Practicing the awareness of embodiment in qualitative health research: methodological reflections

The anatomy of crisis

This phenomenological study deeply explores the individual and collective lived experience of a mental health crisis. A Lifeworld approach provided the entry point to deeper insights into the anatomy of crisis as the embodied emotional, physical, cognitive, and spiritual nature of crisis. Findings uncovered rich descriptions of mental health crises and how the crisis was encountered in a shattered sense of self and relational challenges in the context of receiving crisis care. Overall, the study revealed an embodied understanding of crisis that offers practical direction in providing crisis care that is more attuned to lived experience.

Pain, Shame, and Power: An Autoethnographic Exploration of Chronic Pain

In this autoethnographic study, I explore my lived experience of a chronic pain condition, the difficulty in writing about embodied experience, and the links between pain, shame, and power. Neglecting neither the complex emotional world of the individual nor the embedded cultural and social themes that continuously impact on the individual, at its best, autoethnography bridges the divide between personal writing and social influences. In this paper, I aim to combine my lived experience of a pain condition without any apparent biological cause, to the wider issue of how we conceive and attend to embodied experience, shame, and power in qualitative health research. The implications from the study include personal emancipation, challenging the mind/body split, and emphasizing the interconnections between emotion and embodied experience, and the need for a pluralistic approach to treatment. The autoethnographic approach aims to embrace situated subjectivity and to include the experience of being a pain sufferer in the research community.

"You're Just Stuck in a Hole, Really": Mechanisms of Structural Racism Through Migrant Agricultural Worker Housing in Canada

Worldwide, migrant agricultural workers face poor housing conditions and related health challenges. A growing body of research has documented the substandard housing often occupied by this largely racialized population. Yet limited health research has examined mechanisms of structural racism that determine this group's poor housing and health. Drawing on interviews with 151 migrant farmworkers in Ontario and British Columbia, Canada, we documented the housing experiences faced by migrant agricultural workers and examined the role of structural racism in determining housing and health inequities. Our analysis identified four overlapping mechanisms by which migrants' housing and health were determined by structural racism: (1) scarcity, (2) segregation, (3) sacrifice, and (4) stagnation. These mechanisms both reinforced and normalized housing hardships, making it difficult for migrants to escape unsafe or inadequate housing. Our findings point to the need for immediate action to improve housing conditions for this population and to interrogate the racist design that keeps migrant workers at the margins of society.

A Critical Comparison of Focused Ethnography and Interpretive Phenomenology in Nursing Research

Choosing an appropriate qualitative methodology in nursing research is a researcher's first step before beginning a study. Such a step is critical as the selected qualitative methodology should be congruent with the research questions, study assumptions, data gathering and analysis to promote the utility of such research in enhancing nursing knowledge. In this paper, we compare focused ethnography by Roper and Shapira and interpretive phenomenology by Benner. Though these methodologies are naturalistic and appear similar, both have different methodological underpinnings. The historical, ontological, epistemological, and axiological philosophy guiding each methodology are described. In addition, the methodological underpinnings of both methodologies and a justification for use in nursing research are provided. This paper will assist future researchers who aim to employ these methodologies in nursing research.

The Emotional and Psychological Labor of Insider Qualitative Research Among Systemically Marginalized Groups: Revisiting the Uses of Reflexivity

In response to decades-long exclusionary practices, academic institutions are now recruiting early career researchers (ECRs) from systemically marginalized populations who specialize in equity-related research. As a result, these ECRs are likely to conduct research within their communities on topics that have personal relevance-insider research. Methodological training for insider research places an emphasis on methods, such as reflexivity, to ensure rigor; however, the emotional and psychological impacts of these research methods on the researcher are seldom discussed. Therefore, I use analytic autoethnography to illustrate the embodied impacts of conducting insider research using an example of personal relevance and argue that methodological practices require an embodied reflexivity that centers the researcher and the impacts the research has on them. This paradoxically rewarding and taxing work necessitates changes in methodological training and practice, institutional support, and an openness to innovation when calling for equity, diversity, and inclusion in the academy.

Bodies of concern? A qualitative exploration of eating, moving and embodiment in young mothers

In some countries, including the United Kingdom, young mothers' pregnant and postnatal bodies remain an area of concern for policy and practice, with interventions developed to support improved health behaviours including diet and physical activity. This article explores what young women themselves think and feel about eating and moving during and after pregnancy. Semi-structured interviews with 11 young mothers were conducted within two voluntary organisations. Data were analysed using thematic analysis with the theoretical lens of embodiment, which provided an understanding of how young women's eating and moving habits related to how they felt about their bodies in the world. Four themes situated in different experiences of being and having a body were identified: pregnant body, emotional body, social body and surveilled body. Stress and low mood impacted eating habits as young women responded to complex circumstances and perceived judgement about their lives. Food choices were influenced by financial constraints and shaped by the spaces and places in which young women lived. Whilst young women were busy moving in their day-to-day lives, they rarely had the resources to take part in other physical activity. Holistic approaches that focus on how women feel about their lives and bodies and ask them where they need support are required from professionals. Interventions that address the structural influences on poor diet and inequalities in physical activity participation are necessary to underpin this. Approaches that over-focus on the achievement of individual health behaviours may fail to improve long-term health and risk reinforcing young women's disadvantage.

What do they get out of it? Considering a partnership model in health service research

A research study to evaluate the implementation of a long-term conditions model of care provoked questions regarding the potential impact of the researcher's role in health service research. Traditional methods of qualitative interviewing require researchers to be a disembodied presence, objective, and free from bias. When health service research is conducted by health professionals, role conflict may occur if the topic is one they have expertise in, and therefore the ability to provide guidance or information. An alternative perspective to the idea of an independent and objective researcher is the notion of a partnership. In this research collaboration, participants utilised the interview process to reflect and explore different perspectives, and the researcher bracketed their own participation in the phenomenon being studied. Reflexivity was utilised by both participants and the interviewer to ensure transparency and thus bridge the gap between subjectivity and objectivity in qualitative health service research interviewing.

Researching at sea: Exploring the 'swim-along' interview method

Interest in researching embodied experiences of activity connected to therapeutic landscapes, spaces or places has led to a range of evolving methods that aim to move beyond traditional sit-down, talk-based qualitative modes of researching. Following the sensory turn, this paper explores a novel 'swim-along' method used to interview people whilst swimming immersed in sea water. By juxtaposing this with insights gleaned from a subsequent sit-down interview, the paper examines implications for deepening our understanding of visceral, sensory, embodied experiences, the methods we can use to access them and how these structure researcher/participant interaction.

What Contributions, if Any, Can Non-Indigenous Researchers Offer Toward Decolonizing Health Research?

Four non-Indigenous academics share lessons learned through our reflective processes while working with Indigenous Australian partners on a health research project. We foregrounded reflexivity in our work to raise consciousness regarding how colonizing mindsets-that do not privilege Indigenous ways of knowing or recognize Indigenous land and sovereignty-exist within ourselves and the institutions within which we operate. We share our self-analyses and invite non-Indigenous colleagues to also consider socialized, unquestioned, and possibly unconscious assumptions about the dominance of Western paradigms, asking what contributions, if any, non-Indigenous researchers can offer toward decolonizing health research. Our processes comprise of three iterative features-prioritizing attempts to decolonize ourselves, acknowledging the necessary role of discomfort in doing so, and moving through nonbinary and toward nondualistic thinking. With a nondual lens, working to decolonize ourselves may itself be seen as one contribution non-Indigenous researchers may offer to the collective project of decolonizing health research.

When the paediatric intensive care unit becomes home: A hermeneutic-phenomenological study

BACKGROUND

Family-centred care is the dominant model for providing nursing care in paediatrics. Unit layout has been shown to impact nurses' ability to provide family-centred care. Little is known about the meanings and experiences of paediatric intensive care unit nurses concerning the care they provide to families within their unique physical setting.

AIM

This study examined paediatric intensive care unit nurses' lived experience of caring for families following a major hospital transformation project, which included the construction of a new unit and quality improvement changes.

STUDY DESIGN

A hermeneutic-phenomenological design was selected to study a paediatric intensive care unit in a large Canadian paediatric teaching hospital.

METHODS

Data were collected over a 6-month period through individual interviews, photographs, participant observation, and document review. The sample consisted of 15 paediatric intensive care unit nurses who experienced the unit both pre- and post-transformation. Data were analysed in an ongoing fashion using the method described by Benner to identify common and divergent meanings.

RESULTS

Despite pride in offering a family-friendly environment, nurses' practice prejudiced a family focus in favour of patient-centred care. Nurses in this study negotiated physical and practice spaces with families by interpreting that nurses do not belong in the home-like patient room and exhibiting gatekeeping comportments.

CONCLUSION

Although similar nurse comportments have been identified in prior works, no previous studies have identified these as forming a pattern of negotiating spaces with families.

RELEVANCE TO CLINICAL PRACTICE

This study provides insights into the lived experience of paediatric intensive care unit nurses in relation to family care, which can stimulate reflections at an organizational level about creating environments where nurses and families can both feel at home.

Toward a More-Than-Human Analysis of Digital Health: Inspirations From Feminist New Materialism

New feminist materialism theories potentially offer a foundation for innovative ways to research health-related experiences from a more-than-human perspective. Thus far, however, few researchers have taken up this more-than-human and post-qualitative approach to investigate health topics. In this article, I outline some approaches I have developed. I begin with a brief overview of the central tenets of new feminist materialism scholarship and a discussion of some empirical studies where these perspectives have been employed to address health topics. I then list some key propositions, research questions, and things to think with from the feminist materialism literature that I have put to work as a basis for conducting empirical research and analyzing data. Then follows four examples drawn from my research on digital health, providing instances of how qualitative researchers can take up this approach and what insights can be generated from entering into this kind of "research assemblage."

Exploring a hermeneutic perspective of nursing through revisiting nursing health history

In this article, the nursing health history is revisited with a hermeneutic lens to uncover means by which this tool can better serve nursing practice. It is argued that further distanciation from the developmental and medical model is necessary to accurately uncover health and history in the nurse-client encounter. Based on the works of prominent hermeneutic philosophers, such as Heidegger, Gadamer, Merleau-Ponty, Ricoeur, and Taylor, four orientations to health history and nursing are explored: orientation to caring, orientation to narrative, orientation to time, and orientation to the body. The nursing health history is used as a vehicle for illuminating the usefulness of a hermeneutic perspective in everyday nursing practice. This article reveals views of health, history, and health history that are already known to nurses and the nursing milieu but are concealed by more dominant outlooks. The hermeneutical perspective presented in this article can help to reveal the important dimensions of everyday nursing practice and foster a richer attunement with the complex health experiences of individuals.

Difference Within and Without: Health Care Providers' Engagement With Disability Arts

Re•Vision, an assemblage of multimedia storytelling and arts-based research projects, works creatively and collaboratively with misrepresented communities to advance social well-being, inclusion, and justice. Drawing from videos created by health care providers in disability artist-led workshops, this article investigates the potential of disability arts to disrupt dominant conceptions of disability and invulnerable embodiments, and proliferate new representations of bodymind difference in health care. In exploring, remembering, and developing ideas related to their experiences with and assumptions about embodied difference, providers describe processes of unsettling the mythical norm of human embodiment common in health discourse/practice, coming to know disability in nonmedical ways, and re/discovering embodied differences and vulnerabilities. We argue that art-making produces instances of critical reflection wherein attitudes can shift, and new affective responses to difference can be made. Through self-reflective engagement with disability arts practices, providers come to recognize assumptions underlying health care practices and the vulnerability of their own embodied lives.

Experiences with the daily use of medications among chronic hepatitis C patients

BACKGROUND

Subjective experiences with medication use are individual experiences that can impact health outcomes by contributing to problems related to such use.

OBJETIVES

The aim of the present study was to understand the experiences of chronic hepatitis C patients who were taking chronic medications, based on the phenomenology proposed by Merleau-Ponty and connection among this experience with the essential structures of the experience.

METHODS

Data were gathered from interviews conducted with ten individuals taking long-term medications at the Viral Hepatitis Outpatient Clinic of the Alfa Gastroenterology Institute of the Hospital das Clínicas, Federal University of Minas Gerais, Brazil. The content of field diaries kept during the interviews were also used. Thematic analysis was employed, enabling the identification of the ways in which individuals experienced their medication routines, which were then reorganized to encompass the essential structures of the experience.

RESULTS

The researchers identified four ways patients experience daily medication use, all anchored in corporeality: resolution, adversity, ambiguity, and irrelevance. The first three were based on the perspective that daily medication use is more than a mere mechanical action, involving changes in the phenomenal body, relieving, eliminating or causing symptoms in the physical body, normalizing life and symbolizing the disease.

FINAL CONSIDERATIONS

The present study allowed the researchers to infer that the same individual can even simultaneously experience daily medication use in different ways, depending on the disease and the medication in question. It also allowed for the understanding of the cyclical nature of experience with daily medication use, being that the introduction of a new medication can give rise to a new experience. The results point to the complexity of this experience, which requires formal education and places health professionals as responsible for this aspect of care.

Managing Meanings of Embodied Experiences Theory: Toward a Discursive Understanding of Becoming Healthier

We advance a new theoretical approach for interpreting health communication from an embodied, intersubjective perspective. We propose individuals experience the world as bodied beings and must make sense of their embodied experiences by managing meanings of who they are in the world (being), the actions they perform (doing), and who they want to become (directed becoming). We call this theory managing meanings of embodied experiences (MMEE). Guided by the philosophies of phenomenology, pragmatism, and feminism, we provide a three-fold framework for exploring individuals' management of health meanings during interactions with others in society. The first layer-being-demonstrates a mutually constituting, intersubjective presence with others, whereby we attend to our own and another's embodied expressions accomplished communicatively. The second layer-doing-appreciates experiences directed by personal and social values both perceived and conceived during the unfolding of coordinated communicative events. The third layer-directed becoming-highlights our ability to mindfully direct changes to our identity and actions through critical reflection; it is the transformative potential of our reflective synthesis of being and doing.

The body-space relations of research(ed) on bodies: The experiences of becoming participant researchers

This paper heeds calls for reflections on how the research field is defined through embodied socio-spatial presence and immediacy. Focusing on classroom "body-training" observations that were part of a larger qualitative research project, and on the field notes and reflections of three researchers, we explore the transition from observer-researchers to participant-researchers. That is, we explore how, by researching others, we unexpectedly became researched on as our own bodies became instruments in the research process and were used to elicit knowledge on embodied learning, body-mapping and corporeal trace. As a methodological intervention, conducting research through the body, the positioning of bodies and body-to-body interaction, can tell us much about the often ignored embodied and emotional dimensions of the research field. But, in addition, it can elucidate the power relations between, and the fluidity of, researcher and researched positions in the jolting of secured researcher identity. Here we detail how different researchers performed different embodied and emotional subjectivities in different training research spaces. We explore how ontological anxieties of our own placed bodies, based around constructed notions of femininity, religion and researcher professionalism, shape this immediate body-to-body encounter and the subsequent research process.

"Three in the Room": Embodiment, Disclosure, and Vulnerability in Qualitative Research

The researcher's body in qualitative research is often absented, an absence that can render deceptively tidy research accounts. In this article, I reflect on the interplay of embodiment and disclosure in the interview dynamic and the way in which my body became an object of inquiry in the research process. Three qualitative studies inform the article: the first exploring the experiences of 40 people living with hepatitis C in New Zealand and Australia, the second comprising life-history interviews with 38 people who inject drugs in London, and the third following 27 people through hepatitis C treatment in London. Bodily and verbal disclosures of my history, as someone with/without hepatitis C and a former heroin user, affected the energy of the interview dynamic, also embodied understandings of illness and drug use. Disclosure can enhance researcher vulnerability and I close with reflection on the ethical implications of "enhanced rapport" in the research situation.

Lived Observations: Linking the Researcher's Personal Experiences to Knowledge Development

As researchers in palliative care, we recognize how involvement with seriously ill and dying persons has an impact on us. Using one's own senses, emotional and bodily responses in observations might open intersubjective dimensions of the research topic. The aim of the article is to highlight how phenomenological theories on intersubjectivity can be useful to develop rich and transparent data generation and analysis. We present three field note examples from observation in a hospice ward, which illuminate how researcher awareness of aspects of intersubjectivity can add valuable insights to data and analysis. Out of the examples, we elaborate on three arguments: (a) how the researcher's lived experience of time and space during fieldwork triggers new research questions, (b) how observations as an embodied activity can bring new insights and open new layers of meaning, and (c) the value of observations in gaining insight into relational aspects in a hospice.

The complexities of 'otherness': reflections on embodiment of a young White British woman engaged in cross-generation research involving older people in Indonesia

If interviews are to be considered embodied experiences, than the potential influence of the embodied researcher must be explored. A focus on specific attributes such as age or ethnicity belies the complex and negotiated space that both researcher and participant inhabit simultaneously. Drawing on empirical research with stroke survivors in an ethnically mixed area of Indonesia, this paper highlights the importance of considering embodiment as a specific methodological concern. Three specific interactions are described and analysed, illustrating the active nature of the embodied researcher in narrative production and development. The intersectionality of embodied features is evident, alongside their fluctuating influence in time and place. These interactions draw attention to the need to consider the researcher within the interview process and the subsequent analysis and presentation of narrative findings. The paper concludes with a reinforcement of the importance of ongoing and meaningful reflexivity in research, a need to consider the researcher as the other participant, and specifically a call to engage with and present the dynamic nature of embodiment.

“Most Prized Possessions”: Photography as Living Relationships within the End-of-Life Care of Newborns

This article reports findings from a phenomenological inquiry into how parents experience End-of-Life (EOL) photography around the death of their newborn in the neonatal intensive care unit (NICU) and in their lives beyond the hospital. The study involved semi-structured interviews with 10 parents who had experienced the death of their newborn within the last five years in the same NICU setting. All parents had participated in EOL photography, having photos taken by nurses, by themselves, and/or by volunteer professional photographers. Through an Interpretive Phenomenological Analysis, the theme of “living relationships” emerged, revealing the photography as valued more than for the photos as “mementos,” but further as an activity grounding relationships and fostering interaction between families, newborns, and care-providers; these findings provide insight into how parents came to see their EOL photos as “prized possessions.” The article is concluded with a discussion on a Model for Photographing Living Relationships.

Using care ethics to enhance qualitative research on rural aging and care

Qualitative research offers important insights into the subjectivity, complexity, and relationality of care. In this article, we examine the particular processes and relationships involved in doing qualitative research about care with older people in rural places. We draw on our experience completing two related qualitative studies of rural care in Canada to extend discussions about responsible research practice in relation to participant recruitment, interviews, and focus groups. By applying Hankivsky's principles of care ethics in our reflection on research practices, we make explicit the role of emotions in connecting with research participants, collecting and participating in narrative-based research, and negotiating identity. We conclude with a discussion of the distinct ways in which applying care ethics throughout the research process can augment reflexive practice and enhance the integrity and theoretical contributions of qualitative health research while developing more inclusive understandings of vulnerability in older rural populations.

Ethical reflections: examining reflexivity through the narrative paradigm

Being reflexive and providing these reflections for public scrutiny is often considered a key element of ethical, rigorous qualitative research. Prevalent conceptualizations of reflexivity, however, need interrogating and sharpening. We aim to contribute to this by examining reflexive practice, and in particular researchers' reflexive accounts, through the lens of the narrative paradigm. Our aim is to demonstrate that acknowledging the role of narrative reconstruction in reflexivity creates more ethical research, and that it is therefore crucial for researchers to more explicitly recognize this. Both authors present an analysis of one particular exchange between interviewer and participant. This analysis highlights that despite our best efforts at "doing reflexivity," both immediately following and when reflecting back on an interview, there are influential factors that escape our gaze. Reflections of the past are particularly imperfect. Without fully recognizing this, we are not utilizing all the tools available for ensuring honest, ethical research.

Expanding the notion of researcher distress: the cumulative effects of coding

Qualitative researchers who explore the individual's experience of health, illness, death, and dying often experience emotional stress in their work. In this article, we describe the emotional stress we experienced while coding semistructured, after-death interviews conducted with 38 next of kin of deceased veterans. Coding sensitive topic data required an unexpected level of emotional labor, the impact of which has not been addressed in the literature. In writing this discussion article, we stepped back from our roles as interviewers/coders and reflected on how our work affected us individually and as a team, and how a sequence of exposures could exert a cumulative effect for researchers in such a dual role. Through this article, we hope to generate an expanded discourse on how qualitative inquiry impacts the emotional well-being of researchers.

Older homebound women: negotiating reliance on a cane or walker

Canes and walkers are commonly characterized as assistive devices that serve the same purpose: as walking aides. These general views were reappraised and tempered in this descriptive phenomenological study with 40 older women (aged 85 to 98 years) who were unable to leave their homes without help. The purpose was to describe the phenomena of negotiating reliance on canes and walkers as walking devices and the lifeworld context underlying each phenomenon. Relative to lifeworld, there were differences between coming to terms with using a cane and coming to terms with using a walker. Data revealed similarities and distinctions between the basic intentions of relying on canes and walkers and the associated purposes served by canes and walkers. Participants did not view either device as consistently assistive. Findings evoke opportunities for dialogue among older persons, scholars, practitioners, and designers of these devices about coming to terms with such devices and relying on them.

Giving patients responsibility or fostering mutual response-ability: family physicians' constructions of effective chronic illness management

Current visions of family medicine and models of chronic illness management integrate evidence-based medicine with collaborative, patient-centered care, despite critiques that these constructs conflict with each other. With this potential conflict in mind, we applied a critical discursive psychology methodology to present discursive patterns articulated by 13 family physicians in Ontario, Canada, regarding care of patients living with multiple chronic illnesses. Physicians constructed competing versions of the terms "effective chronic illness management" and "patient involvement." One construction integrated individual responsibility for health with primacy of "evidence," resulting in a conceptualization consistent with paternalistic care. The second constructed effective care as involving active partnership of physician and patient, implying a need to foster the ability of both practitioners and patients to respond to complex challenges as they arose. The former pattern is inconsistent with visions of family medicine and chronic illness management, whereas the latter embodies it.

Narrative beginnings: traveling to and within unfamiliar landscapes

Drawing on the life stories of Debra, an Aboriginal woman living with HIV, I reflect on the feeling of (dis)placement from a geographic landscape and cultural heritage that both Debra and I experienced, although in different ways. I explore how place is inscribed onto and into our bodies and how home can be understood as embodied. In this way I explore place as geographic position of home and as ontological. In the living out of her stories, Debra made me not only understand the deeper conditions of human life, but that stories told are not fixed texts, that they are composed in and out of the living and in relation to others. The textual representation and physical inscriptions of Debra's stories are another way to not only understand, but to inquire into her life and my own. The inquiry deepened my understanding of nursing practice as a particular, contextual, and meaningful relational engagement.