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Monday, 24 November 2014

Health and ethnography: don’t just ask, watch

When it comes to health, consumers’ complex and contradictory behaviour makes observational research highly valuable, says Ipsos Mori director Oliver Sweet.

In getting beyond the rational responses of quantitative surveys, qualitative research looks for the reasons behind the responses. Yet our greatest flaw as quallies is that we are still asking questions rather than watching and learning. The recent resurgence in ethnographic research shows that marketers are gaining confidence in the results that it produces, and researchers are coming up with cost-effective approaches to behavioural insights. The result is that more attention is being paid to the circumstances in which people make decisions, meaning more value is being placed on observation, and what is not being said as well as what is.

Health offers some fantastic examples of this. The question ‘What does health mean?’ is often greeted with a ponderous look, which then leads to answers about food, exercise, and eventually mental health. But ask how important health is to people and the response is much more emphatic: ‘It’s everything. If you haven’t got your health, what have you got?’

Start watching people and you’ll soon see that health is everywhere. We are making health-related decisions all the time without even realising, from the food we eat at breakfast, lunch and dinner, to taking the dog for a walk, to the cream we put on our face to make us look beautiful. Health is all-consuming and extremely hard to explain accurately.

“Emotional aspects of health have their roots in a mesh of social and cultural norms, influenced by friends, family and society. These can’t really be accessed by people telling you – you really need to see them”

This has consequences for us as consumers and as researchers. How do we navigate our complex, choice-filled world to be healthy people? And how, as researchers, do we monitor this? The answer is unlikely to come through simply asking people. This is why we need to place emphasis on observing routines. Paying attention to the mundane gets us beyond articulated responses to understand the more complex aspects of life.

Observation allows researchers to look at healthy behaviours that are often hard to articulate, such as the emotion attached to food, or when we are most likely to make changes to our lives. These emotional aspects of health have their roots in a mesh of social and cultural norms, influenced by friends, family and society. These can’t really be accessed by people telling you – you really need to see them. Through observation, for instance, we have understood how buying local produce in Australia is part of a healthy routine, how collagen cream in Brazil offers a pseudo-medical answer to the quest for beautiful skin, and how praying to ancestors in Japan sets people on a positive mental path for the day. None of these activities is inherently ‘healthy’, but they are certainly part of a healthy lifestyle.

Positive health is often described as the absence of disease or infirmity, yet behaviourally it slips into our daily routines without us noticing, and, as a result, is far more emotionally-driven. It is therefore ironic that when our health is governed by our emotions, we are likely to be less healthy than when we think about health rationally. Food is both a source of fuel for our body and a cause of obesity, because it is so often used as a method of socialising, for comfort or alleviating stress. Alcohol is rarely good for our bodies, but we tend to consume more when we are sad, distressed or celebrating. We need to recognise that in the absence of ill health, our emotions govern our health.

This is precisely how poor emotional wellbeing leads to poor physical health. GPs have a term ‘MUS’ (medically unexplained symptoms) that occasionally appears on patient notes to signify that no explanation is known for a person’s symptoms or distress. This is where the placebo comes into play. A placebo works because people need to feel that what they are taking will make them better, and their emotional side makes this a self-fulfilling prophecy. It’s the same with the products we buy, and many consumers will swear allegiance to a product that ‘makes them better’, even when science suggests the claims are spurious.

None of this is easily explored by asking people about it. What an observational technique will tell you is how people feel at key points in the day. Consumers are rarely buying for rational reasons and health-related products are no different. As researchers, we must remember that simply asking consumers about their health-related decisions is unlikely to reveal the full picture.

Oliver Sweet is head of the ethnography unit at Ipsos Mori. He previously wrote Don’t shoot the messenger

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Readers' comments (3)

  • Interesting post. I would add that the intensity of emotions cannot really be captured through surveys or other traditional approaches. There is a reason why we look at novels and movies to help us understand the emotional complexity of human lives, the way we deal with loss, pain, and suffering. Not only do we need more ethnography in the area of health research but we need to think of research as a humanist endeavor.

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  • It is equally true that you can only find out what people are thinking and feeling by asking them. I don't get much out of watching someone reading a novel, watching a film, or buying a product, I can only understand the intensity of their emotions by asking them about it. When psychologists want to discover people's deepest hidden thoughts and feelings they don't follow them around with a camera, they sit them down and ask them. I can see that ethnography is more accurate for discovering behaviour, but emotions I think are more likely to be found in workshops or depths. As Wordsworth pointed out 'emotion recollected in tranquillity' is more powerful and influential than what is felt at the time.

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  • Sure Dominic. But obviously ethnography is not limited to observation and generally involves in-depth interviews. And in this case, I think I would not try to go for "emotions collected in tranquillity". Being there when a patient receives information about disease, or when they are going through a painful experience, is difficult to simulate or re-create, even through a retelling: “But who can remember pain, once it’s over? All that remains of it is a shadow, not in the mind even, in the flesh. Pain marks you, but too deep to see. Out of sight, out of mind.” Margaret Atwood,

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