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ANTH 56 RESEARCH METHODS IN MEDICAL ANTHROPOLOGY Summer 2008 Class Time: TU, TH 2A (2-3:50) X-hour: W 4:15-5:05 Office Hrs: TU 4-5; W. 9:30-11:30 Office: 404 Silsby Hall Co-Facilitator and Resource Person: Prof. Sienna R. Craig Tel. (603) 646-9356 Email: [email protected] Robert Whitley, PhD Psychological Research Center (PRC) DHMC ­ Lebanon, NH [email protected]

Course Overview This course will introduce students to the various methods cultural anthropologists and those in related disciplines have used to understand and study health, illness, health care, health-seeking behavior. The premier method of empirical research in the field of cultural anthropology involves participant observation, conversation, and interviewing. This method, part of what is often called "ethnography," has provided the discipline with most of its data and is the empirical basis for much cross-cultural study. In addition to participant observation, medical anthropologists have made use of a variety of other research methods to study issues directly relevant to health and illness, and relevant to effective provision of health care. Course Expectations, Organization, and Assignments A primary goal of the course is to provide students with an understanding of how to design and write a research proposal for a medical anthropology project. As a part of the formal course requirements students will undertake their own mini-ethnographic research projects as individuals or in small teams. As a part of these projects, students will become familiar with basic ethical issues such as informed consent, as well as with the mechanics and ethics of writing of research proposals, formulating research contracts, and sharing research results with cooperating individuals and groups. The course will present techniques for planning, formally proposing, and carrying out such research. Basic techniques for recording, storing, coding, analyzing, checking validity and reliability, and, very importantly, writing up of ethnographic data will be discussed. Because of concerns for the protection of research informants, nearly every institution has its own Institutional Review Board (IRB), whose job is to monitor all research involving human subjects. At Dartmouth, the official IRB is the Committee for the Protection of Human Subjects (CPHS). Because concerns about confidentiality, privacy, and informed consent are so central to all biomedical and medical anthropological research, a discussion of these ethical issues will be addressed throughout the term. Undergraduate students expecting to pursue the major in anthropology by means of socio-cultural research and thesis writing supported with departmental funding will find this course to be highly advantageous to their

study plans. Medical school students who plan for careers that involve clinical research will also find this introduction to qualitative, social scientific research methods invaluable. Conceptually, the course is divided into three parts. After a brief introduction to medical anthropological themes and key problems, we turn in the first part of the course to the question of ethics and the protection of human subjects. In the second part of the course students will receive a fast-paced summary of traditional ethnographic methods. A variety of field research techniques will be examined: (1) observation and participant-observation, (2) conversation, dialog and interviewing in natural settings and more structured contexts, (3) action research and participatory research methods (e.g. participatory mapping, collaborative inquiry) (4) recording, storing, coding, retrieving, analyzing, and checking the validity of qualitative data. In the third section of the course, students will be actively conducting research for their mini-ethnographies and then writing up results. We will spend some class time troubleshooting these field experiences and then presenting findings to the class. In each section of the course, we will discuss how anthropologists have approached studying a variety of problems related to health and illness, what kinds of data were produced, and the strengths and weaknesses of these methodologies. The first and second parts of the course will correspond roughly to Weeks 1-5; a full draft of ones mini-ethnographic proposal will serve as the midterm assignment for the class. The third part of the course will correspond to Weeks 6 through Exam Period. Throughout the term students will undertake small-scale "mini-ethnographic" studies. Some projects have been initially vetted by the instructor, and will be discussed on the first class meeting; others may emerge from a students own interests. Some possible sites for research projects include: The Good Neighbor Clinic The Upper Valley Haven Pregnancy Plus Program, DHMC The VA Hospital (working with providers) Hannah House The Norwich Farmers Market and/or Upper Valley CSAs Local Pharmacies (both biomedical and "complementary / alternative") Upper Valley churches or other religious organizations Life history projects with Upper Valley senior citizens Some of these sites will also include some volunteer work. Alternative sites are also acceptable, with permission of the instructor and relevant people at the site. In either the pre-established contacts or your own project, you will develop a small project individually or as a team that will involve participant observation, interviews, and other approaches to qualitative data collection and analysis. You will be expected to do at least 20 hours of fieldwork for this research project, and some class time will be devoted to fieldwork during the latter portion of the class. During the term every student will draft a research proposal and associated "expedited review" application materials for the CPHS at Dartmouth. While your class projects do not meet the requirements for actual IRB review, you will participate in an IRB / CPHS

certification program. The process of drafting a proposal and completing CPHS documents will be invaluable experience for those students who envision developing a fundable and actionable honors thesis research project in anthropology (or related disciplines). Throughout the term, readings will be a mixture of ethnographies that raise particularly salient methodological issues and articles / books on the ethics and mechanics of writing a proposal and doing research. Readings will begin heavily and then get lighter once you are actively engaging in your own research. I also list a number of recommended / supplementary readings that may be useful to you for your projects, or beyond the boundaries of this course.

Grades will be determined on the basis of the following:

1. A research proposal and "expedited review" submission for CPHS; equivalent to MIDTERM ­ 30% 2. A mini-ethnography of about 5000 words (excluding fieldnotes, interview transcripts, and a personal journal, pictures, diagrams, tables etc, all to be submitted during the final examination period, although these will also be turned in) ­ 50% 3. Completion of an ethnographic / methodological exercise, detailed in syllabus ­ 10% 4. Class participation ­ 10%

Academic Integrity and the Dartmouth Honor Principle

By participating in this course, you have affirmed that you will live up to the Dartmouth Honor Principle. You are here at Dartmouth to expand your knowledge of yourself and the world around you, to foster intellectual engagement with your instructors and your fellow students, and to push your creative and analytic abilities through whichever disciplines in which you choose to concentrate. As such, maintaining your academic integrity and protecting the intellectual property of both yourself and others is paramount. You are here to collaborate and also to develop original ideas and arguments, particularly in your written assignments. Plagiarism means the use of other people's intellectual property ­ their ideas and words ­ without properly acknowledging such sources, and claiming the ideas as your own. I take the issue of academic integrity seriously, and expect you to do the same, and to abide by the Dartmouth Honor Code. If you have questions about how to reference sources, please see Sources, Their Use, and Acknowledgement, available at: http://www.dartmouth.edu/~sources/.

Students with Disabilities

Students with learning, physical, or psychiatric disabilities enrolled in this course that may need disability-related classroom accommodations are encouraged to make an office appointment to see me before the end of the second week of term. All discussions will remain confidential, although the Student Accessibility Services office may be consulted to discuss appropriate implementation of any accommodation requested.

Religious Observances

I realize that some students may wish to take part in religious observances that fall during this academic term. Should you have a religious observance that conflicts with your

participation in the course, please come speak with me before the end of the second week of term to discuss appropriate accommodations. Required Texts and Supplementary Readings Below are the required and suggested texts for this course. The books are for sale at Wheelock Books and the Dartmouth Bookstore. All other supplementary articles are

listed in the weekly outlines and will be available as links or PDFs through Blackboard. Ethnographies

Dettwyler, Katherine A. 1995. Dancing Skeletons: Life and Death in West Africa. Prospect Heights: Waveland. Quinlan, Marsha, 2003. From the Bush: The Front Line of Health Care in a Caribbean Village. New York: Wadsworth. Latour, Bruno, 1987. Science in Action: How to Follow Scientists and Engineers Through Society. Cambridge, MA: Harvard University Press. [RECOMMENDED/SUPPLEMENTARY]

Methods Texts

Emerson, Robert, Rachel Fretz and Linda Shaw, 1995. Writing Ethnographic Fieldnotes. Chicago, IL: University of Chicago Press Dewalt, Kathleen and Billie Dewalt, 2002. Participant Observation: A Guide for Fieldworkers. Walnut Creek, CA. [RECOMMENDED / SUPPLEMENTARY] **We will read 2 chapters of this book. LeCompte, Margaret Diane, 1999. Designing and Conducting Ethnographic Research (Ethnographers Toolkit, Vol. 1). Walnut Creek, CA: AltaMira Press. [RECOMMENDED / SUPPLEMENTARY] There are other reference texts in this series. These texts are not required (though vol. 2 may also be useful to you in this class and beyond) but here is the Amazon link to the rest: http://www.amazon.com/Ethnographers-Toolkit-7-paperbackboxed/dp/0761990429/ref=pd_bbs_sr_1?ie=UTF8&s=books&qid=1211924833&sr=8-1 **Also please note, readings marked with [brackets] below are recommended / supplementary. They may also serve as good resources for you at a future date or in writing your proposal. They are not required reading for the day listed.

SCHEDULE OF READINGS, DISCUSSION TOPICS, AND ASSIGNMENTS

Week 1: Introduction to the Course

June 19 (Thurs) Readings:

Overview of the course; initial discussion of project ideas NONE

Week 2: What do Medical Anthropologists do? And, how, and why do they do it?

This week we will begin with a general overview of medical anthropology and discuss the kinds of questions medical Anthropologists have studied. We will use our reading and discussion of Katherine Dettwylers book Dancing Skeletons and selective supplementary readings, to ground this discussion. June 24 (Tues) Readings: What do we mean by "ethnography" and "qualitative research" and how are they applicable to human health and illness? - Dettwyler, Chs 1­7 - Pope C and Mays N (1995) Reaching the part other methods cannot reach: an introduction to qualitative methods in health and health services research. BMJ 1995: 311: 42-5 http://www.bmj.com/cgi/content/full/311/6996/42 - [Pelto, Pertti and Gretel Pelto, 1996. "Research Designs in Medical Anthropology." Medical Anthropology: Contemporary Theory and Method, C. Sargent and T. Johnson, eds. Westport, CT: Praeger, Ch. 15.] Rapport, Culture Shock, and "Fieldwork Terror" - Dettwyler, Chs. 8-14 - Moffat, Michael, 1989. Coming of Age in New Jersey: College and American Culture. New Brunswick, NJ: Rutgers University Press, pp. 1-22.

Link:

June 26 (Thurs) Readings:

Assignment: In-class discussion / brainstorming session for your projects.

Week 3: Key Anthropological Methods and Ethics

This week covers the premier method of ethnographic research in a general way and begins to focus participant observation on a few examples of Medical Anthropology problems. We will read our second ethnographic case study, Marsha Quinlans From the Bush.

**You should begin "hanging out" / volunteering at your project site this week.

July 1 (Tues) Readings:

What does it mean to be a ,,participant-observer? - Quinlan Chs. 4-6 - Emerson, Fretz, and Shaw Ch. 1 - Dewalt, Kathleen and Billie Dewalt, 2002. Participant Observation: A Guide for Fieldworkers. Walnut Creek, CA, Ch. 3-4

Link: July 3 (Thurs) Readings:

- [Mays N and Pope C (1995) Observational methods in health care settings. BMJ 311: 182-184.] http://www.bmj.com/cgi/content/full/311/6998/182 IRBs, Informed Consent, Risk, and Subjects Guest Lecture / Workshop by Ann O'Hara, Dartmouth CPHS - Quinlan, Chs. 1-3 - Adams, Vincanne, Suellen Miller, Sienna Craig et al, 2007. "Informed Consent in Cross-Cultural Perspective: Clinical Research in the Tibet Autonomous Region, PRC." Culture, Medicine and Psychiatry 31(445-472). http://www.springerlink.com/content/r63361776q256k84/fulltext.pdf - [Thomas S B and Quinn S C (1991) The Tuskegee syphilis study 1932-1972. Implications for HIV education and AIDS risk education programs in the black community. American Journal of Public Health 81: 1498-1505]

Link:

Link: http://proquest.umi.com/pqdweb?did=2737633&sid=3&Fmt=2&clientId=4347&RQT=30 9&VName=PQD Assignments: - Hand out Advanced Transit Observation Exercise (Due Tues. July 8)

Week 4: Research Methods ­ Session 1

This week we continue our discussion of what it means to be a ,,participant observer and begin a systematic investigation into the ways we can train ourselves to listen, observe, and record our observations as qualitative researchers. We will also begin a discussion of qualitative interviews, to be continued next week. July 8 (Tues) Readings: July 9 (Wed) X-hour July 10 Readings: Entering "The Field" and Writing Fieldnotes - Quinlan Chs. 7-9 - Emerson, Fretz and Shaw, Ch. 1-2 Individual meetings with Prof. Craig about research projects More on Fieldnotes, Participant Observation, and Interviews - Emerson, Fretz and Shaw, Chs. 3-4 - Rubin, Herbert and Irene Rubin, 2005. Qualitative Interviewing: The Art of Hearing Data, 2nd Edition. Thousand Oaks, CA: Sage Publications, Ch. 6-7

Assignment: In-class group discussions of participant observation / fieldwork experiences thus far.

Week 5: Research Methods ­ Session 2

This week we will focus on qualitative interviews (formal and informal) and life history.

July 15 (Tues)

Research Questions and Life Histories - Charmaz, "The Grounded Theory Method" in IN R. Emerson, ed. Contemporary Field Research: Theory and Method, 2nd Ed. Long Grove, IL: Waveland Press, pp 335-352Readings: - Cole, Arda and J. Gary Knowles, 2005. Lives in Context: The Art of Life History Research. Walnut Creek, CA: AltaMira Press, Ch. 3-4 - Miller, Robert, 2000. Researching Life Stories and Family Histories. Thousand Oaks, CA: Sage Publications, Ch. 2.

Assignment: In-class workshop on developing your research question. July 16 (Wed) X-hour Individual meetings with Prof. Craig about research projects July 17 (Thurs) Readings: Link: Cognitive Maps and Knowledge Networks - Cravey, Altha et al 2001. Developing socio-spatial knowledge networks: a qualitative methodology for chronic disease prevention. Social Science and Medicine 52: 1763-1775. http://dx.doi.org/10.1016/S0277-9536(00)00295-1 OR - Thompson, Lisa, et al 2007. Nxwisen, Ntzarrin or ntzo'lin? Mapping childrens respiratory symptoms among indigenous populations in Guatemala. Social Science and Medicine 65(7): 1337-1350. http://dx.doi.org/10.1016/j.socscimed.2007.05.018

Link:

Assignment: In-class workshop on developing your research proposal.

Week 6: Research Methods ­ Session 3

This week and next we will continue our discussion of research methods, with a specific focus on focus groups and other more participatory research methods. JULY 21 (MON) July 22 (Tues) Readings: RESEARCH PROPOSAL AND CPHS PAPERWORK DUE More on Qualitative Interviews Facilitated by Rob Whitley - Groleau, Danielle, Allan Young and Laurence Kirkmayer, 2006. "The McGill Illness Narrative Interview (MINI): An Interview Schedule to Elicit Meanings and Modes of Reasoning Related to Illness Experience." Transcultural Psychiatry 43(4): 671-691. - [Britten N (1995) Qualitative interviews in medical research. BMJ 311: 251-253.] http://www.bmj.com/cgi/content/full/311/6999/251

Link:

July 24 (Thurs) Readings: Link:

Focus Groups Facilitated by Rob Whitley and Ms. Vernon (Frances's mom) - Kitzinger J (1995) Introducing focus groups. BMJ: 311: 299-302 http://www.bmj.com/cgi/content/full/311/7000/299 - Mason, Karen et al. 2004. "Exploring the Consumers and Providers Perspective on Service Quality in Community Mental Health Care." Community Mental Health Journal 40(1): 33-46.

Week 7: Research Methods ­ Session 4

This week we will explore some of the methodological and philosophical approaches generally called "Action Research" ­ including the ways such approaches are premised on social action and social change agendas. We will also explore some of the ways these approaches can be applied to health-related problems. July 29 (Tues) Readings: (Participatory) Action Research - Greenwood, Davydd and Morten Levin, 1998. Introduction to Action Research: Social Research for Social Change. Thousand Oaks, CA: Sage Publications, Part 2, pp. 51-125. Collaborative Inquiry, Research Ethics, and Social Change - Fluehr-Lobban, Carolyn, 2003. "Dialogue for an Ethically Conscious Practice," IN Ethics and the Profession of Anthropology, 2nd Edition, Walnut Creek, CA: AltaMira Press, pp. 225-243.

July 31 (Thurs) Readings

Week 8: Coding, Interpreting, and Evaluating Data

This week we will begin to discuss what you do with data once youve collected it, and as you take stock of what youve collected thus far, to guide further data collection. You will be given a chance to begin debriefing and troubleshooting your own field experiences. Aug 5 (Tues) Readings: Link: Reviewing Fieldnotes and Coding Data - Emerson, Fretz and Shaw, Chs. 5-6 - Pope C, Ziebland S and Mays N (2000) Analysing qualitative data. BMJ 320: 114-116. http://dx.doi.org/10.1136/bmj.320.7227.114

Aug 6 (Wed) X-hour Qualitative Software ­ Introduction to Atlas/Ti WORKSHOP Facilitated by Rob Whitley Aug 7 (Thurs) Readings: Evaluating and Interpreting Data - Silverman, David, 2005. "Analyzing Talk and Text." IN Denzin, Norman and Yvonna Lincoln, eds. Sage Handbook of Qualitative Research, 3rd Edition. Thousand Oaks, CA: Sage Publications, pp. 869886. - Malterud K (2001) Qualitative research: standards, challenges, and guidelines. Lancet 358: 483-88.

Link: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=4984151&site=ehostlive

Week 9: Writing Up Results

This week we will revisit different ways to tell an ethnographic story and discuss a variety of models for writing up your own research findings (narratives, methods, results, discussions, etc.) Aug 12 (Tues) Readings: Aug 14 (Thurs) Readings: Narrative Representations and Storytelling - Emerson, Fretz and Shaw, Ch. 7 Discerning "Results" and Delimiting "Discussion" - Emerson, Fretz and Shaw, Ch. 8

Week 10: Wrap Up and Presentations

Aug 19 (Tues) Readings: Aug 20 X-hour Readings: Aug 24 Research Presentations NONE Research Presentations NONE FINAL ETHNOGRAPHY (plus related materials: fieldnotes, images, etc.) DUE 4PM

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