An outline of my theoretical perspective

The theoretical perspective which informs my work underpinned my decisions about methods – including data collection and sampling – and approaches to transcription and analysis.

First, I will explain the related concepts of ontology and epistemology. Ontology is the philosophical study of the nature of reality. Epistemology is the philosoph-ical study of the nature and scope of knowledge. Research traditions vary in their ontological assumptions, and this in turn relates to different assumptions about the status of knowledge that the research generates. As Green and Thorogood (whose helpful introduction to these philosophical positions I draw on in the following paragraphs) point out:

Many debates about the value of research findings are rooted in epistemological differences between researchers in terms of what kind of knowledge they believe research should produce, or what counts as adeq-uate evidence for conclusions to be drawn

(page 11) (Green and Thorogood 2004b).

For example, positivist approaches which have been popular since the Enlight-enment (an example is the randomised controlled trial, regarded as the gold standard by proponents of evidence based medicine) assume an objective reality which is stable, ‘out there’ and exists independently of knowers or their values. It is a reality which, through experimental methods can be explained, predicted, measured and controlled. The scientific method which is used is one which is objective, rational and neutral and the assumption is that there exists a single reality or ‘truth’ which can be sought out (an epistemological claim). A

63 positivist view of language would be one which assumes a clear corres-pondence between the world we experience and the words and language used to represent and describe it. From this perspective, language is a transparent window through which the world is seen and information transmitted. This is an assumption which underlies many studies based on survey methods and many (though not all) qualitative interview studies in the healthcare field.

In contrast, an interpretivist approach which is often adopted in the social sciences seeks to explore the meaning-making and interpretations of research participants with a view to understanding human behaviour, rather than seeking to explain, measure or predict the ‘reality’ of the world. A researcher working within this paradigm makes no explicit (or even tacit) ‘truth claim’ but regards the knowledge obtained through research as partial and situated, related to the researcher’s world view and value system.

Researchers in a related tradition – that of social constructionism – make an even bolder ontological claim in opposition to the positivist approach. In this tradition reality itself is assumed to be socially constructed – the result of historical, social and political processes – and this opens up the possibility that there exist multiple realities or ‘truths’. It is a relativist position in which the interest of the research is in how phenomena come into being, the processes by which they come to be constructed as they are. Researchers may consider themselves along a spectrum of constructionism which – at its extreme – is sometimes referred to as ‘strong’ social constructionism (in which all reality is regarded as a construction). Where one positions oneself on this spectrum is related to one’s ontological assumptions about the nature of reality. Even within the field of discourse analysis – which I will explain in §4.4 – there is room to accommodate a range of different ontological and epistemological positions, traditions varying in their understanding of the role of the social.

My own work programme sits within an interpretivist frame of reference in that I seek to explore the meaning-making of the research participants. My core data set, which consists of video data of clinician-patient interactions, opens up the detail of interaction, or ‘language-in-use’ to analysis. My perspective on

64 language which underpins my analytical approach is that language and disc-ourse (which incorporates more than just the spoken word) are socially constructed. This orientation assumes that language does not just reflect or express intentions or decisions (the representational role of language) but it makes them (the constitutive role of language) (Roberts and Sarangi 2005).

However I fall short of believing that the ‘real’ has no place whatsoever in discourse, or that there is never any ‘reality’ at all. I would therefore conclude that my ontological stance is one of weak social constructionism.

4.3 Ethnography and the ‘linguistic ethnographic’ approach Ethnography is a little used research approach in general practice settings although valuable insights have been made using ethnographic approaches in recent years – for examples see Gabbay and le May (Gabbay and le May 2004), Checkland (Checkland, Harrison, & Marshall 2007), and McDonald etc al (McDonald, Harrison, Checkland, Campbell, & Roland 2007). There have been recent calls for greater attention to methods such as ethnography (Checkland 2009;Greenhalgh et al 2011;Pope and Mays 2009), Pope arguing that researchers are not exploring the full potential of qualitative methods and Checkland proposing that engaging critically with different research traditions is crucial to broadening the evidence base on the organisation and delivery of services.

The term ‘ethnography’ (from Greek: ‘ethnos’ means ‘people’ and ‘grapho’

means ‘to write’) is used rather ambiguously to refer both to the process of conducting the research and the product (i.e. the written report) (Agar 1980). A specific interest of this kind of research is to render explicit those aspects of

‘culture’ – including beliefs and perspectives – that are held outside of conscious awareness and cannot be readily articulated by informants (as one might assume is possible in an interview study) (Erickson 1985). The writing is not simply a description, but incorporates an interpretive perspective and serves a rhetorical function, although the stance of the field worker is not manifestly evaluative (Erickson 1985).

65 Ethnography is small scale observational research, carried out in every day settings which uses several methods, evolves in design throughout the study and focuses on the meanings of individuals’ actions and explanations (Savage 2000). Analysis is driven by an exploration of the tension between what is called the ‘emic’ (or insider) perspective and the ‘etic’ (or analyst’s) perspective, such that the product of the ethnography goes beyond simple ‘insider’ description towards a theoretical description (Green and Thorogood 2004a). The research-er can be regarded as ‘research instrument’, becoming part of the evresearch-eryday life of the social world being studied, through observing interactions and behaviour and talking to members (Pope 2005) as one seeks to make meanings out of the fundamental question “What is happening here?” A ‘naturalistic’ approach, the aim is to study the world in its natural state, undisturbed by the researcher (Fox 1998). However, as Hammersley and Atkinson point out this is an idealised view since:

It is true that we cannot avoid relying on “common-sense” knowledge nor, often, can we avoid having an effect on the social phenomena we study. In other words, there is no way in which we can escape the social world in order to study it

(page 17) (Hammersley and Atkinson 1995b).

The responsibility on the researcher, therefore, is to remain highly reflexive.

This reflexivity incorporates a sense of one’s own socio-historical location, values and interests, sensitivity to the importance of one’s own personal characteristics, awareness of one’s effect on the people and processes one studies and an understanding of research as an active process in which accounts of the world are produced through selective observation and theoretical interpretations (Hammersley et al 1995b). The ethnographer is constantly exploring the interplay and the tension between ‘strangeness’ and

‘familiarity’ whilst seeking to make sense of everyday practices, by immersion within the field.

Linguistic ethnography is a very recent theoretical and methodological dev-elopment and the debate about ‘what is’ and ‘what is not’ distinctive to an understanding of linguistic ethnography is current, but it is grounded in the

66 practice of a number of scholars in recent years (Creese 2008). Rampton, in a recent discussion paper states:

Linguistic ethnography generally holds that to a considerable degree, language and the social world are mutually shaping, and that close analysis of situated language use can provide both fundamental and distinctive insights into the mechanisms and dynamics of social and cultural production in everyday activity

(page 2) (Rampton, Tusting, Maybin, Barwell, Creese, & Lytra 2004).

There is a productive tension between ethnography and linguistics (and so by implication, discourse) and it is at this boundary that scholars of linguistic ethnography see its potential. In contrast to ethnography, linguistics (in its many forms) identifies structural patterns in the ways in which communication occurs, patterns which are relatively stable, recurrent and socially shared, which can be identified using well established procedures and described using technical vocabularies (Rampton et al 2004). One particular tension stands out – the focus of ethnography on the situated particularities of everyday life sits in contrast to linguistics as it seeks to generalise about language structure and use. Rampton characterises linguistic ethnography by its interest in working at this interface, in which linguistics “ties ethnography down” and ethnography

“open linguistics up” (Rampton et al 2004). Although this contrast is helpful, it is the value of working at this interface rather than the assumed direction of effect that is most productive. Roberts has suggested that ethnography may “tie linguistics down” by making some interpretations more likely than others, just as linguistics may “open up ethnography” to more discoveries (Roberts, personal communication).

Whilst linguistic ethnography does not encompass any specific method or approach, the underlying assumption is that persons, encounters and instit-utions are profoundly interlinked and one concern is the nature and dynamics of these linkages. Two methodological tenets help to define its remit. Firstly, the contexts for communication should be investigated rather than assumed.

Second, analysis of the internal organisation of verbal (and other kinds of

67 semiotic) data is essential to understanding its significance and position in the world. Meaning is more than just “expression of ideas” (Rampton 2007).

Scholars of linguistic ethnography thus draw on two well established traditions, those of ethnography (with its origins in anthropology and the social sciences) and linguistics, whilst embracing a ‘post-structuralist’ research paradigm. I will discuss the distinction between structuralism and post-structuralism in §4.4 when I turn my attention to discourse analysis. Discourse analysis offers tools for exploring language practices which contribute to the construction, circulation and reworking of socially meaningful categories and identities within the social worlds which lie at the centre of ‘linguistic’ ethnographic observation.