For decades, there has been a constant preoccupation with the epistemological and ontological concerns that are associated with ethnographic practice. Ethnography is an inductive process; it works from evidence gathered over a long period of time towards a theory and, thus, has a close relationship with epistemology. In ethnography,
epistemology is the study of cultural knowledge as the goal of an ethnographer is to learn from people what counts as cultural knowledge for them, within the context of their specific environments. Epistemology is also concerned with the meaning of knowledge and “what it means to know. It is a background for deciding what kinds of knowledge are legitimate and adequate” (Gray, 2004, p.19).
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Ethnography is an interpretive, constructivist, and reflexive process. To ensure that this methodology is developed, I will first describe the qualitative research approach that has been applied to this study.
3.3.1 The Qualitative Approach
Cresswell (1994) suggests that qualitative enquiry involves understanding human and social processes, reporting detailed views of individuals and conducting studies in a natural setting. The goal of qualitative research is to discover patterns that emerge after close observation, careful documentation, and thoughtful analysis of the research topic. What can be discovered by qualitative research are not sweeping generalisations but contextual findings. The purpose of qualitative research is to understand and explain participant meaning (Morrow & Smith, 2000). Creswell (1994) defines qualitative research as:
“an inquiry process of understanding based on distinct methodological traditions of inquiry that explore a social or human problem. The researcher builds a complex, holistic picture, analyses words, reports detailed views of informants, and conducts the study in a natural setting” (p.15).
An inductive approach was taken to the generation and interpretation of data. The inductive view believes that the data collected can be used to develop concepts and theories that help us to understand the social world. This is in line with qualitative approaches, which are exploratory and focus on discovery and investigation. The qualitative research approach is concerned with the understanding of phenomena and meanings that people give actions, beliefs, or values in their social world. Because of this, I could see that the qualitative research approach would be the most useful for my
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study, as I am looking at the social world of childbirth in the context of the OptiBIRTH study and the effect that the intervention may have had on an individual‟s beliefs, or the meanings they attach to trying for a VBAC. By choosing the qualitative research
approach for this study, it allowed me to collect information to understand the culture of the hospital with respect to VBAC and decisions around mode of birth while
OptiBIRTH was in place and to observe if any change in this culture occurred,
following the implementation of the intervention. Choosing a qualitative approach for my study gave me greater access to deeper and more sensitive information, and
facilitated me to observe the social and political world ingrained in the hospital more-so than a quantitative research paradigm would have. Thus a qualitative research approach was deemed best to achieve my study‟s aims and objectives.
That being said, I am also aware that there are some weaknesses associated with the qualitative research approach. Rubin & Babbie (2009), for example, argue that
qualitative data are extremely limited in their extent to generalise findings to the overall population, which contrasts sharply to quantitative studies which are based on “rigorous sampling and standardised measurements” (p.230). This limited ability to generalise findings is due to smaller sample sizes in qualitative studies and the subjective nature of the topic being investigated. Yet, because of the nature of my embedded ethnography, a qualitative approach is appropriate as OptiBIRTH involves a specific intervention, aimed at a specific population and sample size (women with a previous CS and healthcare professionals in one study site). Therefore, some of the findings of this ethnography may only be related to the field-site in which this study was conducted. However, it could be suggested that the findings could be transferable to other units if
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the intervention is seen to be effective. This ethnography explored the experiences and perspectives of women and clinicians that were participating in OptiBIRTH in one field-site at a specific point in time but the findings may be transferable to other maternity units.
Additionally, there is a possible risk in qualitative research that, due to the personal and subjective nature of qualitative research, analysis and interpretation of data may be influenced by the researcher‟s prior knowledge and personal perspectives on the topic under investigation (Rubin & Babbie, 2009). As I am not a healthcare professional, it is unlikely that I would have many pre-conceived ideas about decisions that need to be made around mode of birth following a first CS. However, I am a woman of
childbearing age, and had some prior knowledge and views about normal birth versus CS. I was acutely aware of the danger of influencing data collected and every effort was made to conduct the ethnography in a reflexive and unbiased way. These potential limitations were taken into account when discussing the validity of the current study‟s findings and the reflexive process is discussed in greater detail in section 3.7.
3.3.2 The Interpretive Paradigm
A paradigm is a framework of beliefs, values and methods that the researcher utilises in order to design his/her study. Interpretivism is the set of beliefs that are associated with the qualitative approach. Interpretivists believe that there are many truths and multiple realities and that different people have different perceptions, values, and experiences. This way of thinking began in the late 18th century with the publication of the “Critique
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of Pure Reason” by Immanuel Kant (1724-1804). Kant proposed that it is individuals that interpret their sensations rather than experiencing the “out there” world as it is. He was more interested in perception rather than objective reality and believed that reality and the world was a product of human perception and that these perceptions can change when the world that humans perceived is changed (Scott, 2002). This way of thinking was expanded on by Wilheim Dilthey (1833-1911) and Max Weber (1864-1920), who introduced the concept of verstehen.
Verstehen means to understand in German. It is a concept that refers to entering into the shoes of the other in order to understand their point of view. The advocates of verstehen
define it “as a singular form of operation which we perform whenever we attempt to explain human behaviour” (Abel, 1948, p.211). In achieving verstehen Weber emphasised that the researcher must understand the meanings of actions in the social world and humans must be seen to create that world by the organisation of their social world. Researchers should not treat the individual and the lived experiences like objects. This philosophical thinking was in a contrast to the more positivist position of the world which believes that “the nature of the world can be revealed by observation and that what exists is what we perceive to exist” (Burr, 2015, p.3).
The aim of interpretivism is to understand the experiences of those being studied in a subjective manner and, at the core of this paradigm, assumes that social actors generate meaningful constructs of the social world in which they inhabit and operate.
Additionally, the interpretive paradigm is associated more with the methodological approaches that provide an opportunity for the voice, concerns, and practices of
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research participants to be heard (Weaver & Olson, 2006). Interpretive researchers believe that reality consists of people‟s subjective experiences of the external world; thus, they may adopt an inter-subjective epistemology and the ontological belief that reality is socially constructed. Walsham (1993) argues that, in the interpretive tradition, there are no „correct‟ or „incorrect‟ theories. Instead, they should be judged according to how „interesting‟ they are to the researcher as well as those involved in the same areas. This is the interpretive approach, which aims to explain the subjective reasons and meanings that lie behind social action.
This research paradigm has been chosen due to its relationship withqualitative methodologies. It allowed for an in-depth exploration and greater insight into the subjective experience of participants in the OptiBIRTH trial. Furthermore, I believed that it was suitable for the embedded ethnography as the study is being conducted in a natural setting, which allowed me to collect substantial situational information through unstructured observation and open interviews. This research paradigm recognised the potential impact that I, as the research instrument, can have on participants and data. This was extremely important in this ethnography, as I was a new entity in the field-site, and new behaviours might be exhibited due to my presence, which must be
acknowledged.