Research Methods in Health Communication

Principles and Application

Bryan B. Whaley, Bryan B. Whaley

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781136294440
• Edition: 1
• Topic: Langues et linguistique
• Subtopic: Études sur la communication

This volume provides an essential roster of primary research methods as they apply to health communication inquiry. Editor Bryan B. Whaley brings together key health communication researchers to write about their primary methodological areas. Their chapters offer guidance and insights for a variety of approaches to answering research questions. The methods included here cover:

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• Exploration and Description: interview/focus groups, case study, ethnography, and surveys;

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• Examining Messages and Interpersonal Exchanges: narrative analysis, conversational analysis, analyzing physician-patient interactions, social network analysis, and content analysis;

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• Causal Explication: experimental research, meta-analysis, and meta-synthesis; and

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• Cultural, Population, and Critical Concerns: rhetorical methods and criticism, and methodological issues when investigating stigmatized populations, and groups with health disparities.

Chapters cite or use examples from allied health areas -- nursing, public health, sociology, medicine -- to demonstrate the breadth of health communication studies.

This work highlights the importance of methodology in health communication research in multiple contexts. Developed to provide a fundamental reference for investigating health communication, this volume will serve as an invaluable tool for researchers and students across the social science and health disciplines.

Examining Messages and Interpersonal Exchanges

Narrative Inquiry

Attitude, Acts, Artifacts, and Analysis

Jill Yamasaki, Barbara F. Sharf, and Lynn M. Harter

“I am led to the proposition that there is no fiction or nonfiction as we commonly understand the distinction: there is only narrative.”

E. L. Doctorow (1977, p. 231)

When Mr. Nelson, an 80-year-old widower, arrived by ambulance at the shock trauma unit, he had a collapsed lung, shattered pelvis, seven broken bones, multiple abrasions—and the remains of a leather leash clenched firmly in his hand. His distraught family explained he was walking his beloved dog, Patch, when a car hit them in the middle of a crosswalk near his home. The car continued forward, dragging Patch and Mr. Nelson, who refused to let go of the leash until, finally, it snapped.

When Dr. Duke, a 30-year veteran of the unit who “lives and breathes medicine and the hospital,” met the ambulance, he saw an elderly, physically broken patient in emergent need. Mr. Nelson was alert but largely unresponsive, looking at Dr. Duke and trembling only when they gently pried the leash from his fingers. “What happened to the dog?” Dr. Duke asked the waiting family, later explaining he had a hunch it was worth asking. The family said Patch was alive, having only suffered minor scrapes, and safe with a neighbor who found him at the scene of the accident. “I’ve got to get this guy into surgery, and we’ve got to get this dog down to the hospital,” Dr. Duke told a nurse.

When Donna, the co-founder of PAWS Houston, met Mr. Nelson’s neighbor with Patch in the hospital lobby hours later, she learned that Patch had been inconsolable since the accident. He wouldn’t eat, paced nonstop, and let out frequent sorrowful cries. Donna escorted the neighbor and Patch to the hospital’s critical care unit, where a still-despondent

Mr. Nelson was recovering after the first of multiple surgeries. There, Donna watched as Patch, a 55-pound husky, gingerly crawled up the bed and nestled at his master’s side. Moments later, Mr. Nelson visibly softened when he saw the companion he thought he’d lost, and he lifted his hand to pat Patch’s head. They stayed that way together for an hour, when Dr. Duke returned to see his patient. “There are forces there between people and their dogs that I firmly believe we don’t know and will never know,” mused Donna out loud. “That may be,” replied Dr. Duke, “but I know one thing. Not all caregivers are human.”

We feel it particularly fitting to begin a chapter that explains narrative inquiry as a particular approach to health communication research with a story. Not just any story, but one carefully crafted from field notes, detailing informal tales told in ordinary conversations about extraordinary circumstances. It’s the kind of material that often comes up in interactions with research participants, that powerfully makes a point, with meanings that remain with readers or listeners.

The initial story of Mr. Nelson and his beloved companion, Patch, as well as additional participant voices, photographs, and research design issues used throughout the chapter to illustrate our explanations come from an ongoing narrative project conducted by Jill (first author) and a team of graduate students in collaboration with PAWS (Pets Are Wonderful Support) Houston¹. PAWS Houston is a volunteer-driven nonprofit organization dedicated to preserving the human–animal bond between people and their pets during periods of hospitalization for chronic and/or terminal illness. Its unique personal pet visitation program is available to all patients, except those in bone marrow units, through all major hospitals comprising Houston’s Texas Medical Center, the largest medical complex in the world. PAWS Houston volunteers facilitate approximately 25 personal pet hospital visits each month, with more than 85 percent of those visits occurring in critical care. Visits require a physician’s order, are usually arranged within 24 hours (or in as little as 30 minutes in end-of-life situations), and normally last about an hour.

In this chapter, we provide an overview of narrative inquiry with particular emphasis on the attitude of the analyst and the ubiquity of narrative material in a wide variety of discursive acts and verbal/visual artifacts for narrative analysis. To exemplify narrative inquiry in health communication research, we draw from and highlight the narrative work of multiple scholars (including our own), making sure throughout to acknowledge the method’s strengths and challenges. First, we examine narrative as an orientation toward the study of social phenomena and detail the variety of sources available to and co-constructed by narrative scholars. Then, we discuss several alternative ways of anchoring and shaping analyses from a narrative perspective. As part of this discussion, we demonstrate how narrative analysis may proceed, using two brief excerpts from the PAWS Houston project. We conclude the chapter with an acknowledgment and appreciation of narrative inquiry as an ultimately dialogic practice.

FIGURE 6.1 Patient and Dog

Seeking, Constructing, and Attending to Stories

Narrative inquiry entails a deliberate inclination to seek out and discern the storied elements within human depictions of life events to understand and convey inherent meanings. The search for coherency or sense making in a complex, confusing, ever-evolving, globalized world seems pervasive. References to narratives that frame events, including those that are problematic or discordant, occur in all kinds of commonplace activities—political debates, international diplomacy, cultural gatherings, religious rituals, social and commercial marketing, artistic renderings, family relationships, and, not least among these, interactions pertaining to healthcare, illness, and well-being. Thus, narrative inquiry also requires an aesthetic spirit, or the “boldness of the imagination,” which physician and literary critic Rita Charon (2006) describes as “the courage to relinquish one’s own coherent experience of the world for another’s unexplored, unplumbed, potentially volatile viewpoint” (p. 122).

As an approach to health communication research, narrative inquiry is enacted through study objectives and design, and particularly the ways in which data are elicited. Investigators with an attitude open to narrative sensibilities consider both the acts of making stories and the resulting textual artifacts as important areas of study. While conceptualizing and implementing their research project, this chapter’s first author, Jill, and her students purposefully oriented to narrative (i.e., attitude). They recognized the narrative logics guiding the PAWS Houston personal pet hospital visitation program, posited overarching research questions regarding inherent and resulting narrative practices in the medical care that incorporates these visits, and invited stories from patient families, healthcare providers, and volunteers during informal interactions, semi-structured interviews, and participant observation. These relational acts yielded a variety of material artifacts for analysis, including transcribed interviews, field notes, and journals documenting their experiences as trained volunteers who facilitated pet visits and participated in various community outreach events. Additional artifacts collected during the study included PAWS Houston organizational materials, photographs, published articles, and patient reports submitted by volunteers after each visit. Importantly, as we demonstrate with the inclusion of the project in this chapter, narrative inquiry doesn’t end with analysis. Our engagement with and representation of these artifacts is itself a narrative act, as is your engagement and understanding as the reader—an ongoing narrative process Arthur Frank calls “thinking with stories” (1995, p. 23).

Fisher (1987; Theory of the Narrative Paradigm) argues that most human communication is inherently organized in story form, but investigators can nonetheless encourage—or, conversely, discourage—participants in field research settings to provide rich, in-depth narrative responses. During interviews conducted for the PAWS Houston narrative project, Jill and her students asked family members, healthcare providers, and volunteers a series of open-ended questions in which they described their own roles and motivations for being involved with PAWS Houston, as well as the ways their views of healthcare have been influenced by participating in the pet visitation program. While several interview questions were aimed at evoking specific memories told in story form (e.g., favorite and least favorite aspects of their involvement, how they became involved with the organization, and typical experiences as part of the pet visitation program), at least one explicit item asked that the respondent share a personal story illustrating the mission of PAWS Houston. Wording interview questions in this way encourages participants to move away from general perceptions and impressionistic accounts to detailed descriptions of defining moments, what Flanagan (1954) aptly termed “critical incidents,” often related with deeply felt emotions rekindled through the process of storytelling.

Narrative inquiry in the social sciences is most often associated with gathering data in the form of in-depth interviews; in essence, asking people to tell their stories. Interviews are typically audio- or video-recorded and then transcribed into written text. However, there are myriad other sources for accounts of health-related experiences, including transcriptions of focus group discussions (which, after all, are group interviews); ethnographic field notes that detail the investigator’s observations of contexts, interactions, and other phenomena, tending to focus on organizational or community settings (e.g., Ellingson, 2005; Mattingly, 1998); and recorded clinical interactions between health providers and care recipients (e.g., Charon, 2006; Kleinman, 1988; Sharf, 1990). Researchers are also tapping health narratives from less conventional data sources with increasing frequency. These include electronic forms of social media (e.g., Chou, Hunt, Folkers, & Augustson, 2011); photographs, video, art, and other visual formats (e.g., Harter & Hayward, 2010; Makoul, 1999; Radley, 2009; Yamasaki, 2010); television, radio, film, theatre, and other types of performance or entertainment education (e.g., Harter & Japp, 2001; Quinlan & Harter, 2010; Sharf & Freimuth, 1993); creative nonfiction in multiple forms, such as biographical and autobiographical depictions (e.g., Frank, 1991), personal journals (e.g., Tillman-Healey, 1996), and poetry (see Sharf, Harter, Yamasaki, & Haidet, 2011, for a combination of several data sources); and fictional literature that serves as a form of exemplary case study (e.g., Stanford et al., 1995; Yamasaki, 2009).

Narrative inquiry operates on the premise that storied meanings are inherent in human symbolic activities open to the interpretations of research participants and investigator-observers, and herein lies another essential aspect of this approach to scholarship. Narratives that are the focus of study are necessarily co-constructed by research participants and investigators; in some situations, the distinctions between these roles may merge into that of collaborators (e.g., Schneider, 2010). Social psychologist Elliott Mishler (1986) observed many years ago that research interviews are as much shaped by the questioner as the respondent, both by the questions asked, as we’ve previously discussed, as well as how the questioner responds to the informant’s comments. The resulting narratives that emerge from these interviews are thus a byproduct of interviewer and interviewee reacting to one another. The process of transforming spoken discourse or field observations into written transcriptions is also a significant form of story editing and co-construction (Mishler, 1991; Riessman, 2008) that is part of the broader undertaking of interpretation (i.e., discerning patterns within and assigning meanings to the various sorts of texts, verbal and visual, selected for a particular research project).

In essence, narrative inquiry requires a sensitivity to attending to discourse and other symbolic forms in terms of their narrative elements, such as plots and characters, accentuated by research designs and questions that encourage participants to provide storied accounts. It also necessitates a realization that stories are related in multiple formats and media, with an openness toward delving into whichever of these may provide ways of understanding queries guiding the investigation.

Approaches to Narrative Analysis

Once data have been identified or elicited, narrative analysis commences. We wish to assert right away that there are many different approaches to analysis, with no one approach especially preferred (for a broad sampling of various narrative analyses, see Harter, Japp, and Beck’s 2005 landmark collection); in fact, researchers define what constitutes a narrative in various ways. In her splendid text on narrative methods, sociologist Catherine Riessman (2008) proposes four main analytic...

Table of contents

• Cover Page
• Half Title page
• Title Page
• Copyright Page
• Dedication
• Contents
• List of Figures
• List of Tables
• List of Contributors
• Preface
• Acknowledgments
• Method Matters
• Exploration and Description
• Examining Messages and Interpersonal Exchanges
• Causal Explication
• Cultural, Population, and Critical Concerns
• Method Reflections
• Index