Consideration of research methods

As a medical anthropologist, I am well aware of the benefits of both

quantitative and qualitative methodologies, and I weighed the relative value of the two approaches in considering the design of the present study. Quantitative methods had the capacity to capture the wider picture of what a large number of people believed and practiced in terms of thermal care of infants. Qualitative methods had the capacity to capture the depth and complexity of people’s beliefs

20 South Asian countries include Afghanistan, Bangladesh, India, Nepal, Pakistan and Sri Lanka.

103 and practices related to thermal care of infants. Participant observation, or

ethnography, is regarded as an excellent method for evaluating whether people do what they say they do, although the presence of the researcher must always be acknowledged as a source of potential bias (Flick 2004; Mason 2006). The rules and norms of any culture are, in some circumstances, allowed to be broken, and understanding these rules and their exceptions is best accomplished through observation. I found a perfect example of this during the pilot (which is described in detail in section 5.2 below). I asked a Bangladeshi mother if she took her infant and young children out in cold weather if one of them was sick, and she told me she would avoid doing so in order to keep from making her daughter’s illness worse. The next week I arrived in the cold, driving rain to the parents and toddler group, and she informed me that her daughter had a fever. I said I was surprised that she had taken her daughter out of the house on a cold day if the baby was sick, and the mother told me that, since she was the coordinator of the toddler group and since she had no one to leave her daughter with at home, she reluctantly had to take her daughter out in the cold. Thus, even this brief period of participant observation revealed a difference between what she said she did and what she actually did, and allowed me to gain some insight into her reasons for breaking rules related to thermal care practices.

When language barriers are present, direct observation is also useful since in-depth conversations, even when aided by an interpreter, are likely to be limited. I considered recruiting a small group of 30 Bangladeshi mothers by offering English conversation classes in their own home, which would have been focused on the topics of health and infant care that would be most beneficial to them when taking their children to a local doctor perhaps. However, although these classes would have allowed me to conduct in-depth discussions about thermal care practices with these women, the intensive nature of such data collection measures would have meant that I would be limited to a small sample of mothers belonging to only one ethnic group. Furthermore, conducting direct observations of the way that mothers dressed their infants in their own homes at night would have been particularly intrusive for both white British and South Asian mothers. Such methods were therefore not appropriate, ethical, or feasible for the present study.

104 My guiding research question, combined with the lack of existing studies on the topic, ultimately informed my choice of methods for this study. Given that so little is known about infant thermal care beliefs in the UK, and given that I was interested in gathering information on these beliefs among two different ethnic groups, I chose a mixed methods approach. I decided that quantitative methods involving structured questions would be used to obtain information on the

background of the mother and infant, the thermal environment of the infant’s room, and the items of clothing and bedding that were used at night for the infant.

Qualitative methods, involving unstructured questions, were used to explore the mothers’ reasoning behind the thermal care beliefs and practices. I also chose to use observational techniques where possible, although these were not as extensive as those involved in purely ethnographic studies.

This thesis is more than just a mixed-methods approach, because it uses a medical anthropological analysis of thermal care practices and beliefs that question current medical assumptions about thermal regulation in infants. Furthermore, it aims not just to document what people do, but also to explore why they do it.

Likewise, it examines how the beliefs and practices of other cultures can help us better understand and evaluate our own thermal care beliefs and practices. It provides a unique synthesis of clinical and anthropological research to address the interaction of cultural beliefs and behavior on the physiology and health of infants.

This represents the unique contribution of medical anthropology. Inhorn (1995) has argued that an anthropological-epidemiological synthesis can lead to results that are greater than the findings generated by either discipline alone. Inhorn (1995) argues that the use of opposing approaches to study the same medical topics can lead to a greater understanding of health-related behaviour.

There is much to be gained by integrating clinical and epidemiological models of disease with anthropological perspectives and data. To my knowledge, this combined approach has not been used in the study of thermal care of any age group, and has been used to only a very limited extent in SIDS research. How I finalized the details of the methods is discussed below. In summary I used a questionnaire of 56 questions, which included both structured and unstructured

105 questions. I showed mothers my Durham University identity card and obtained consent before commencing each interview. Before asking for a signature for consent, I reviewed a participant information sheet that gave details of the study and gave mothers a copy to take home. I also provided them with my contact details in case they decided to withdraw consent afterwards. I did not write names on the questionnaires and kept the questionnaires and consent forms in separate, secure locations accessible only to members of the research team. I allowed

discussion of any topic throughout the interview, and offered a small gift at the end of the interview.