FREE ARTICLE: Please sign in or create a free account to access the leading collection of peer-reviewed work on ethnographic practice. To access video, Become an EPIC Member.
Refining Themes: Ethnographic Analysis
The data collected as part of the video ethnography was analyzed separately. To analyze ethnographic data, video clips were first uploaded to video management platform Big Sofa and translated. Multi-day analysis was then conducted online using an analytic framework that contained pre-determined questions to be answered/explored by each ethnographic task.
In South Africa, the local ethnographer, together with the Ipsos team, analyzed the footage and responses using an anthropological lens. Of particular note during this phase was participants’ experiences queuing up to access public healthcare, the experience in the queue itself, contrasted with other experiences of healthcare such as visiting the pharmacy, using traditional medicine etc. Further tasks probing deeper into healthcare experiences were discussed between local ethnographers and the Ipsos team, and were proposed to participants. This was to ensure the right questions were being asked and that the research was participant led.
After these final tasks were complete, the Ipsos team and local ethnographers collaboratively analyzed the new footage, responses from participants, and fieldnotes from interviews with the participants (conducted throughout the research process). Particular attention was paid to the cultural context of the participants, their family and community dynamics, as well as the relations between various actors within the healthcare system.
In Bangladesh, after the ethnographic phase was complete, the video footage as well as field notes from the interviews, and observations from the local ethnographer, were analyzed. Three internal analysis sessions took place, whereby an anthropological lens was applied to the findings with the intention of understanding how cultural context shapes and may determine understandings of health and relationships with healthcare systems.
Analysis Frameworks: Strand Framework and Mapping Journeys of Health Seekers
An affinity mapping or clustering approach was used for analyzing the data collected from the second round of design research as well. However, in this round, since refined themes had already been articulated, there were pre existing clusters to serve as starting points for the exercise. Two clear pathways emerged from this analysis, which led to the identification of Frictions and Design Principles, the core outputs of Project ARC.
Strand Framework
Over the past 15–20 years there has been widespread acceptance of the social determinants of health (Braveman, Egerter, & Williams, 2011). The World Health Organization (WHO) recognises a number of factors that can influence health in positive and negative ways (Social determinants of health, n.d.). These are:
- Income and social protection
- Education
- Unemployment and job insecurity
- Working life conditions
- Food insecurity
- Housing, basic amenities and the environment
- Early childhood development
- Social inclusion and non-discrimination
- Structural conflict
- Access to affordable health services of decent quality
To complement and build on these determinants, which are ostensibly conditions that influence the health of individuals as evidenced by over a decade of research, the Project ARC team sought to discover and develop the factors that health seekers themselves identify as constituent parts of their health. Our core line of inquiry here was, “what does health mean for individuals and communities”. Unsurprisingly the constituent parts of health we discovered are related to the social determinants of health, but unlike the social determinants of health, which are (or at least understood as) factors that influence health, the strands we discovered were, in many ways, for seekers, health itself. One of the key insights that emerged in ARC was that health seekers understand their own health in an expansive way. This understanding of health can be broken into constituent parts for analytical purposes but for health seekers, they are not discrete components that they consider individually but are more akin to an indivisible whole of entangled concerns that drive their perception of health. For Project ARC, this led to the Strand Approach of understanding health. The strands that we identified were:
- Physical health – the ability to perform the daily activities of one’s choice in the absence of illness.
- Emotional Health – the psychological and emotional wellbeing of an individual.
- Financial Health – the ability of a person or household to support and look after themselves.
- Social Health – the ability to create healthy and positive interpersonal relationships with one another to foster a supportive community.
- Spiritual Health – the feeling that an individual is living a meaningful life, in line with their moral code of conduct and belief system.
- Environmental Health – the ability to live in a safe, stable environment in which an individual can live their life the way that they choose to.
According to our findings these six strands come together to form a holistic perception of health among individuals and communities and stress on any of these strands is often seen as a stress on their overall health. The diagram below visualizes this approach as a rope consisting of strands.
Figure 9: Health Strands. Illustration © Project ARC.
Once the strand based approach was articulated, it formed a core component of further analysis, centering the concerns of health seekers and helping identify points of friction between the health system and the people who use it.
Health Seeking Journey Maps
Mapping a user’s journey as they use a product or a service is a critical design thinking tool (Design thinking bootleg, n.d.). In most design-led public health projects this would likely form an integral part of the methodology and would typically involve mapping journeys of health seekers as they access healthcare services – understanding the barriers and enabling factors in these journeys as well as seeker’s experiences through various points in the journey (Bartlett et al., 2022). After detailed health seeking journeys from participants were captured in Round B, visual journey maps were created for ease of analysis. The journey maps broke a health seeking journey into clear constituent parts, which were often inflection points in these journeys, such as, for example, a diagnosis. The refined themes, which were updated after the clustering exercise in Round B were used as lenses to conduct preliminary analysis of these journey maps. However, the most effective method of analysis emerged when the team began to leverage the Strand Approach to analyze the health seeking journeys. This approach led to the final outputs of Project ARC, which are described in the next section.
Figure 10. A sample of the journey mapping exercise. Screenshot © Project ARC.