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EDUCATION AND DEBATE: Helen Lambert and Christopher McKevitt Anthropology in health research: from qualitative methods to multidisciplinarity BMJ 2002; 325: 210-213 [Full text]

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Qualitative Tools, Qualitative Theories

Chris Carmona   (1 August 2002)

Anthropological Methods

Claire L Somerville   (2 August 2002)

Seeing is believing: the value of anthropolgy in health research

Robert M Power   (14 August 2002)

Qualitative Tools, Qualitative Theories 1 August 2002
Chris Carmona, Health Development Worker Norwich PCT, St Andrews House, Northside, St Andrews Business Park, Norwich, NR7 0HT Send response to journal: Re: Qualitative Tools, Qualitative Theories	Editor – It was refreshing to see the Education and Debate article about medical anthropology and qualitative methods (BMJ 2002; 325: 210-3) and I would entirely support the view that anthropology has a unique contribution to make to our understanding of health and illness, as do the other social sciences. I would like to pick up on the point made about qualitative methods being used as a tool divorced from theory (Summary point 1 – Emphasis on methods in health related qualitative research obscures the value of substantive knowledge and theoretical concepts based in some social sciences). This argument is completely valid, and I would like to draw out a strand which is alluded to in the text. Theorists who are steeped in qualitative method use an entirely different set of theoretical underpinnings to those used in the clinical sciences. There is a very different concept of the nature of social reality and, often, an outright rejection of the positivist and essentialist standpoints which underlie a huge proportion of health research. For example, Grounded Theory approaches (which are used widely in health research) are based in Symbolic Interactionist and social constructionist approaches to the world and ‘reality’ , Interpretive Phenomenological approaches are exactly that - Phenomenological. Phenomenology rejects outright the idea that there is a single, measurable, definable world . If health researchers are going to use qualitative methods, then they cannot do so simply by removing the tools and methods from their theoretical roots and relocating them within a bio-medical, positivist framework. The whole theoretical tradition of the qualitative model being used needs to be embraced to give any validity to the research at all.
Anthropological Methods 2 August 2002
Claire L Somerville, PhD Student (submitted) Dept.of Social Anthropology and Dept of General Practice and Primary Care, Cambridge. Send response to journal: Re: Anthropological Methods	The BMJ has been an interesting and unexpected forum for the social scientific debate on the value, and associated problems, of qualitative methodology in health research. This undoubtedly reflects the growing interest in the social sciences from within medicine. However, as Lambert and Mckevitt (BMJ 2002; 325: 210-3) eloquently expose, the wholesale adoption of selected methods has led to some confusion. In particular, a conflation of anthropology and ethnography with "popular" qualitative methods (e.g. focus groups, interviews) has developed. Anthropology, as Lambert and Mckevitt argue, has a distinctive approach, a theoretical and methodological history, and a vast, cross-cultural literature that is a vibrant source of comparison, ideas, and tools for general understandings of the human condition. As a result, anthropology does not lend itself to the stark division between qualitative and quantitative methods. In general, anthropologists adopt a highly elastic approach and will draw upon any number of methods of data collection and processes of analysis in order to achieve a fuller understanding of a question. It can be as appropriate to collect quantitative data (e.g. household economic data, prevalence of illness, disease, attitudes, agricultural production) as it is to collect qualitative data through cultural immersion. For an excellent account of the value and difference between qualitative and quantitative social research, I would recommend Richard Lapiere's 1934 paper "Attitudes Vs. Actions" in Social Forces, Vol 13. My point is that it is inappropriate to fit social or medical anthropology into a binary system of classifying methods, something the authors do not make explicit in their paper. In Cambridge we have overcome this problem by establishing an institutional collaboration between the Department of Social Anthropology and the Department of General Practice and Primary Care. As a Ph.D student, I was supervised and supported by both departments and given time to develop an anthropological approach to a pilot programme to prevent type 2 diabetes. The thematic focus (risk) became the engine that drove the success of the collaboration. In order to understand the ways that risk was being interpreted and acted upon in everyday social worlds, it was necessary to consider the ways in which risk was constructed, often quantitatively, within epidemiology and public health. In keeping with a flexible anthropological approach and making use of the heuristic device of "making the familiar strange" (and vice versa), it was possible to reveal how medicine had constructed a system of risk classifications which resonate in some ways, but not others, with the lived ('lay') experience of risk. Furthermore, the use of participant observation in both the medical and non-medical fields of research, allowed the difference between verbal responses and social action to become apparent. This an important element of an anthropological approach and is elaborated upon in Lapiere's paper. Without the institutional collaboration, along with peer support, it is possible that as an anthropologist working in a predominantly medical environment would lose sight of their disciplinary insights and engage only with "popular" qualitative methods. In summary, I firmly agree with Lambert and Mckevitt's conclusion that anthropology can offer relevant conceptual frameworks, knowledge and methodological insights. However, I would add that the success of such truly multidisciplinary approaches are greatly facilitated by a supportive institutional or disciplinary collaboration.
Seeing is believing: the value of anthropolgy in health research 14 August 2002
Robert M Power, Reader in Social Science Department of STDs, Royal Free & University College Medical School, London, WC1E 6AU Send response to journal: Re: Seeing is believing: the value of anthropolgy in health research	Lambert and McKevitt's recent article(1) makes a number of important points regarding the value of integrating a truly anthropological approach in health research. It also raises new challenges to those steeped in the positivist traditions still dominant in this area. Is the medical fraternity really ready to adopt an anthropological paradigm focusing on empirical particularity and social and cultural specificity? It is one thing to run a focus group, or append a few touchy-feely questions to the end of a interview schedule, or even to develop a multi-indicator qualitative study as is the case in much of the highly fashionable rapid assessments (2); but it is quite another to embrace wholeheartedly the theoretical complexities of anthropology. This would mean moving away from a bland acceptance of self-reports in the form of the spoken and written word towards cultural and contextual interpretations and direct observation. This is not a new line of argument, but what Lambert and McKevitt (1)add to the debate is the call for theory not to be detached from method. Anthroplogy without rationality and classification is like epidemiology without probabilty and randomisation. Anthropologists love to immerse themselves in the lifestyles and mores of their research subject, classically for considerable periods of time (3). Where this is not wholly viable then an ethnographic approach, underpinned by anthropological theory can produce significant insights in health research. This is certainly true in the field of research in which I have been involved for the best part of two decades. Anthropology and ethnography have highlighted the nuances of HIV risk-behaviour amongst injecting drug users, noting, for example, the importance of drug preparation techniques (4), cultural and contextual specificity (5) and the sharing of injecting paraphernalia (6). Such research can provide fascinating insights into behaviour and meaning, but can also have practical and clinical ramifications and implications. There is certainly an untapped potential for utilising the skills and theories of anthropology in many areas of health research. For those of us happily working in what has become a broad church of health related qualitative research, the notion of a truly theorised anthropolgy is an exciting prospect. For our epidemiological and clinical colleagues this may be another difficult challenge. But then again, who, ten years ago, would have predicted the respected medical press would be giving so much careful thought and consideration to the role and status of qualitative social science in mainstream health research? 1. Lambert H and McKevitt "Anthropology in health research: from qualitative methods to multidisciplinarity." BMJ 2002;325:210-213. 2. Rhodes T, Stimson G, Fitch C et al "Rapid assessment, injecting drug use and public health. Lancet 1999; 354:65-68. 3. Whyte W.F. "Street corner society." 1955; Chicago: University of Chicago Press. 4. Grund J-P, Adriaans N and Blanken P. "Drug sharing and HIV transmission risks: the practice of frontloading in the Dutch injection drug users population." Journal of Psychoactive Drugs 1991;23: 1-10 5. Power R, "Rapid assessment of the drug injecting situation at Hanoi and Ho Chi Minh City, Vietnam." Bulletin of Narcotics 1996;48:89-99. 6. Koester S, Booth R and Wiebel W. "The risk of HIV transmission from sharing ater, drug mixing ci=ontainers and cotton filters among IV drug users." International Journal of Drug Policy 1991; 1: 28-31.