Beyond the unobtrusive observer: reflections on researcher-informant relationships in urban ethnography

Pediatricians' role in healthcare for Latino autistic children: Shared decision-making versus "You've got to do everything on your own"

LAY ABSTRACT

Latino parents may choose to use complementary health approaches, such as vitamins, supplements, and special diets, for their autistic children. However, they might not tell their pediatrician about their complementary health approach use if they worry that the pediatrician will disapprove or judge them. This fear, along with pediatricians' lack of autism knowledge, creates barriers to "shared decision-making" between parents and pediatricians. Shared decision-making is a process where families and healthcare providers collaborate and exchange information in order to come to an agreement about treatment options. In our qualitative study with 12 bilingual Latino families of autistic children, we interviewed and observed families to learn about their experiences with both conventional healthcare (their pediatrician) and complementary health approaches. Our study results describe the parents' different pathways to an autism assessment, a process that is sometimes called the "diagnostic odyssey." The parents reported that conventional healthcare met their needs for their child's physical health but not for their child's developmental challenges. The parents who used complementary health approaches for their autistic children were more frustrated about a lack of autism information from pediatricians than those who did not use complementary health approaches. Finally, we describe two examples of successful shared decision-making between parents and pediatricians. We conclude that pediatricians who are able to talk about complementary health approaches with Latino families may help to facilitate shared decision-making and reduce healthcare disparities for Latino autistic children.

Goal Setting Among Experienced and Novice Occupational Therapists in a Rehabilitation Center

BACKGROUND.

Collaborative goal setting is an important part of client-centered occupational therapy. However, not all therapists have comparable skills when it comes to setting goals.

PURPOSE.

The aim of our study was to explore the experiences of novice and expert occupational therapists who use the Canadian Occupational Performance Measure in the process of goal setting.

METHOD.

This study followed a focused ethnography approach. Four beginners and four experienced occupational therapists were interviewed about their experiences with goal setting. We also observed them during a goal setting session. Data were analyzed using thematic analysis.

FINDINGS.

The four main themes that emerged from the analysis showed both similarities and differences between novice and experienced therapists, especially in the areas of communication, guidance, and flexibility, as well as dilemmas they were facing.

IMPLICATIONS.

Our findings challenge the client-centeredness of the participants and the relevance of work experience when it comes to collaborative goal setting.

A narrative study of mental health recovery: exploring unique, open-ended and collective processes

Purpose: Guided by narrative theory and by use of a narrative-in-action approach, the aim of this study was to explore how mental health recovery unfolds through individuals’ engagement in everyday activities.

Method: Data were created through participant observations with four individuals while doing everyday activities, and analysed through a narrative, interpretive approach.

Findings: The findings show how mental health recovery involves unique and open-ended processes of narrative meaning-making, which unfold through an interplay between everyday activities, places and persons.

Discussion: Based on these findings, we discuss how we may understand and support mental health recovery as collective processes.

Strategies of older couples to sustain togetherness

The aim of this study was to explore how elderly couples, who are in need of social services in the community, act and reason over time regarding their everyday togetherness. Data were generated through repeated interviews and participant observations with three older couples. A narrative method was used for data generation and analysis. The findings present four parallel narratives illustrating how the couples, over time, strove to continue living their lives in togetherness despite the many challenges that had emerged. These narratives show the complexity and variety of strategies that the couples adopted to handle different situations of everyday life and the couples' experiences and feelings connected to these situations. The strategies that the couples used resulted, for example, in performing more activities together in another way, using respite care and reorganizing their social interactions. The spousal caregiver had a leading role to manage day-to-day life and to initiate and perform the strategies. Simultaneously, an important reciprocity existed in their relationship that gave meaning to their efforts of sustaining togetherness. These findings give a deeper understanding of the complexity of their situation and of how meaning is created in their everyday life through enacted togetherness. The findings highlight the need for professionals within social services in the community to embrace a couple's whole situation, involving both partners.

A Qualitative Study of Caregiving for Adolescents and Young Adults With Spinal Cord Injuries: Lessons From Lived Experiences

Objective: To examine characteristics of caregiving from the perspectives of adolescents and young adults (AYAs) with spinal cord injuries (SCIs) and their informal caregivers to address outstanding gaps in knowledge relating to definitions of caregiving and its associated practices for this population. Methods: A multiphase qualitative design was applied, using phenomenological and narrative methods to capture data in participants' homes and communities. Participants were recruited from rehabilitation hospitals and community organizations throughout Los Angeles County, California. Inclusion criteria for AYAs included being 15-22 years old, having acquired an SCI within the previous 5 years, and using a wheelchair for mobility. The AYAs nominated persons they identified as primary caregivers to also participate. Data were collected through individual and group interviews as well as activity observations. Results: Data from the 17 participants (9 AYAs and 8 informal, primary caregivers) revealed ways in which the meaning of caregiving varied among dyads. Caregiving practices extended beyond physical assistance to include support for a range of day-to-day activities spanning from practical needs to facilitating developmental trajectories. Although AYAs expressed ideas about preferred caregiver characteristics, care partnerships appeared to be guided more by availability than preference. Conclusion: Phenomenological analysis revealed that the meaning of "caregiving" and its associated practices are highly individualized for AYAs with SCIs. Caregiving is rooted in personal needs related to effects of SCI and developmental goals. Everyday practices are shaped by individual relationships and the beliefs of AYAs and their caregivers. Addressing influences of caregiving on long-term health and function may require attention to developmental processes, caregiver "fit," and ways care is, or can be, distributed throughout broader networks according to personal needs and preferences.

Beyond Words: Using Qualitative Video Methods for Researching Occupation With Young Children

Researching with children is fundamental for furthering our understanding of children's occupational worlds. Furthermore, researching occupation from a transactional perspective is important for gaining a deeper understanding. However historically, most approaches to researching with children do not capture the transactional nature of occupation. The use of video methods in qualitative research is proposed as a potential solution. This article illustrates how videography can be used as an effective, inclusive qualitative research method, and uses a study of infant play occupation to illuminate video techniques. Drawing on a longitudinal study with five infants and their families, methodological challenges are presented. We discuss key considerations in data generation and analysis when utilizing videography and outline insights gained regarding infant occupational development and meaning-making in the physical environment. Video methods are an effective means of researching from a transactional perspective and have potential to strengthen occupation-centered research particularly with infants.

Collective occupation in public spaces and the construction of the social fabric

Background.

Contemporary research is expanding understandings of occupation beyond that of the individual’s doing, including the shared and social nature of occupation. The concept of collective occupation has been introduced to capture this broader understanding.

Purpose.

This study aimed to explicate the concept of occupation in a Greek town.

Method.

Ethnographic methodology was used and primary data were collected through observation, participation, and informal interviews. Analysis involved a hermeneutic process to develop a narrative of occupation in the town, including action, setting, and plots.

Findings.

Occupation, a dynamic and multidimensional process, served to maintain the self, family, and social fabric and balance between and within them. Collective occupation maintained the social fabric through three forms: informal daily encounters in public spaces, organization and associations, and celebration and commemoration.

Implications.

Occupational therapists may consider engaging with the potential power of such collective occupation when working toward social change to enable just and inclusive societies.

"What Do You Think We Should Do?": Relationship and Reflexivity in Participant Observation

This article uses three concepts as a framework by which to examine how the interrelational elements of ethnographic approaches to qualitative inquiry reflect dimensions of therapeutic engagement. Participant observation, reflexivity, and context are all widely and routinely included within research methods; however, they are less frequently attended to directly in their experiential capacity through the lens of the researcher, clinician turned investigator. A unique study design will be profiled to reflect the complicated juxtaposition between methods, questions, sample population, time, space, and identity. Studying occupational therapy students traveling abroad for a short-term immersion experience, this narrative study called on a necessary and attentive awareness of locality as the researcher traveled with the group. Conducting ethnographic research where the researcher's therapeutic skills aided and constrained relationships resulted in rich, guarded, and relevant insights that parallel the therapeutic use of self in occupational therapy practice.

Balancing struggles with desired results in everyday activities: strategies for elderly persons with physical disabilities

The number of elderly persons with disabilities needing support with everyday activities increasing in Japan and around the world. Yet, engagement in everyday activities can support the quality of their daily life. Despite research focusing on reported meanings of people's actions, there is still limited knowledge on how engagement in everyday activity is enacted along with the meanings of persons' actions. The aim of the present study was to identify meanings of persons' actions within everyday activities of elderly Japanese with physical disabilities. Five elderly persons with physical disabilities living in the community participated in this study. Data were gathered by 10 participant observations of everyday activities supplemented with 13 unstructured interviews. Narrative analysis was used to identify meanings of persons' actions. The analysis identified an overall plot termed 'balancing struggles with desired results'. This plot illustrated that participants' and other involved individuals balanced problematic situations with finding situations that accommodated their needs. Meanings of these actions were further identified as three complementary strategies. Two of three strategies aimed to mitigate given problems, one by 'acting on a plan to achieve one's goals', the other by 'taking a step in a preferred direction by capitalising on emerging opportunities'. The third strategy focused on avoiding undesirable experiences by 'modifying problematic situations'. In conclusion, these findings call for care and rehabilitation providers' sensitivity to shifting foci of what matters in daily life's situations as well as aligning with persons' skills, resources and perspectives. Accordingly, the judicious and flexible use of these complementary strategies can enhance elderly persons' quality of daily living through everyday activities.

"And I look down and he is gone": narrating autism, elopement and wandering in Los Angeles

'Wandering' and 'elopement' have been identified as common in autism, affecting half of all diagnosed children ages four to ten, yet families rarely receive advice from practitioners even after the fact. Family perspectives have been missing from the literature as well as from public health and policy debates on how and when to respond to this problem. The problem of 'wandering' and 'elopement' reveals a complex intersection of larger issues encountered by families of children with autism. To consider these issues, this article examines 'wandering' and 'elopement' from the perspectives of African American mothers of children with autism, an underrepresented group in autism research. We consider how the mothers experience these behaviors and the response to these behaviors by professionals, such as service coordinators and law enforcement personnel working within various jurisdictions that become involved with the problem. We analyze the mothers' narratives about 'wandering' and 'elopement' drawn from ethnographic interviews that were collected between October 1, 2009 and August 31, 2012. These interviews were part of a larger project on disparities in autism diagnosis and services that followed a cohort of 25 four to ten-year old children. Drawing on narrative, phenomenological and interpretive traditions, we trace the mothers' developing understandings of 'wandering' and 'elopement' over time, and show how these understandings become elaborated and transformed. This article provides a nuanced, moment-to-moment and longitudinal picture of the mothers' experiences of 'wandering' and 'elopement' that enriches the cross-sectional view of large-scale surveys about the problem and contributes unique insights at the family and community levels. Implications for professional awareness, clinical practice and service provision are also suggested.

Newly qualified midwives' transition to qualified status and role: assimilating the 'habitus' or reshaping it?

AIM

to ascribe meaning to the everyday experiences of midwives during their first year of practice as they interact with their social environment.

DESIGN

a qualitative, ethnographic study.

SETTING

a major maternity department located in the West Country, UK.

PARTICIPANTS

seven newly qualified midwives working in the chosen setting.

MEASUREMENTS

as befits an ethnographic approach, observant participation and interviews in the field were the selected data collection tools. Reflexivity was at the hub of the research process. A field diary was kept in order to ensure that the researcher took into account both her own perceptions and the interactions with participants and significant others. This paper draws on data that illustrates some of the predispositions that may constitute the midwifery habitus.

FINDINGS

the main themes that emerged from the data were in relation to the culture of midwifery, fitting into the culture and determining what type of midwife the neophytes wanted to be ('what is a midwife?'). To enhance transparency, the latter theme is focused upon in this paper using a model that is a synthesis of some of the findings and Bourdieu's notion of habitus.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

this research provides insight into the professional and cultural experiences of newly qualified midwives, especially how cultural interactions, education and expectations may shape the midwifery habitus. It would seem that midwives who take a critical and reflective approach to practice are key players in the cultural re-creation of midwifery. Accordingly, to enable the aforementioned approach to practice, it is important that reflective and reflexive practices are an integral part of midwifery education. Nevertheless, the implications for practice are not merely one-dimensional. Observations in the field suggest the importance of making the quality of midwives' working lives a priority by facilitating a more supportive working environment. Moreover, midwives should not be marginalised for preferring to work in the community, the birth centre or the high-risk environment. Future planning of the maternity services needs to consider how a 'being with the woman' approach can be facilitated for all women, balancing the virtues of both the medical and midwifery models of care.

I/We narratives among African American families raising children with special needs

This paper examines a statistics debate among African American caregivers raising children with disabilities for insights into the work of "African American mothering." Using ethnographic, narrative and discourse analyses, we delineate the work that African American mothers do--in and beyond this conversation--to cross ideological and epistemological boundaries around race and disability. Their work entails choosing to be an "I" and, in some cases, actively resisting being seen as a "they" and/or part of a collective "we" in order to chart alternative futures for themselves and their children.

Studying narrative-in-action in women with chronic rheumatic conditions

In this article we aim to sculpt a possible methodology for studying how a good everyday life comes about when living with chronic rheumatic conditions (CRC). Our "how" focus acknowledges a woman with CRC as one member of a diverse population, whereby we question the biomedically based view that she differs from the population. The more frequently asked "what" question colors study designs and results in categories and characteristics regarding what she is able to do and what adaptations she has made in everyday life as a consequence of her disease. Adopting a narrative approach, we ask how a good everyday life comes about, and illustrate this with ethnographic material of the everyday activities of women living with CRC. We conceptualize narrative as embedded in the process of enacting activities. Furthermore, we highlight hermeneutical interpretative processes of how meaning works in the stream of everyday action.

Narrating September 11: Race, Gender, and the Play of Cultural Identities

This article considers the September 11 tragedy as an event that has created a powerful experience-an astonishing and unthinkable "breach" from the expected and routine-that has riveted the American public and provoked personal storytelling. September 11 and its aftermath have provided an occasion for rethinking and reworking cultural identity. We explore how September 11 and subsequent events have been experienced, constructed, and narrated by African American women, primarily from working-class and low-income backgrounds. These stories, and the commentaries and discussions that surround them, provide vehicles for these women to ponder what sort of social contexts they inhabit, within what sort of subject positions they are placed, and how these may be shifting in light of the attacks and America's "War on Terrorism.