvement at a team level. For example, Stevens et al. [ 43 ] promoted video ethnography as a way to capture in-depth data on intimate interactions, in their study of elective caesareans. The video data allowed them to make use of timing data (e.g. of certain actions), physical positioning of different actors and equipment, and verbatim dialogue recording. The video data also suited the technical nature of the procedure, which was relatively time-limited. This form of data collection may not suit environments where healthcare activities are more spread out.

The impact of healthcare practitioner involvement in ethnographic fieldwork and findings

We noted that the use of ethnography for healthcare improvement has led to healthcare practitioners’ widespread involvement in data collection or analysis. We suggest that this is a form of negotiation across the healthcare-academia boundary, translating from ‘real world’ to data and back again. This has potential to create rich and relevant ethnographic studies that are geared towards improvement. However, some studies were undermined by a lack of reflexivity about the dual practitioner-ethnographer role.

A significant number of papers involved healthcare practitioners in fieldwork (e.g. Abdulrehman, 2017, Hoare et al. 2013; [ 37 , 44 ]). For example in Hoare et al. the lead researcher was a nurse, and wrote that they hoped “to bring both an emic and etic perspective to the data collection by bracketing my emic sense of self as a nurse practitioner in order to become a participant observer within my own general practice ” [ 37 ]. In this study, the findings fed directly into local service improvement as the lead researcher felt compelled to “share new ‘best practice’ information and join in the conversation.” There was little discussion about how this affected the generalisability of the findings, and whether their recommendations were adopted.

Similarly, Bergenholz et al. [ 45 ] conducted a study where a nursing researcher completed the main fieldwork and “assisted the nurses with practical care .” They acknowledged that “This may have caused limitations with regards to ‘blind spots’ in the nursing practice, but that it also gave access to a field that might be difficult for ‘outside-outsiders’ to gain .” However, there was no commentary on where the blind spots or extra access occurred, and how this may have affected the relevance and dissemination of their findings.

How might ethnography support healthcare improvement habits?

In this section, we evaluate the studies included in the review in terms of how their methods relate to improvement. We draw on the idea that successful improvement is based on a set of habits and their related skills acquired through experience and practice [ 19 ]. This section is structured around Lucas’s five habits of ‘improvers’: creativity, learning, systems thinking, resilience and influencing [ 19 ]. Under those headings, we describe the mechanisms by which ethnographic studies can support healthcare improvement habits, using illustrative examples.

Resilience is defined as being adaptable, particularly tolerating calculated risks and uncertainty, and proceeding with optimism. Being able to recover from adverse events is core to improvement, reframing them as opportunities. Adaptation and the ability to bounce back from adverse events and variation are core to improvement.

Tolerating the uncertainty of ethnographic data collection

While we did not relate these traits to any particular ethnographic approach in our studies, we would consider that undertaking any ethnographic project requires resilience, as data collection is inherently exploratory and uncertain. For example, Belanger et al. wanted to know how health care providers and their patients approach patient participation in palliative care decisions. The authors explicitly eschewed the pull to create guidelines or other formalised knowledge, but aimed to explore the “unforeseen and somewhat unavoidable ways in which discursive practices prompt or impede patient participation during these interactions.” [ 46 ]

Creativity is defined as working together to encourage fresh thinking by generating ideas and thinking critically.

Using a theoretical lens

Researchers may consider healthcare through a particular theory or framework (e.g. private ordering [ 47 ], masculine discourse [ 48 ], compassion [ 49 ]). The restriction of the theoretical lens enables critical thinking, and keeps the ethnographer creatively engaged. For example, Mylopoulos & Farhat [ 28 ] used the concept of adaptive expertise in a cognitive ethnography to explore “the phenomenon of purposeful improvement” in a teaching hospital. This theoretical lens revealed that clinicians were engaging in “invisible” improvement in their daily work, in “specific activities such as scheduling, establishing patient relationships, designing physical space and building supporting resources”. The authors suggested that these practices were devalued in comparison to more formal improvement activities, justifying the utility of the ‘adaptive expertise’ theory in bringing the daily improvement practices to light.

Challenging current problems and perspectives

We identified studies that challenged or reframed existing improvement problems e.g. Mishra [ 50 ]. This role removes the ‘blinkers’ of improvement research [ 51 ], and can ‘dissolve’ previously intractable implementation problems. For example, Boonan et al. [ 52 ] studied the practice of bar-coded medication from the perspective of nurses using the intervention. In their discussion, the authors challenge the assumption that if you introduce technology, then you will mitigate human factor risks. They highlighted that external pressures on hospitals perpetuate this perspective, and that “nurses and patients are consequently drawn into this discourse and institutional ruling, to which they are not oblivious”. Their recommendation was to understand the skills of nurses in tailoring technology to meet individual patients’ needs rather than trusting in systems blindly.

Learning is defined as harnessing curiosity and using reflective processes to extract meaning from experience.

Inviting reflection

We noted that some studies did not make explicit recommendations for improvement, but wrote their findings in a manner that would invite reflection on its subject matter. For example, Thomas & Latimer [ 53 ] wrote that they view their role as provocateurs of new ideas, stating that their intention “is not to propose specific policies or discourses designed to change or improve practice. More modestly, we hope that by analysing the everyday and by theorising the mundane, this article will ignite reflexive, ethical and pluralistic dialogues – and so better communication between practitioners, parents and the wider lay public – around reproductive technologies and medical conditions” (authors’ underline; p.951-2) [ 53 ]. Others such as Mackintosh et al [ 54 ] used their discussion section to examine their results in the context of other theories and provide illumination: “Our focus on trajectories illuminates the physiological process of birth and the unfolding pathology of illness (and death). This frame provides a means for us to link the agency of those involved in organising the care of acutely ill patients with the wider socio-political factors beyond the clinic, such as governmentality and risk (Heyman 2010, Waring 2007), death brokering (Timmermans 2005) and the medicalisation of birth and death (De Vries 1981).” (p.264). These two examples show that ethnographic work can be offered as an opportunity for learning and reflection, without a translation to specific recommendations.

Supporting a more ethical, expansive, inclusive, and participatory mode of healthcare

Problem-finding is highlighted as an important part of learning in improvement [ 19 ]. Several studies paid attention to multivocality and power, using this to find problematic, unethical and exclusive practices in healthcare. For example, some studies reported previously unheard viewpoints [ 55 – 57 ], or identified restrictive organisational barriers and normative assumptions [ 58 , 59 ]. Others promoted ethnography as a way of exploring ethics and morality [ 47 , 60 , 61 ], such as criticising research that prioritizes the needs of individuals over the good of society [ 62 ]. Ross et al. [ 63 ] suggested that it is also more ethical to use critical ethnography than other evaluative methods in researching vulnerable populations (e.g. neurological illness), by being able to “explore perceived political and emancipatory implications, [clarify] existing power differentials and [maintain] an explicit focus on action” .

Some studies directly researched power within the healthcare setting. For example, Batch and Windsor’s study of nursing workforce suggested that senior nurse leaders should use their positions to advocate for better working conditions [ 35 ], “ Manageable nurse/patient ratios, flexible patient-centred work models, equal opportunity for advancement, skill development for all and unit teamwork promotion”. Challenging traditional cultural assumptions that have produced and reproduced stereotypes is problematic because they most often are, by their very nature, invisible. In a more critical approach, Gesbeck’s thesis [ 62 ] on diabetes care work challenges the very mechanism of achieving healthcare improvement through research, stating that “we need to change the social and political context in which health care policy is made. This requires social change that prioritizes the good of the society over the good of the individual—a position directly opposed to the current system oriented toward profit and steeped in the ideology of personal responsibility.”

Systems thinking

Systems thinking is defined as seeing whole systems as well as their parts and recognising complex relationships, connections and interdependencies.

Suggesting reorientation to new ‘problem’ areas

We found that many ethnographic studies emphasised skills of synthesis and connection-making, reorienting improvement to different areas, for example in overarching policy recommendations (e.g. Hughes [ 36 ]; Liu et al. [ 64 ], Matinga et al. [ 65 ]), or resetting priorities. For example, Manias’ [ 66 ] ethnography of communication relating to family members' involvement in medication management in hospital suggests that “greater attention should be played on health professionals initiating communication in proactive ways ” [p.865]. In another example, Cable-Williams & Wilson’s (2017) focussed ethnography captures cultural factors within long-term care facilities. Their discussion suggests that acknowledgement of death is under-represented in front-line practice and government policy, reorienting discussions towards an integration of living and dying care.

Exposing hidden practices within the everyday

We found that several studies drew attention to ‘hidden’ practices in healthcare work, allowing them to evaluated and improved. For example, we found reference to practices such as coordinating [ 67 ], repair [ 68 ], caretaking [ 69 ], scaffolding [ 68 ], tinkering [ 52 ] and bricolage [ 58 ]. We also found that some studies had new interpretations of ‘the everyday’ or ‘taken-for-granted’ (e.g. nursing culture [ 34 , 35 , 45 , 70 ], interprofessional practice [ 67 , 71 – 75 ]). Authors’ outputs included frameworks [ 76 ] or models [ 69 , 71 , 77 , 78 ] that map these types of practices in a way that is helpful for intervention development or quality improvement. For example, Mackintosh et al. [ 54 ] looked at rescue practices in medical wards and maternity care settings using Strauss’s concept of the patient trajectory. Their findings highlighted the risks inherent in the wider social practices of hospital care, and suggested that improvement was needed at a level “beyond individual and team processes and technical safety solutions.”

Influencing

Influencing is defined as engaging others and gaining buy-in using a range of facilitative processes.

Direct translation of findings to targets for improvement

Lucas suggests that to be influential, ethnographic studies need to have some empathy with clinical reality, whilst being facilitative and comfortable with conflict [ 19 ]. This was shown in ethnographic studies that made pragmatic recommendations, such as in Jensen’s study of clinical simulation. They advised that simulation might be useful in staging “adverse event scenarios with a view to creating more controlled and safer environments.” ( 80). In MacKichan et al. [ 79 ] observations and interviews were used to understand how primary care access influenced decisions to seek help at the emergency department. The authors made empathic, actionable recommendations such as “ simplifying appointments systems and communicating mechanisms to patients.” (p.10).

Evaluating the context of healthcare improvement

By capturing contextual and social aspects of healthcare improvement, ethnographic evaluations can support leaders and managers who are trying to implement improvement activities. This is a particularly helpful trait in ethnographic studies that pay attention to politics, governance and social theory in their evaluation of new interventions, “zooming out” [ 80 ] beyond the patient-clinician interaction to broader social networks. For example, Tietbohl et al. [ 81 ] investigated the difficulties of implementing a patient decision support intervention (DESI) in primary care through the theoretical lens of relational coordination between “physician and clinical staff groups (healthcare professionals)”. The authors’ recommended attention to the “underlying barriers such as the relational dynamics in a medical clinic or healthcare organization” when creating policies and programs that support shared decision-making using support interventions. This sort of insight can make it more likely that new policies or interventions will succeed. This skill was particularly fertile in the tradition of techno-anthropology, exploring technology-induced errors and the real-world interaction between people and technology, e.g. decision-support tools [ 81 – 86 ], the introduction of robot caregivers [ 87 ] and clinical simulations [ 88 ]. Other approaches included an investigation of one intervention or change but with a theoretical lens of inquiry.

Summary of findings

This scoping review has identified the methodological characteristics of 5 years of published papers that self-identify as ethnography or ethnographic in the field of healthcare improvement. Ethnography is currently a popular research method in a wide range of healthcare topics, particularly in psychiatry, e.g. mental health, dementia and experiential concerns such as quality of life. Focused ethnography is a significant sub-group in healthcare, suggesting that messages about the importance of research timeliness have taken hold [ 89 ].

We have identified ethnographic methods reported in these papers, and considered their utility in developing skills and habits that support healthcare improvement. Specific practices associated with the ethnographic paradigm can encourage good habits (resilience, creativity, learning, systems thinking and influencing) in healthcare, which can support improvement. For example, using relevant theories to look at every day work in healthcare can foster creativity. The use of critical and institutional ethnography could increase skills in ‘systems thinking’ by critically evaluating how healthcare improvement problems are defined and solved, and by whom.

Comparison with previous literature

This scoping review is the first to consider how current ethnographic methods and practices may relate to healthcare improvement. Within the paradigm of applied healthcare research, there is normative value in being ‘useful’ or ‘impactful’ in our research, which affects our prospects for funding and career success [ 12 ]. However, our review has uncovered a multitude of ways that an ethnographic study can be useful in relation to healthcare improvement, without creating actionable findings. We found a spectrum of interactions with healthcare improvement: some authors explicitly eschewed recommendations or clinical implications; others made imperative statements about required changes to policy or practice. However, this diversity was not necessarily a reflection on how ‘traditional’ the ethnographic methodology was. This challenges the paper by Leslie et al. which puts ethnographic studies in two output categories with respect to healthcare improvement: critique versus feedback [ 8 ]. Instead, we uncovered a variety of ways that ethnography can support healthcare improvement habits, such as encouraging reflection, problem-finding and exposing hidden practices in healthcare.

We did find that supporting healthcare improvement through ethnographic research can require strategic effort, however. For example, we noted that several authors wrote multiple articles based on the same project, often for different types of journal to reach different audiences such as diverse readerships in health services and academic settings. For example, Collier and colleagues published two papers based on a video ethnography of end-of-life care (both in 2016), one in a healthcare quality journal [ 32 ] and one in a qualitative research journal [ 76 ]. The former is shorter, with explicit recommendations for patient safety, whereas the latter is longer, has more detailed results and long sections on reflexivity. Similarly, Grant published an article in a sociology journal [ 90 ] and a healthcare improvement paper [ 91 ] on the same work about medication safety. The sociological paper covered “spatio-temporal elements of articulation work” whereas the other put forward “key stages” and risks, suggesting that it was more closely oriented to improvement.

There have been some considerable debates about changes in ethnographic methods and tools, with concerns about lost researcher identity, dilution of the method, and challenges to “upholding ethnographic integrity” [ 92 ] . We contest this, suggesting that new variants such as focussed and cognitive ethnography are evolving in response to the complexity of hospitals and healthcare [ 93 ], while also being highly regulated, standardised and ordered by biomedicine. Such complex environments cannot be studied and improved under one paradigm alone. Ethnographic identity and method have also been affected by the cross-pollination of ethnography with other social science paradigms and applied environments (e.g. clinical trials, technology development). Debates about theoretical and methodological choices are not only made merely with respect to healthcare improvement, but also in response to professional pressures (e.g. university requirements for impact) [ 12 ], and the mores of taste situated within the overlapping communities of practice that evaluate ethnographic healthcare research [ 94 ]. That said, we echo previous authors’ calls for attention to reflexivity, particularly in embedded or clinician-as-researcher roles [ 95 ].

Our scoping review challenges a previously expressed concern that ethnographic studies may not produce findings that are useful for improvement [ 10 , 12 , 16 ]. By considering different ethnographic designs in relation to skills and habits needed for improvement, we have shown that studies need not necessarily produce ‘actionable findings’ in order to make a valuable contribution. Instead, we would characterise ethnography’s role in the canon of healthcare research methodologies as a way of enhancing improvement habits such as comfort with conflict, problem-finding and connection-making.

Strengths and limitations

This review has a number of limitations. The search may not have found all relevant studies, however the retrieved papers are intended as an exemplar rather than an exhaustive or aggregative review. The review is also limited to journal articles as evidence of researchers’ approach to improvement. This ignores many other ‘offline’ and ‘online’ activities such as meetings, presentations, blogs, books, and websites, which are conducted to disseminate findings and ideas. Our reliance on self-report for the identification of ethnographic studies will have excluded some studies within an ethnographic paradigm who chose different terms for their methodology (e.g. critical inquiry, case study). The strengths of this paper are its comprehensive coverage, incorporating all representative studies in healthcare research published within a five year period, and a wide range of ethnographic sub-types and healthcare subjects, drawn from an international pool of research communities.

We did not prescribe the right way for ethnographers to engage in healthcare improvement, indeed, we have identified that a variety of approaches can be relevant to improvement. The habits we identified may help ethnographers reflect on their approaches in planning healthcare improvement studies and guide peer-review in this field. Issues of taste, traditionalism and researcher identity need to be scrutinised in favour of value and audience. An important area of future research will be to understand how ethnographic findings are received by decision-makers, and further focused reviews on the relationship(s) between ethnographic methods, quality improvement skills and improvement outcomes.

Acknowledgements

The authors wish to thank Lorelei Jones, Natalie Armstrong, Justin Waring and Bill Lucas for their insightful comments and direction in the undertaking of this work.

Authors’ contributions

NJF and GB led the development and conceptualization of this scoping review and provided guidance on methods and design of the scoping review. GB, SVO and SM made contributions to study search, study screening, and all data extraction work. All authors analysed the data. All authors contributed to the writing and editing of the paper, and all authors have read and approved the manuscript.

This paper is independent research funded by the National Institute for Health Research CLAHRC North Thames. The views expressed in this publication are those of the author(s) and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care.

NJF is an NIHR Senior Investigator. GB is supported by the Health Foundation’s grant to the University of Cambridge for The Healthcare Improvement Studies Institute.

Availability of data and materials

Declarations.

The authors have no competing interests to declare.

The original online version of this article was revised: due to incorrect figure 1 and the number of included papers need to be changed from "283" to "274".

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Change history

A Correction to this paper has been published: 10.1186/s12874-022-01587-9

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Speaker 1: Welcome to this overview of qualitative research methods. This tutorial will help give you the big picture of qualitative research, and introduce key concepts that will help you determine if qualitative methods are appropriate for your project study. First, let's review what research, particularly educational research, is designed to do. Research is an organized, systematic, disciplined approach to answering questions about our observations and experiences in the world. It is a structured approach to gathering and interpreting information that allows us to understand, theorize about, or explain experience. What, then, is distinctive about qualitative research? Qualitative research focuses on generating meaning and understanding through rich description. It can be a particularly useful approach to studying educational problems that requires developing an understanding of complex social environments, and the meaning that people within those environments bring to their experience. Qualitative research differs from quantitative research in several ways. It typically addresses different problems, arises from a different philosophical view of the world, works to achieve different goals, and uses different methods and design. This table illustrates some of the key differences. Focus Qualitative research focuses on the quality of experience, trying to describe or understand the essence or nature of human experience. Quantitative research, on the other hand, focuses on more measurable factors, asking questions such as, how much, how many, or how frequently. Philosophical Roots Qualitative research integrates more subjective human experience, rather than purely objective external reality. It belongs to the school of constructivism or interpretivism. Quantitative research is based on positivism that holds that physical and social phenomena are independent of the observer, are fairly stable over time and place, and can be objectively observed and quantified. Goals of Investigation The goals of qualitative research are to understand, describe, discover meaning, or generate hypotheses or theory. Quantitative research aims to predict, control, confirm, and test hypotheses. Design Characteristics The designs used in these two types of research are suited to their goals. Qualitative research design is more flexible, evolving, and emergent, while quantitative research design is structured and predetermined. It should be emphasized that the flexible structure of qualitative research in no way suggests that it is less disciplined or easier to design or implement. Quite the contrary. Well-designed, valid, scholarly qualitative research has flexible structure and is designed and implemented with the same care and attention to detail as any well-designed, valid, and scholarly quantitative study. Data Collection In qualitative research, the researcher is the primary instrument, bringing his or her own perspectives to the selection and meaning of data. Quantitative research depends upon external instruments, such as tests, surveys, or other tools used to measure and quantify a particular phenomenon. Now that we have discussed the nature of qualitative research and the kinds and forms of qualitative data, it is easier to understand how qualitative research pursues its research goals. In its very earliest stages, qualitative research aims to explore. The goal is to identify patterns, themes, hunches, and initial models that provide an initial understanding of this phenomenon. Description is the heart of qualitative research. The essential characteristics of description is that it conveys information with the detail and specificity necessary to accurately convey the experience. Ultimately, qualitative research strives to produce meaningful interpretations of events and phenomena. With interpretation, the goal is to make sense of what goes on, to reach out for understanding or explanation. Through exploration, description, and interpretation, the qualitative researcher arrives at a complete understanding of a phenomenon in a particular setting or context. Case studies explore a program, an event, an activity, a process, or one or more individuals in depth. Grounded theory derives a general abstract theory of a process, action, or interaction grounded in the views of participants. Ethnography studies an intact cultural group in a natural setting over a prolonged period of time. Phenomenology identifies the essence of human experiences. Narrative approaches study the stories that individuals provide about their lives and experiences. Methodologies come out of different social sciences. For example, ethnography has its roots in anthropology, while grounded theory got its start in sociological research. Phenomenology is rooted in the philosophy of phenomenology. Case study can combine any number of qualitative and quantitative traditions and techniques in order to meet the specific needs of the research situation. Case study is perhaps the most flexible methodology, able to bend several traditions into a valid research design. Consequently, it is among the most widely used research methodologies, particularly for applied research. Qualitative data are typically obtained from sources such as interviews, focus groups, observations of real-life settings, and existing documents. One study may include data from one, several, or all of these sources. For example, a researcher studying a school environment might observe students as they work on daily tasks in the classroom, including students' reactions to the activities such as body language and facial expressions. A researcher might interview the teacher and students individually, or as part of a small group, about what they were thinking or feeling during the lessons. She may also examine documents such as student work samples and lesson plans to paint a holistic picture of the educational experience. As you plan your research study, you must create a justification for your data collection methods in order to explain why the methods you propose are the most appropriate and most effective way to understand the phenomenon or focus of your study. Before you collect any data for your study, you must receive approval from Walden's Institutional Review Board, or IRB. Visit Walden University's IRB website in order to make sure that you obtain the proper permissions to collect and use data. Qualitative data analysis follows three basic steps. First, the researcher prepares and organizes the data. This could include transcribing interview notes, organizing field notes from observations, or ensuring all documents to be included in the analysis are present and available. Second, the researcher reduces the data by identifying themes, coding data elements, and creating categories. Finally, just as quantitative data must be presented in tables or figures, qualitative data can be presented in narrative form, tables, or visual diagrams. In qualitative research, the data analysis process is flexible and designed to meet each study's needs, but also follows an established protocol and relies on rigorous methodological approaches. The processes of analysis and preparing results are not distinct steps, but are interrelated and often occur simultaneously. In qualitative research, validity is the extent to which the data and the interpretation of the data are credible. Qualitative researchers use different terms to refer to validity. Maxwell uses validity, Lincoln and Guba use trustworthiness, and Creswell uses validation. In addition, these authors use other related subterms. It is important for students to use one recognized author to define all relevant terms for validity. For instance, Lincoln and Guba use four additional terms to specify different aspects of trustworthiness – credibility, transferability, dependability, and confirmability. As with any research approach, the researcher must take steps to ensure the validity or accuracy of the research findings. In qualitative research, validity is the extent to which the data and the interpretation of the data are credible. Creswell identifies eight different strategies used by qualitative researchers to ensure the validity of their findings. Prolonged engagement and persistent data gathering ensure that the researcher does not draw conclusions based upon an isolated idiosyncratic experience with a phenomenon. Using rich, thick description ensures that a sufficient level of detail about the phenomenon studied is included so that others might draw the same or similar conclusions. Triangulation refers to using multiple data sources in order to build up a complete picture of a phenomenon. Member checking allows the researcher to present the study's findings or conclusions to the original participants so they can comment on whether they believe their perspectives are accurately portrayed. Presenting negative or discrepant information acknowledges observations or findings that run contrary to the study's key themes. Clarifying one's biases as a researcher similarly acknowledges those preconceptions or biases that will inevitably color the study's conclusions. Peer debriefing enlists the aid of a person other than the researcher to review the findings and ensure that they make sense. Finally, an external auditor is someone not familiar with the researcher or the study who can review the study's overall logic, coherence, and consistency. When considering whether a qualitative approach is right for your study, ask yourself the following questions. First, what kind of phenomenon are you planning to study? Is it related to some aspect of human experience that cannot be counted or expressed in numbers? Does it relate to subjective experience, cultural characteristics, personal perspective, idiosyncratic ideas, or comparisons of intangibles? Second, what do you want to know about the phenomenon? Can you find out what you want to know by immersing yourself in the environment in which you will study the phenomenon, by observing or talking to people within that environment, or by studying the materials they have created? Third, why are you doing the study? Are you interested in interpreting, generating meaning, and gaining a holistic view of a phenomenon, rather than in comparing, measuring, or quantifying a phenomenon? If you answered positively to these questions, qualitative research may be the right choice for your study. Qualitative research is a powerful method of studying the implicit as well as the explicit. It accomplishes this by focusing on personal perceptions of the world and the experiences of people as they construct the reality in which they live. Because of these characteristics, qualitative research can be a powerful tool for social change. As a Walden student, social change is a feature of every student capstone. Qualitative methods may help you meet this requirement. Once you have decided to embark upon the process of conducting a qualitative study, use the following steps to get started. First, review research studies that have been conducted on your topic to determine what methods and research traditions were used. Consider the strengths and weaknesses of the various research traditions, data collection methods, and data analysis methods. Next, review the literature on qualitative research methods. Every aspect of your research has a body of literature associated with it. Just as you would not confine yourself to your course textbooks for your review of research on your topic, you should not limit yourself to your course texts for your review of methodological literature. Read broadly and deeply from the scholarly literature to gain expertise in qualitative research. Additional self-paced tutorials have been developed on different methodologies and techniques associated with qualitative research. Make sure you complete all of the self-paced tutorials and review them as often as needed. You will then be prepared to complete a literature review of the specific methodologies and techniques you will use in your study. Thank you for watching.