A scoping review of the use of ethnographic approaches in implementation research and recommendations for reporting

Abstract

Background: Researchers have argued for the value of ethnographic approaches to implementation science (IS). The contested meanings of ethnography pose challenges and possibilities to its use in IS. The goal of this study was to identify sources of commonality and variation, and to distill a set of recommendations for reporting ethnographic approaches in IS. Methods: We included in our scoping review English-language academic journal articles meeting two criteria: (1) IS articles in the healthcare field and (2) articles that described their approach as ethnographic. In March 2019, we implemented our search criteria in four academic databases and one academic journal. Abstracts were screened for inclusion by at least two authors. We iteratively develop a codebook for full-text analysis and double-coded included articles. We summarized the findings and developed reporting recommendations through discussion. Results: Of the 210 articles whose abstracts were screened, 73 were included in full-text analysis. The number of articles increased in recent years. Ethnographic approaches were used within a wide variety of theoretical approaches and research designs. Articles primarily described using interviews and observational methods as part of their ethnographic approaches, though numerous other methods were also employed. The most cited rationales for using ethnographic approaches were to capture context-specific phenomena, understand insiders’ perspective, and study complex interactions. In reporting on ethnographic approaches, we recommend that researchers provide information on researcher training and position, reflect on researchers’ positionality, describe observational methods in detail, and report results from all the methods used. Conclusion: The number of IS studies using ethnography has increased in recent years. Ethnography holds great potential for contributing further to IS, particularly to studying implementation strategy mechanisms and understanding complex adaptive systems. Plain language summary: Researchers have proposed that ethnographic methods may be valuable to implementation research and practice. Ethnographic approaches have their roots in the field of anthropology, but they are now used in many fields. These approaches often involve a researcher spending time in “real-world” settings, conducting interviews and observation to understand a group of people. That said, researchers disagree on the meaning of ethnography, which presents a challenge to its use in implementation science (IS). We searched for articles in the field of IS that described their methods as ethnographic. We then reviewed the articles, looking for similarities and differences in how and why ethnographic approaches were used. Many of these articles said they used ethnographic methods because they were interested in issues like context, research participants’ views, and complex interactions. We found a large amount of variation in how ethnographic methods were used. We developed recommendations for describing ethnographic methods in a way that readers can clearly understand. We also made several observations of the value ethnographic approaches can bring to IS. Ethnographic methods may be especially useful to studying unplanned and unexpected changes that take place during implementation. These recommendations and observations could be helpful to implementation researchers wishing to use ethnographic methods.

Oilcloth sessions as an implementation strategy: a qualitative study in Denmark

“…Interviews alone would not have made it possible to obtain many of these insights. Gertner et al [ 81 ] advocate using ethnographic approaches in IS because they believe these methods are particularly well suited to capture contextual factors and to incorporate the perspectives of end users in implementation processes. By combining the methods, the reliability of the results is enhanced by cross-checking information and returning to the same topic in different circumstances and by comparing statements with observations [ 77 ].…”

Understanding dynamic complexity in context—Enriching contextual analysis in implementation science from a constructivist perspective

“…Case studies are often conducted within ethnographic approaches, which seem to be well-suited to study the complex and dynamic interactions between context, implementation and intervention (56,101,102). Ethnography is a theorydriven approach, providing a detailed description of diverse agents, their behaviors and interactions in everyday practice, as well as how agents make sense of the context based on their norms, values, beliefs and roles [27, p.148, 102].…”

Research and scholarly methods: Implementation science studies

“…For successful and meaningful evaluation of IS studies, it is critical to develop outcomes measures from multiple stakeholder perspectives (eg, what matters to leaders vs clinicians vs patients) that consider representativeness and to collect a combination of quantitative and qualitative data. [77][78][79][80] Finally, there are resources and repositories that can support identification of IS measures. These include the SIRC Instrument repository, 81,82 the Grid-enabled Measures IS workspace, 83,84 and the IS policy measures database by Washington University in St. Louis.…”

“…In this paper, we highlight only one and encourage the reader to explore additional guidance from other publications. For successful and meaningful evaluation of IS studies, it is critical to develop outcomes measures from multiple stakeholder perspectives (eg, what matters to leaders vs clinicians vs patients) that consider representativeness and to collect a combination of quantitative and qualitative data 77‐80 . Finally, there are resources and repositories that can support identification of IS measures.…”