Читать книгу A Companion to Medical Anthropology - Группа авторов - Страница 71

Methods of data collection in medical anthropology fall into three broad categories: participant observation, systematic observation, and interview methods. Participant observation is the bedrock of data collection in medical anthropology, as it is in the parent discipline. DeWalt and DeWalt (2011, p. 2) define participant observation as “a way to collect data in naturalistic settings by ethnographers who observe and/or take part in the common and uncommon activities of the people being studied.” The key task of participant observation is to create a systematic record of everyday life by writing field notes about informal observations, interactions, and conversations.

There is variation in how researchers balance the roles of participant and observer in ethnographic research (Spradley 1980). For his work on immigration, social hierarchy, and health, Holmes (2013) immersed himself in the lives of migrant farmworkers. Over 18 months of participant observation, he lived in the village of San Miguel in Oaxaca State, earned the trust of Triqui people planning to cross the U.S.–Mexico border, was apprehended with but separated from his Triqui companions by U.S. border patrols, and eventually lived and worked in a labor camp, picking strawberries in Central California. Holmes placed high value on participation, drawing attention to his own bodily experiences as a field worker (in both senses) as a source of insight into social suffering (p. 34).

In health services research, Sobo (2009, p. 211) is more often a participating observer than an observing participant, but she emphasizes a sentiment all participant observers would embrace: “There is no substitute for being there.” Barrett (2008) distinguishes between two major kinds of participant observation in his ethnography of Aghor medicine. The first is “the classic form of ‘active participation’ in which the ethnographer increasingly engages in the distinctive behaviors of his or her informants in order to better understand those behaviors in their appropriate cultural context” (p. 14). The second drew on Barrett’s previous clinical experience as a registered nurse and volunteer at clinics in his field site. Barrett wasn’t engaged in these roles during his research, as is typical in active participant observation; rather he used participation in relevant contexts as a framework for making sense of ethnographic observations. Strong (2020), by contrast, “participated in nearly all aspects of the life of the hospital” in the Rukwa region of Tanzania where she studied maternal mortality and the ethics of care (p. 17).

Systematic observation differs from participant observation because it imposes more structure on sampling and measurement (Johnson and Sackett 1998). For that reason, methods of systematic observation – including continuous monitoring, spot sampling, and time allocation – are best suited to confirmatory research questions. Systematic observation deserves wider use in medical anthropology, because many research questions concern what people do, not just what they say. And there is ample evidence that what people say is seldom a good proxy for what they do (Bernard et al. 1984).

Vitzthum (1994) studied concordance between maternal recall and systematic observation of breastfeeding in the Peruvian Andes. She interviewed 30 Nuñoa women with children under three years of age and asked each woman to estimate how often and how long her child breastfed each day. Vitzthum then monitored a subset of 10 women over a total of 86 hours and recorded the frequency and duration of breastfeeding to the nearest second. She found little association between observational and recall data: Women generally underreported frequency and overreported duration of breastfeeding, but not in a consistent pattern. If we rely only on maternal recall – as epidemiologic studies of breastfeeding often do – we are likely to make mistakes (see also Li et al. 2005; Miller et al. 2013).

Most of the methods in Table 4.3 involve collecting data through interviews. The unstructured–structured continuum is a useful way to organize the diversity of interview methods. Bernard (2018) identifies three types of interviews: unstructured, semistructured, and structured. Each type of interview, in turn, includes a diverse array of techniques. Structured interviews, for example, are used in survey research, in the collection of social network data, and in tandem with formal elicitation techniques such as free-listing and pile-sorting. Semistructured interviews and focus group discussions are likewise similar in level of structure and purpose.

Many medical anthropologists recognize the complementary value of different methods and often combine them in a single study. For example, Singer et al. (2006) designed a five-year study on the prevention of sexually transmitted infections and unwanted pregnancies among low-income, inner-city African-American and Puerto Rican youth in Philadelphia and Hartford. They used a wide range of methods: focus groups, formal elicitation (e.g., free-listing), in-depth individual sexual and romantic life histories, sexual behavior diaries, and structured interviews. This strategy paid off, because different methods yielded different insights. Focus groups helped to identify the range of relevant sexual behaviors and relationship types that people recognized, while in-depth individual interviews revealed the personal, emotional meaning of particular experiences. These complementary findings illustrate the benefit of creating redundancy, or triangulation, by using different types of methods (LeCompte and Schensul 2010, p. 174).