Activity Theory Principles and Methods

In Chapter 3, a comprehensive rationale for the choice of a qualitative case study

using an activity theory framework was provided. It was also noted that activity

theory does not provide guidance on selection of methods or analysis (Engeström,

1993, p. 97), but it requires the observation of specific principles (see section 3.6.2.3).

Instead, it is necessary to select methods compatible with the principles of the theory

and the research setting to gather and analyse data. Justification for the choice of

methods based on the theoretical principles is provided below to clearly demonstrate

how it aligns with the overall theoretical framework (Twining et al., 2017).

4.2.1 Activity Theory Principles and Implication for Selection of Methods The first principle of activity theory is that a collective artefact-mediated and object

oriented activity system is the prime unit of analysis for the investigation. In this chapter. the unit of analysis is Engeström’s minimal unit – two interacting activity

systems (Engeström, 2001, p. 136), as shown in Fig. 4.1 below.

Figure 4.1. Unit of Analysis: The unit of analysis is interacting activity systems (intern and tutor) with a partially shared object.

Therefore the method(s) chosen needed to appropriately represent the perspectives of

the two primary subjects (interns and tutors) in sufficient detail to comprehensively

describe elements of the activity system (Daniels, 2008, pp. 123-126).

Activity systems are multi-voiced and represent many points of view, traditions, and interests based on their diverse histories. This is multiplied in networks of interacting

activities (Engeström, 2001, p. 136), such as this research where there are two (see

Fig. 4.1). Therefore, the method(s) chosen appropriately accommodated the collection

of multiple perspectives on WBA practice.

Activity systems take shape and transform over periods of time, and should be

considered against their own history. This third principle is termed historicity. History should be considered in terms of the local history of the activity but also the

theoretical ideas and tools that have shaped the activity (Daniels, 2008, p. 124). This

means that it was necessary to consider the origins of the WBA practice in detail and

interpret the findings carefully in terms of the history and literature described in

Chapter 2.

Engeström (2001, p. 137) terms the fourth principle contradictions. He highlights the central role of contradictions as sources of change and development. Distinct from

problems or conflicts, they are historically accumulating tensions that arise within and

between activity systems. They are a source of disturbances and conflicts, but also

innovations. They should be considered in terms of how they manifest in activity

systems materially or discursively (Engeström & Sannino, 2011). The methods chosen

would need to be able to identify these contradictions in existing WBA practice.

The fifth principle relates to the potential of activity systems to undergo expansive transformations. This happens when contradictions are aggravated and participants

begin to deviate from established norms, in some cases escalating to a collaborative

collective change effort where the motive and object are reconceptualised (Daniels,

2008, pp. 125-126). Therefore, methods would need to allow such information to be

gathered.

4.2.2 Choice of Methods

While the theoretical principles had the primary influence on the choice of methods,

practicalities were also an important consideration. Yamagata-Lynch (2010, pp. 63-

79) provides a comprehensive overview of issues to be considered when selecting

methods and analytic approaches when using activity theory. She suggests that

observations, interviews (individual or group), and document analysis are all

approaches that are compatible with activity theory, and that practical considerations

will also influence selection (Yamagata-Lynch, 2010, p. 70). While observations are

useful for providing first-hand experience of participants’ activities, there are

practical, logistical and ethical issues associated with observing practice in

healthcare environments, and participants may feel uncomfortable with being

observed (Heath, Hindmarsh, & Luff, 2010, pp. 10-13). These challenges were

previously found to also arise in observational studies based in pharmacies (Parry,

Pino, Faull, & Feathers, 2016). Alternative approaches, such as interviews and

focus groups can help gather information about the participants’ natural setting,

experiences, and details about activity system elements (their community, how

they use tools etc.). In this research, practical considerations such as participant

recruitment for each of the elements, and feasibility of data collection also

contributed to decisions relating to selection of methods. For example, document

analysis can allow researchers to find contextual information such as rules, and

certain sources may be challenging (Yamagata-Lynch, 2010, p. 71), e.g. if the

materials are not available for research purposes.

The strengths and practicalities of each approach were considered. For the purposes

of this chapter, document analysis and focus groups were identified as the most

appropriate methods to gather the required data. As observations have additional

ethical and practical considerations, access to and recruitment of participants may

be more challenging (Heath et al., 2010, pp. 14-19), and recognising that these

approaches would be vital when addressing the second study objective they were

not used in this part of the research.

In this chapter, the methods are used sequentially. First, document analysis is used to

study how tutors and interns learned about the WBA practice. These findings are used

to develop a ‘normative’ activity system, representing what should happen. This is because Nicolini (2012, p. 227) suggests that the first step in studying practice should ‘zoom in’ to how it is learned. This allows researchers to understand the “specific ways of seeing, talking, and feeling that make a person a member of that specific practice”.

This would therefore provide important context and allow for triangulation of other

findings. It was also a helpful approach to facilitate a critical reflection on faculty

development, which was a key feature of the WBA literature reviewed in Chapter 2, and

an important aspect of WBA (Holmboe et al., 2010). While this would help establish

what practice should be, and consider faculty development, it would not allow the exploration of what it actually was in reality, or the identification of the strengths and weaknesses in practice and compare these to the literature in Chapter 2, or the role of

technology in existing practice. Therefore, the focus groups were used as a second

method to gather data relating to elements of the activity system, in line with the activity

with improving quality, as it allows triangulation of findings and increases certainty in

results (Twining et al., 2017). In the following sections, use of the document analysis

(section 4.3) and focus groups (4.4) methods are described