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A better starting point for thinking about research design is to recognize a continuum of research objectives, ranging from exploratory to confirmatory research questions. Exploratory questions seek to understand how and why things work as they do; confirmatory questions seek to test hypotheses based on new or existing theory. These different types of questions imply different types of methods along a parallel continuum of relatively unstructured to structured methods of data collection and analysis (Figure 4.2). This framework is useful because it helps to ensure that decisions about research design flow from the research questions.

Figure 4.2 A continuum of research questions and methods of data collection and analysis.

Exploratory research questions are common in medical anthropology. For example, Chavez et al. (1995) studied beliefs about breast and cervical cancer in Orange County, California. They asked: “‘Do Latinas, Anglo women, and physicians have cultural models of breast and cervical cancer risk factors? If so, how similar or different are their models?’ Another way of asking this question is, ‘Do they agree on the relative importance of risk factors?’” (p. 42). Here researchers began with limited expectations about what they would find and sought to detect patterns that would help to generate theory. This approach is appropriate whenever there is insufficient existing theory or evidence to establish expectations.

Exploratory questions are also apt for centering people’s expertise about their own lives, which can challenge dominant narratives, existing theory, or researchers’ preconceptions. For example, Reese (2019) begins her ethnography of racialized food apartheid and Black self-reliance in Washington, DC, by recounting a “conversation on Mr. Johnson’s front porch.” Reese chose this starting point because of the way it and other conversations “changed what I was listening for” (p. 2). Her initial concern was the influence of the built environment, a theoretical orientation “heavily influenced by anthropology, food studies, and sociology.” But Mr. Johnson had other stories to tell, and by “listening to him more than doing much talking” (p. 1), Reese left with a new set of questions that framed the rest of the work.

The flow of his storytelling revealed what Zora Neale Hurston wrote about in Dust Tracks on the Road: that research was the blessing through which I could formalize the curiosities that emerged on Mr. Johnson’s porch, and that if I got out of the way, Black people would tell their stories how and when they wanted. It was not my job to dictate which stories should be told, but if I let them, Black storytelling would lead me places that I had not planned to go. (Reese 2019, pp. 2–3)

Reese exemplifies the power of listening to generate theory. Although she “had not planned to go” where she ended up, she had, undoubtedly, made a choice to respect people’s experience. And so she entered the field with a fundamentally exploratory question: What is going on here? Her decision to listen allowed people to define what matters on their own terms; her job, then, was to “formalize the curiosities that emerged.” Reese did so primarily using methods that prioritize discovery: participant observation, archival research, and semistructured interviews.

When prior theory and evidence warrant specific expectations, confirmatory research questions are appropriate. One distinctive feature of confirmatory research in medical anthropology is that it often builds on an exploratory phase in the same study. We see that progression in Reese’s work. Toward the end of her fieldwork, Reese and a community collaborator conducted a survey designed to place the ethnographic findings in context. Part of the purpose was strategic: “The hope was that this data would put some numbers behind the anecdotal experiences that we all knew were true but were not always heard by those in power” (p. 15). But there is also an implicit confirmatory question: To what extent do the stories of Mr. Johnson and others characterize a broader geographic and social context?

Similarly, in their exploratory work, Chavez et al. (1995) found that Latinas’ beliefs about cervical and breast cancer differed from biomedical models more than Anglo women’s beliefs did. “We were left wondering,” they later wrote (Chavez et al. 2001, p. 1114), “to what extent these patterns of belief were associated with behavior, specifically the use of Pap exams, a screening test for cervical cancer. In other words, to what degree do cultural beliefs matter in the use of medical services?” Chavez et al. (2001) combined ethnographic interviews and survey research to address this question and found that, under certain circumstances, beliefs matter a lot.

Dressler’s (2005, 2020) research on culture, stress, and health also illustrates the progression from exploratory to confirmatory research questions. The central thread of Dressler’s work is to identify how culturally meaningful aspects of social status shape the distribution of stress-related health outcomes. This objective entails (a) a set of exploratory research questions about how social status is culturally constructed in specific times and places and (b) confirmatory research questions about the relationship between locally meaningful aspects of social status and health. This example illustrates the interdependence of exploratory and confirmatory questions in medical anthropology. Dressler drew on existing theory to anticipate an association between social status and health. This theory – and substantial empirical evidence – justified confirmatory, hypothesis-testing research, but Dressler first adapted the general theory to specific ethnographic contexts through exploratory research. Dressler refers to this strategy, which depends on working across the exploratory–confirmatory continuum, as “the ethnographic critique of theory” (Dressler 1995, p. 45).