Ethnography and evaluation: temporalities of complex systems and methodological complexity

Abstract

In public health there is increased focus on evaluating 'complex' interventions for health improvement, examining how their multiple components interact dynamically with the contextual system in which they are delivered. Amid this complexity framing are calls for methodologies that can facilitate contextual understanding as part of the evaluation process, including ethnography. However, while ethnography's attention to 'context' has been recognised as valuable for evaluation, few questions have been raised about the possible tensions of aligning what are quite different expectations for knowledge making in evaluation and in ethnography. This paper introduces a special section illustrating empirical examples of conducting ethnography for and with evaluation of 'complex' health interventions. Central to these experiences, this paper argues, are the concepts of time and temporality through which experience, change and knowledge making are invariably structured. It considers the different expectations for time and temporality in ethnographic and evaluation research, and how the 'long conversation' of ethnography aids interpretation of an intervention's interaction with the pasts, presents and possible futures of people's health experiences. Furthermore, in understanding time not as linear and constant but experienced through a series of encounters, ethnography highlights the spaces in between action and change, vital for understanding the complex dynamics of a health intervention in context. Through temporality, this paper and the related empirical papers present an intricate exploration of the challenges and productive opportunities posed by the use of ethnography for and with evaluation.

When all else fails: The (mis)use of qualitative research in the evaluation of complex interventions

“…RCTs will likely continue to be considered the gold standard in the evaluation of complex interventions, despite critiques of the methodology 24 . Qualitative methods (as part of process evaluation, or on their own) have been identified as part of the solution to many of the limitation of RCTs 25 . We explored how QR was integrated into evaluations of three complex interventions and identified challenges in collecting useful data and applying the findings in appropriate and scientifically grounded ways to inform the evaluation results even with qualitative methodological support.…”

“…In contrast, the goal of evaluation research is generally to determine the value of an intervention to ensure evidence based care. A tension is created in taking such contextualized accounts to determine potential effectiveness in new contexts or at health system levels 25 . These challenges arise when QR is embedded into a research environment that does not appreciate or take advantage of the epistemological differences inherent in QR approaches 33…”

‘He called me out of the blue’: An ethnographic exploration of contrasting temporalities in a social prescribing intervention

“…Our ethnographic insights are derived from the piecing together of such moments of synchronicity. While these snapshots result in an ‘interrupted conversation’ (Reynolds & Lewis, 2019, p. 11), we have been continuously in tune ‘to the gaps and the in‐between spaces of the ethnographic encounter, and therefore, in turn, to the gaps and in‐between spaces of how an intervention unfolds and brings about change (or otherwise)’ (ibid., p. 11). There were many moments in this research which offered opportunities for reflection in what Mannay and Morgan (2015) refer to as the ‘waiting field’.…”

Tingbjerg Changing Diabetes: experiencing and navigating complexity in a community-based health promotion initiative in a disadvantaged neighbourhood in Copenhagen, Denmark

“…Although such a study provides important insights into the complexities of partnership formation in complex initiatives, there is still a need to understand more deeply how complex partnership dynamics, contextual factors, and diverse organizational structures are experienced and navigated by practitioners in different settings. Drawing on ethnographic fieldwork as a productive way of addressing the complexity of social life [ 22 , 23 ] the objective of this ethnographic study is to explore how professional stakeholders experience and navigate complexity in a community-based multi-stakeholder intervention implemented in the disadvantaged neighborhood of Tingbjerg in Copenhagen, Denmark. By focusing on navigational practices, this study provides in-depth knowledge on the complexity of context that may strengthen and improve the development and implementation of complex community health interventions.…”