Qualitative health research beyond and alongside COVID-19

By Sue Chowdhry, Emily Ross and Julia Swallow

As qualitative researchers in academia, like many others our practice has been transformed in light of the global Coronavirus pandemic. The ‘lockdowns’ enforced across the world have introduced greater awareness of our proximity to others in everyday life, and of the need to maintain a prescribed distance between bodies. This has implications for our work as researchers in the field of health and illness, whose tools include face-to-face methods such as focus groups, interviews and ethnography.

In this blog post, we reflect on the meaning and implications of doing qualitative health research beyond and alongside COVID-19. Drawing on examples from our individual research projects, we first focus on who and what might be excluded or silenced through the changes to our research environments and practices prompted by the pandemic. We then reflect on several implications of the ruptures caused by the pandemic for qualitative research in health more widely.

Exclusions and silences

Research interactions

As researchers in medical sociology and science and technology studies, we had been undertaking separate projects at the time of the pandemic. Sue’s research concerned pregnant women with experience of pre-term birth, and Emily and Julia’s considered patient and practitioner engagement with novel cancer treatments (genomic techniques and immunotherapies respectively). All three of our projects thus involved individuals classified as especially ‘vulnerable’ to COVID-19 by the UK Government (see Ganguli-Mitra’s opinion piece for a wider discussion of the classification of ‘vulnerability’ as related to COVID-19). As a result, in addition to the restrictions imposed by Institutional and NHS bodies on research practice, we were particularly mindful of the potential consequences of face-to-face methods for our participants.

The prospect of continuing our research in the absence of physical proximity to our participants was daunting. Viewing interactions between researcher and participant as sites for the active co-creation of qualitative data, we were concerned that the inability to conduct research encounters in person, and loss of the intersubjective encounter, could be detrimental to our practice. As Alondra Nelson’s blog post on this issue points out, valuable research insights can be gained from being close enough to observe gestures such as “toes tapping and nervous hands”. Sue interpreted her physical presence as key to the success of focus groups she had conducted prior to COVID-19 restrictions. For example, her occupation of the physical space was performed so as to signal to participants that they controlled the discussion. Equally, participants orientated their bodies to each other in ways that indicated interest and support, through spontaneous shared laughter, eye contact and sometimes fleeting touches of hands at emotional junctures.

We have also been reflecting on the implications of a move away from face-to-face methods for relations of power within qualitative research practice. Our research projects have often focused on life-events that can be distressing and emotional for participants, and throughout we have all maintained a commitment to democratising the research process. We have endeavoured to forge reciprocal relationships with participants, and adopted forms of practice that more equitably distribute control whilst qualitative interviewing. Reflection on the issue of power in research is significant for those turning to online methods in light of the pandemic, particularly where online material pre-exists the research encounter. Here the intimacy of face-to-face methods, which feminist scholars have claimed better allow for the involvement of participants in the production of knowledge (Ramazanoğlu and Holland, 2002), is absent. Having used pre-existing online material in previous projects, Emily felt that the creativeness of qualitative research practice as a shared project between researcher and participant was not as achievable in online research, nor was the closeness that comes from being a key participant in the creation of qualitative data. As such, those adopting online methods in light of the pandemic may try to re-craft participant involvement and reciprocity in other ways. This may be through initiating contact with authors of online material, sharing information about the research with them, and if appropriate seeking consent from authors to use online posts in research.

Research landscapes and spaces

The concerns discussed above are further situated within the landscapes and spaces in which qualitative research takes place. In the example of focus groups, the ‘affective atmospheres’ (Anderson, 2009) shaping the research encounter provided the backdrop for Sue and her participants’ responses to the research and each other. Sue offered refreshments to her focus group participants, and vividly recalls the smells, tastes and sounds of this shared experience. The atmosphere was carefully fashioned for respondents to feel valued and at ease, and to allow for the exchange of intimate reflections on experience.

The arrangements of care provision, and situated contexts in which care is given and received, shape patient, clinician and researcher accounts of disease and treatment. In the time of COVID-19, the research spaces with which we as health researchers had been familiar are being re-shaped, with this particularly visible in cancer care. Before the pandemic, the settings for Julia’s ethnographic research were already stratified and fragmented, with consequences for the practice of healthcare and patients’ biosocial experiences of cancer. Novel immunotherapies could not be accessed by all, raising questions around the inclusions, exclusions and silences provoked by these therapies – who has access and who benefits? COVID-19 is potentially (re)producing or exacerbating existing inequities. As researchers, who we are able to observe and engage in our projects is a key concern, as we ask what and whose realities, experiences and practices might be privileged over others in the context of contemporary cancer care, and in relation to the healthcare worlds (re)shaped by COVID-19.

Responding and intervening

Although the current situation has prompted us to halt or reformulate our ongoing research, in our experience the need to reflect on and adapt our methodologies has also provided opportunities. Importantly, recognising and responding to the methodological restrictions prompted by the pandemic has encouraged us to think about the inclusions, exclusions and silences that already exist in healthcare worlds, which have been exacerbated or magnified by COVID-19. Attention to these issues through an alternative lens has prompted us to question how we can use method to respond and intervene. Method as practice is a means of understandingrather than organising for complexity and uncertainty, and a way to respond to the disruptions, inclusions/exclusions and silences which are rendered visible and exacerbated by COVID-19. Method produces particular realities and as such, drawing on feminist STS scholars, we have the opportunity to intervene, and to do what Alondra Nelson describes as ‘creating knowledge pathways to a better world’. If methods shape how and what we know and are always political (Annemarie Mol (1999) would describe this as ‘ontological politics’) – what kinds of social realities do we want to create or bring into being?

Online methods afford possibilities for responding to the contemporary challenges we face as researchers. Qualitative analysis of pre-existing blog posts, solicited online diaries and other methods helpfully detailed by Deborah Lupton and colleagues allows us to continue research projects disrupted by the pandemic. Further, online spaces present opportunities to intervene; to engage with those typically excluded from qualitative research due to geographical location or accessibility – with this even more pronounced in a time of ‘shielding’ those deemed most vulnerable. Online approaches can capture forms of networking and support-seeking around experiences of ill health which have been obscured by the pandemic, but which continue to be shaped by inequalities in access and survival.

As another approach, the benefit of doing ethnography, however limited this might be and whatever this might look like in the future, is that it is about opening space for complexity and uncertainty. It allows us to acknowledge and respond to the messiness of practice as an attempt to understand, rather than organise, the uneven and unpredictable ways in which knowledge is produced in research (Law, 2004). It is about taking the world as it is,whilst also keeping in mind the importance of doing what Donna Haraway would describe as critical, political, partial and situated work which is always on-going.

Reflecting

In an academic environment which emphasises activity and impact, COVID-19 has forced upon us ‘space to breathe’ (Will, 2020). The restrictions imposed by our governments and institutions have demanded an additional layer of reflexivity as we contemplate our research projects in light of the pandemic. In some cases, this has entailed the adaptation of research questions, as well as consideration of how alternative methods align with our wider research paradigms. With restrictions in our ability to engage in face-to-face research methods, we lose key aspects of the relational qualitative research encounter, and are pulled away from the research atmospheres, landscapes and spaces with which we are familiar. However, the loss of face-to-face methods has provided us with an unexpected opportunity to explore new approaches, encouraged tough reflection on our research questions and methodologies, and prompted deeper contemplation of the worth of our research itself.

The authors of this post are supported by the Wellcome Trust (grants 104831/Z/14/Z and 218145/Z/19/Z) and NIHR (grant 17/22/02).

Anderson, B. (2009) Affective atmospheres. Emotion, Space and Society. 2, pp.77-81. doi:10.1016/j.emospa.2009.08.005

Haraway, D. (1988) Situated Knowledges: The Science Question in Feminism and the Privilege of Partial Perspective. Feminist Studies, Vol. 14, No. 3, pp. 575-599.

Law, J. (2004) After Method: Mess in social science research. London: Routledge.

Mol, A. (1999), Ontological politics. A word and some questions. The Sociological Review, 47: 74-89. doi:10.1111/j.1467-954X.1999.tb03483.x

Ramazanoğlu, C and Holland, J (2002) Feminist methodology: challenges and choices. London: Sage.

Will, C.M. (2020), ‘And breathe…’? The sociology of health and illness in COVID ‐19 time. Sociology of Health & Illness, 42: 967-971. doi:10.1111/1467-9566.13110