Interpretive Description

Sally Thorne

• Publisher: Routledge
• Year: 2016
• Print ISBN: 9781598743302, 9781598743296
• eBook ISBN: 9781315426235
• Edition: 1
• Topic: Psychology
• Subtopic: Research & Methodology in Psychology
• Index: Psychology

This book is designed to guide both new and more seasoned researchers through the steps of conceiving, designing, and implementing coherent research capable of generating new insights in clinical settings. Drawing from a variety of theoretical, methodological, and substantive strands, interpretive description provides a bridge between objective neutrality and abject theorizing, producing results that are academically credible, imaginative, and clinically practical. Replete with examples from a host of research settings in health care and other arenas, the volume will be an ideal text for applied research programs.

Part I
Interpretive Description in Theory

Chapter One
Qualitative Research in the Applied Disciplines

Theorizing and Application

Several years ago I had the experience of engaging in a week-long intensive workshop with a group of academics, composed roughly equally of social scientists and health professional researchers. Although everyone was highly enthusiastic about the topic of discussion (it happened to be genetics and ethics), fundamental schisms began to form quite early in the week between the two groups, such that by the end of the time there seemed an insurmountable impasse. Essentially, for the clinician researchers, the entire point of questing for knowledge was to apply it to real human beings caught in complex and difficult human health problems so that their quality of life could be improved in some manner. For the social scientists, the point of knowledge development was theorizing, and the idea that people would put their ideas to use prematurely was an anathema. While I am well aware that many clinicians theorize and many social scientists do applied work, it seemed that the extreme situation of the workshop had revealed a polarizing tendency that I had not previously appreciated in its fullness. In the context of our interprofessional, multidisciplinary health research world, especially within the qualitative research community, it becomes easy to forget that we do represent distinct disciplines with very different origins and intellectual objectives. After all, we are all friends, working together on projects that are of common interest, and we are all trying to make a better world. We all think of ourselves as enlightened individuals, free thinkers capable of drawing on the ideas and insights of a universe of disciplinary orientations. However, this workshop experience humbled me into grappling with the extent to which we are what we study, and caused me to recognize anew the extent to which the disciplinary traditions into which we are educated shape the angle of vision we take into all of our multidisciplinary activities.

Much of the fine tradition of qualitative health research derives from those social sciences, especially anthropology, sociology, and psychology, from which have evolved such widely known methods as ethnography, grounded theory, and phenomenology (Hamilton, 1994; Vidich & Lyman, 1994). It is therefore important to understand that the intended trajectory of new knowledge in these disciplines is enacted primarily through careful theorizing (Berger & Luckman, 1966; Che-nail, 1992; Durrenberger & Thu, 1999; Porter & Ryan, 1996). Anthropology documents and interprets human variations toward enhancing our grasp of what may be universal about being human. Sociology concerns itself with working out the way human nature is manifest in social behavior. And psychology seeks to understand the workings of the human mind, with the social psychology subgroup particularly concerned with the manner in which it plays out in the ways we engage with one another. Although within each of these disciplines there are subspecialists working in an applied “real world” context, the origin of the discipline within human philosophical curiosity ensures that its scholarship remains solidly grounded in theoretical and empirical rather than practical problems (Reason, 1996; Reason & Torbert, 2001; Thorne, 2001).

Applied to the study of health issues, then, the fundamental point of social science research is not to solve everyday problems of patients, but to capitalize on health phenomena to answer problems of a more elemental nature related to understanding how social groups behave and what constitutes the core nature of human experience. To illustrate, there exists a strong sociological tradition of studying epilepsy as a prototypical lens through which to learn more about the workings of social stigma (Goffman, 1968; Scambler & Hopkins, 1990; Schneider & Conrad, 1980). While such work constitutes fine social theorizing and can inform us about the “nonclinical” world in which health and illness are played out, health care professionals and planners would clearly be remiss in assuming this constitutes evidence that epilepsy produces more problematic social disclosure issues than do other chronic diseases.

In direct contrast, applied science within the health disciplines takes its nourishment directly from the clinical context (Chenail, 1992; Miller & Crabtree, 1994). Certainly the applied health disciplines theorize, and often brilliantly so, but when they do, they tend to do so because of a hope that theorizing will produce better application. Essentially, it is in the nature of the clinician to see the human client at the end of the theorizing—to envision the need out there in the world and to want to strive as quickly as possible toward meeting it. In contrast, it is in the nature of the social scientist to see the theorizing as a legitimate and worthy goal in and of itself, and sometimes to see the human being and his or her plight as an opportunity to advance that theorizing. I’m purposefully being extreme here, but I believe that the distinction becomes an important one when it comes to grasping why it is that conventional social science methods cannot advance clinical knowledge in quite the manner that the applied health disciplines require, and why different approaches to discovery are sometimes needed.

The Nursing Example

For those who are not members of the tribe, nursing is a complex and “messy” discipline, having developed on the basis of a common, universal requirement to care for the sick within society and having grown up in partnership with its scientifically oriented cousins in clinical medicine. It has weathered the additional storms of gender bias and economic disadvantage, and has come through a period of political awakening in which it thought of itself primarily as an oppressed group within professional society. It has grappled with what it considers itself—a (quasi-religious) “calling,” an occupational group, or a profession—and whether it does or does not possess a distinctive scientific basis apart from medicine and its related health sciences. Further, for much of its modern history, it has attempted to resolve these matters through theorizing, an activity that has often seemed an uncomfortable bedfellow with its practice aims.

However frustratingly problematic the nursing discipline may be, it is also exquisite in its complexity and its purity of purpose. And it is these properties that are important in understanding why nursing’s need for knowledge would drive a quest for new methodological options (Dzurek, 1989; Reed, 1995; Sidani, Epstein, & Moritz, 2003; Thompson, 1985; Watson, 1995). Nursing always and inherently requires knowledge about patterns and themes within people in general so that it can better inform the care of the unique and distinct individual. For nursing, knowledge always evolves in dialectic. The care of any individual patient inherently involves examination of the interplay between objective and subjective information, such that technical information about the hip replacement procedure that is about to take place is carefully tempered by the distinctive humanity of the person who is entering that experience. As you discover things about an individual patient, these inform your interpretation and uptake of the available knowledge, which includes not only formal evidence, but also shared clinical wisdom, pattern recognition, established practice, ethical knowledge, and the “how to” of artfully putting all of those together into competent practical application (Johnson & Ratner, 1977; Liaschenko, 1997). You draw upon an amazing array of knowledge sources, sorting and organizing those knowledge options according to a conceptual framework that derives from the philosophical understanding of why we nurse, and on the basis of that organized knowledge you create applications tailored to the specific patient before you today. Even if you are applying a standardized intervention for a health problem you have encountered hundreds or thousands of times before, nursing holds dear the notion that this particular individual may be the one who requires a new twist, a new adaptation, in order to achieve his or her optimal level of health. And this marvelous tension between the general and the particular characterizes the inherent complexity of nursing’s intimate relationship with knowledge development.

Of course, nursing’s praxis orientation—that dialectic between practice and knowledge—is not unique, and other applied disciplines certainly share many of the same qualities and draw upon many of the same historical thought traditions (Maxwell, 1997). However, nursing is so utterly steeped in them, and they are so central to the core business of the discipline, that forms of knowledge capable of shedding light on that dialectic between conceptualization and action have tremendous value within the everyday practice world. Thus, nursing’s comfort within the world of complexity and contradiction, its enthusiasm for ways of thinking that acknowledge the messiness of the everyday practice world, help explain why it would take a lead in what has become a generation of methodological development within the applied qualitative health research field.

Methodological Ancestry

Interpretive description is an approach to knowledge generation that straddles the chasm between objective neutrality and abject theorizing, extending a form of understanding that is of practical importance to the applied disciplines within the context of their distinctive social mandates. It responds to the imperative for informed action within the admittedly imperfect scientific foundation that is the lot of the human sciences.

The methodological form that grew into what is now called interpretive description arose from a need for an applied qualitative research approach that would generate better understandings of complex experiential clinical phenomena within nursing and other professional disciplines concerned with applied health knowledge or questions “from the field.” Disentangling methodological strategies from the theoretical assumptions associated with the original social science disciplinary projects for which many of the conventional qualitative research approaches were originally intended, interpretive description reflected the challenge of retaining the coherence and integrity of a theoretically driven approach to knowledge development while supporting defensible design variations according to the specific features of context, situation, and intent. In so doing, it emphasized research design logic as a hallmark of excellent qualitative description of phenomena of concern to the health and applied professional disciplines.

I first wrote about the need for an alternative to the conventional qualitative approaches for applied health research in 1991. At that time, qualitative researchers in the health field were still quite defensive about the quality of their contributions, and tended to rely quite heavily on “established methods” from the social sciences in order to lend credibility to their empirical contributions. Not only did it seem requisite to “locate” oneself within a particular methodological tradition, naming the particular theorists upon whose work one was building, but also one was expected to follow the associated rule structure meticulously (Bartolomé, 1994; Janesick, 1994). However, consideration of the disciplinary projects from which the available methodological traditions derived makes it evident that those rule structures had clear and explicit origins within certain assumptions about knowledge and its creation that were not necessarily applicable (and, at times, in direct contradistinction) to scholarship in the applied context.

As the informed reader will immediately recognize, the disciplines to which I refer and the methodological traditions that have evolved from them over many generations are extensive, complex and multi-faceted. They have taken up the working lives of armies of scholars and warranted millions of pages of thoughtful text. In providing a very brief synopsis of each of these fields, I invariably do a great injustice to the integrity of their traditions within the intended context. However, it seems necessary to provide some comment on what these traditions entail before it begins to make sense why I believe that they can’t and don’t work as primary research methods for applied health and professionally motivated knowledge generation.

Ethnography Ethnographic methods as we know them today have evolved over the past century or so as anthropology has attempted to unravel the mysteries of the nature of human existence through careful study of its diverse expressions. Emerging a century ago out of the dominant perspective that “primitive” cultures revealed something of the evolutionary heritage of modern humankind, the ethnographic tradition celebrates human cultural variation as a window into understanding the logic of social organization, cognitive function, and human complexity (Howard & McKim, 1983). It does this through decoding the specific elements of human experience that emerge within the contextual whole of a culture (Sanday, 1983).

In ethnography, direct observation of human behavior and interviewing participants about the meaning of that behavior form central mechanisms for ensuring that the cultural actor’s perspective will inform the researcher’s analysis. Although scholars have differed on the matter of the extent to which the cultural actor’s emic view illuminates or blinds us to the more complete etic view of a culture (Hammersley & Atkinson, 1983; Kaplan & Manners, 1972; Pelto, 1970; Van Maanen, 1988), most agree that, with the majority of anthropologists themselves the product of a dominant western perspective, a fairly profound degree of relativism has characterized the ethnographic tradition (Hammersley & Atkinson, 1983).

Grounded Theory Grounded theory is an approach whose origins are attributed to the early collaboration between Barney Glaser and Anselm Strauss (Glaser & Strauss, 1967). Reflecting solid sociological origins, its intricate methodological direction derived from the fundamental assumption that human behavior can only be understood within a “collective consciousness” to which the members of the group have no conscious interpretive access (Bowers, 1988; Heller, 1986). Sociology itself arose out of the project of anthropology, with which it was originally closely allied (Strauss, 1987). It departed from the ethnographic enterprise in the extent to which knowledge about the meaning of social behavior is accessible to direct inquiry methods at the local level. Where key informants might provide the anthropologist with the basis upon which to interpret the meaning of certain characteristic behavioral patterns within a society, sociologists felt that the naturalistic and relativistic bias of consciously accessible information was more likely to distract scholars from grasping the underlying network of social structures within which the patterns begin to make larger sense. This distinction between perspectives on whether people’s own subjective interpretations of their actions are or are not likely to be accurate in the wider scheme of things is a fundamental feature of the distinct methodological distinctions between grounded theory and its predecessors.

Since the vast majority of sociological activity occurs at the level of understanding the interaction between societies and the individuals who compose them (Outhwaite, 1975; Schwartz & Jacobs, 1979), the objective of sociological research was to understand those social forces that shape human activity (Schatzman & Strauss, 1973). While sociologists might participate in field research in a manner that was somewhat akin to ethnographic study, analysis was firmly located at the dialectic between micro and macro levels (Cicourel, 1981; Fielding & Fielding, 1986). Thus, the products of sociological inquiry using grounded theory are explicitly theory building, in contrast to the ethnographer’s pursuit of documenting what sense people make of how they are structuring their world or the phenomenologist’s efforts to render articulable those essential elements of subjective human experience that are beyond the reach of normal discourse.

Phenomenology As a methodological derivation of a philosophical stance on fundamental questions of ontology (the nature of being) and epistemology (the nature of knowledge), phenomenology seeks to understand the essential nature of a thing, or those dimensions “without which it would not be what it is” (Van Manen, 1990, p. 10). Phenomenology holds as a central value the premise that the most basic human truths are accessible through the understanding of human subjective experience (Burch, 1989; Cohen, 1987; Giorgi, 1970). Phenomenologists strive to work through the filter of human thinking to obtain knowledge of the deeper essential structure of what it means to be human. “It is the methodology through which I come to understand myself as that ego and life of consciousness in which and through which the entire objective world exists for me, and is precisely as it is” (Husserl, 1929/1975, p.8). As such, within the phenomenological tradition, all knowledge is an interpretation, inevitably made through “exteriorization” of life and reflection upon the effects it produces on others (Ricoeur, 1981b). Phenomenological approaches to research draw on an empathic understanding through sympathetic introspection and reflection—a tradition known as verstehen (Patton, 1980). As such, it promotes a fascination for the places of contact between the person and his or her reality (Van Kaam, 1966), especially as brought to expression through linguistic form (Gadamer, 1975/1985; Schutz, 1932/1967). An inherent paradox within phenomenology is that, by generating human consciousness of a truth that is already manifest within the intelligibility of human experience, that truth inevitably changes (Burch, 1989).

Departure and Diversification

In keeping with the disciplinary projects for which they were invented, ethnography, grounded theory and phenomenology spawned complex procedural rules regarding the use and application of their various approaches to inquiry. So, for example, ethnographers developed a set of traditions as to what constitutes fieldwork, and the extent of immersion required in order to make credible claims about a culture. Grounded theory scholars developed rule structures relating to maximal variation of sample, theoretical saturation, and various layers of essential coding. Similarly, phenomenologists developed technique for bracketing prior knowledge, and meticulously distinguishing interpretation from explanation. Because the conclusions a scholar within these disciplines might reach were entirely dependent upon the integrity of the method by which he or she arrived at them, rigid attention to methodological tradition became a primary hallmark of credible qualitative science. While numerous methodological derivations and refinements emerge annually, this adherence to recognizable tradition has remained an important dimension of the scholarly approach to evaluating quality.

When nursing and other health sciences began to take up qualitative methods, this methodological “purity” was generally regarded as essential for rendering qualitative work meaningful within the larger academic health research context. Most of the well-known pioneers in qualitative health research had solid academic grounding within one or another of the traditions, commonly through the socialization of doctoral training. The methodological detail within their written reports made explicit the genealogical heritage they were...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• CONTENTS
• Foreword
• Preface
• PART I • INTERPRETIVE DESCRIPTION IN THEORY
• PART II • INTERPRETIVE DESCRIPTION IN PROCESS
• PART III • INTERPRETIVE DESCRIPTION IN CONTEXT
• References
• About the Author
• INDEX