"Whatever their answer, double it and you should be close..."

Posted by Hannah Mehmood, Medical Student, Newcastle University

Hannah undertook a 6-week NIHR School for Public Health Research (SPHR) internship with Fuse based at Newcastle University in summer 2020. She was supervised by Fuse / NIHR SPHR Doctoral Student, Cassey Muir.

A question asked in every GP consultation is how much alcohol a patient drinks. It provides a useful insight into a person’s physical, social, and psychological health. According to my GP tutor, most people underestimate the amount they drink, as well as the impact this has on them.

Substance misuse is a complex issue, and as a medical student I have learned to focus on the impact of problematic drug and alcohol use on individual patient wellbeing. Last summer, as an NIHR SPHR intern, I studied substance misuse from a different perspective. The basis of my internship was a research project focusing on young people whose parents misuse drugs and alcohol. I aimed to explore how young people viewed school and education to understand if this environment could be used to deliver supportive interventions.

I analysed ten UK based qualitative studies which examined the experiences of young people affected by parental substance misuse. Qualitative studies examine non-statistical data to develop themes and deep understanding of the research question. The young people from the studies I explored were under the age of 25 and from various social, economic and demographic groups.

Young people viewed school as a space away
 from issues they may face at home

I was particularly interested in the ways in which young people viewed school as a separate space away from issues they may face at home, to the extent that many young people did not even discuss their home life with close friends. But despite the mental separation of home and school, the reality of their home life often prevented a complete detachment of the two. One young person described how caring for her parent resulted in frequently missing school, while another recognised that his aggressive behaviour in school was a way to offload stress at home.

Many young people also expressed a lack of trust towards their place of education, as well as a desire to blend-in with their peers. This contributes to barriers in identifying young people who may benefit from intervention, as many are fearful of being singled out while in the detached school environment.

In conducting my research, I came to appreciate the difficulty in generating themes from such varied experiences. I often felt that my insights did not do justice to the nuances of each individual story. I discussed this in a virtual meeting with a programme coordinator at ADFAM, a national charity that works with families affected by drugs and alcohol. Her experience, delivering interventions at an operational level, allowed me to see how my research fit into the real world. I came to understand that while research is conducted with the aim of applying findings to whole populations, these findings are only actionable when combined with existing knowledge and expertise. This discussion was a lesson in the value of cross-collaboration, an important tool in bridging the gap between research and intervention.

Over six weeks I have broadened my understanding of public health, conducted my own research project, developed my professional skills, and furthered my personal career goals. Although this internship took place remotely, my mentors enabled me to virtually meet various public health professionals. Hearing about their research roles, motivation and future plans has shown me the variety of career paths available within public health and helped to develop my own ambitions. The NIHR SPHR internship with Fuse has been a valuable personal and professional experience and I would recommend it to other students interested in pursuing a career in public health.

Part of our Fuse blog Student Series

The Fuse blog Student Series showcases posts by students who have been challenged to write a blog as part of their studies at one of the universities in the Fuse collaboration, the NIHR School for Public Health Research, or perhaps further afield. The authors may be new to blogging and we hope to provide a 'safe space' for the students to explore their subject and find their voice in the world of public health research.

Images:

1. 'Doctor with prescription stop drinking alcohol' by Marco Verch Professional Photographer via Flickr.com, copyright © 2019 (Attribution 2.0 Generic (CC BY 2.0)): https://m.flickr.com/photos/30478819@N08/48719845996

3. Logo courtesy of ADFAM https://twitter.com/AdfamUK/photo

Research on the go with women in walking groups

Posted by Stephanie Morris, Research Fellow, University of York

In this blog Steph reflects on the use of mobile ethnography in a recent study of the place of walking groups in the lives of women in deprived areas of north-east England.

Ethnography’s signature method, participant observation, or ‘hanging out’, provides rich data inaccessible by other forms of qualitative research. Mobile ethnography, as the name suggests, uses this methodology in the context of mobility. It can involve ‘go-along’ interviewing (See Carpiano 2008, Kusenbach, 2003) and participant observation as researchers travel and converse with participants.

When conducting research with women in walking groups, I found that mobile ethnography facilitated inclusivity and openness. For example, some women were interested in participating in the study, but uninterested in having a formal ‘sit down’ interview. So this approach opened up the study to those who might not usually opt to take part in research. Walking with study participants also enabled me to build rapport in a more ‘natural’ way than in a one-off interview, when the research and participant go in ‘cold’. Walking and talking, what the women did on the walks, encouraged free and open conversation: participants talked a lot to me about the intricacies of their lives, as they did with each other.

Mobile ethnography produces data which I feel is not likely to be created in static interview interactions. In ‘go along’ informal interviews, objects and embodied experiences along the route are often talked about. Conversations ranged from discussing fly tipping and historical features in the landscape, to sharing experiences of bodily sensations whilst walking in all weathers! Walking with the groups also provided a first-hand experience of the sense of safety and solidarity that comes with group walking. The following excerpt from my fieldnotes* shows an example of how this happened:

"As we walk along, Ashley who is in front of us by a few metres, points out that there is a hole in the path. She puts her stick down it and shouts to us to be careful of the hole. We do the same for the people behind us. Less than a minute later, Lisa says ‘step’, as there is a slight step in the hard soil and she is warning me about it. I do the same for the people behind me, and I get the feeling that I am being watched out for, and that I am instantly doing the same for the others."

Acts like this also quickly make the researcher feel part of the group, an insider participant-observer.

Despite its broad affordances, mobile ethnography is not without its challenges. The logistics of note taking when walking are tricky to say the least! I used the note function on a smartphone to take notes and took photographs along the route to remind me of encounters noteworthy of description. I walked with a Nordic walking group, which was even more difficult as I often had to carry the Nordic poles in one hand or clip and unclip at the group’s brief stops to quickly take notes of conversations or observations. However, as it was usual for people to walk alone for moments during walks, these times provided me with opportunities for note-taking. Conducting ‘go along’ formal interviews with a voice recorder was for the most part unproblematic; however, external noise was an issue at points near busy roads.

As with all ethnography, doing it well requires a lot of time and emotional labour. For instance, as transcribing fieldnotes is time intensive and needs to be completed as soon as possible after participating in the activity/group being studied, this task can clash with life’s other responsibilities. Likewise, as participants can become friends, research relationships and boundaries need to be carefully negotiated. And lastly, when using a method that helps to build rapport and relationships valuable for research, at the end of a project it can be difficult to say goodbye (and it was particularly hard to say goodbye to the many pleasures of group walking!).

There are many other contexts where mobile ethnography could contribute to health research, including but not limited to other physical activity and sustainable travel interventions. Why not give it a try?!

*Anonymised using pseudonyms

Struggling to see a way through your data? Try a different lens

Posted by Peter van der Graaf, AskFuse Research Manager / Fuse Knowledge Exchange Broker, Teesside University

“Having trouble analysing your qualitative data? Are you lost in the sheer amount of data you have collected and don’t know where to start?”

This was the strapline of a course at Kings College London last week, called ‘Ethnography Language and Communication’ and a big reason why I attend the summer school. Within my NIHR Fellowship research, I have collected big piles of observation notes, interview transcripts and meeting minutes and struggled to make sense of them. So did the course deliver?

Over five days, we were presented with a range of analytical tools borrowed from linguistics and applied to qualitative data (interview transcripts and video recording of job interviews and classrooms) with an ethnographic lens. In essence, this means trying to understand how meaning is constructed in social interactions by studying text and recordings generated from these interactions in fine detail. First from the perspective of the specific situation in which these texts were constructed, but with an explicit aim to make valid statements about the wider social structures in which these interactions are embedded.

The course leaders* have even come up with a name for this academic discipline: ‘linguistic ethnography’. Linguistic ethnographers acknowledge that texts are representations of social actions and, therefore, that to understand these texts you need to closely investigate the social interactions that produced them.

However, they also explore how these interactions are embedded in institutional contexts and are closely linked to social interactions elsewhere, both in time and location, adding a historic and place perspective. Sociological concepts of power, social class, inequality and identity feature eventually in these analyses but are not presumed and not used in the first instance. The specific context of the social interaction is initially key for understanding what is going on.

The course attracted speakers and participants from across the globe, including the UK, US, China, Spain, Germany, Austria, Belgium, Turkey, Israel and many more. This international gathering aligned nicely with the aims of the course: being highly interactional, working across different contexts with different types of data and approaches coming together to co-create a better understanding of their data.

Although we discussed many theoretical concepts, the course was also practical and gave us the opportunity to experiment with a range of analytical tools (or what Ben Rampton preferred to call ‘sensitizing concepts’): from micro-analysis (a form of Goffmanian conversation analysis: applying a dramaturgical lens (life is a stage!) to data interpretation) to discourse genres featuring The X Factor, multi-modal analysis (looking simultaneously at different modes of communication such as language, gaze and gestures), semiotic landscapes (e.g. how shop signs in neighbourhoods communicate change) and trans-contextual analysis (how text moves and changes across contexts and interactions). If you are confused by the plethora of terms and concepts, you feel exactly as we did during the course!

However, this was also the point: gaining experience of applying a range of tools that overlap or sometimes contrast with our data to find new insights that we wouldn’t otherwise have discovered. If it is helpful, use it; if not, try another tool or a combination of tools. In this sense, the course was very pragmatic. And this also applies to the role of being a linguistic ethnographer. You do not need to do X, Y and Z as a minimum, with a potential dusting of C to call yourself a linguistic ethnographer. Instead, you prescribe to a set of principles about the nature (social interaction), context (multi situational) and structure (institutional framing) of texts and recordings, that help you to choose from and apply an analytical toolkit.

Applying a different lens

Did it help me make more sense of the qualitative data I collected for my research project? No (at least not yet), but the course provided me with a starting point for analysis. It also helped me realise that trying to incorporate and do justice to all the data that I collected is simply not possible. Instead, applying a linguistic ethnographic lens to my data will help me to identify instances of text that signify social interactions that are critical for my understanding. This will ultimately help me to build an argumentative structure for my papers.

I will still need to go through all my qualitative data in detail but have a better sense of how to navigate this now.


*Ben Rampton, Kings College London; Adam Lefstein, Ben-Gurion University of the Negev; Jan Blommaert, University of Tilburg; Jeff Bezemer, University College London; and Julia Snell, University of Leeds