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Cross-cultural comparative research methods workshop
Kuopio, Sept. 2011Prof. Edwin van Teijlingen
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Is cross-national research possible?
“Holland differed enormously from other countries …. also in
its arrangements for childbirth… It is difficult, given
these factors, to find bases for comparison. In
attempting to explain such differences, we are also drawn
inevitably into an analysis of Dutch society and economy,
educational provisions ... the culture surrounding childbirth
…” Lieburg van M.J. & Marland, H. (1989) Medical History 33: 296-317
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Overview
Traditional approaches to comparative research / cross-national studies.
Decentred Comparative Research
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Strengths comparative research
• You learn to question your own ways of doing things from observing the “strange” ways of others.
• You can (may) study approaches which have not been considered in certain countries, for example, “looking at the problems from a different angle, questioning present practices, raising warnings as to possible negative effectiveness”
(Collins et al. 2000: 97).
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Traditional approaches
Types of comparisons:• Over time;• Between geographical areas;• Between populations within a
community / society• Between countries / cultures
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Comparisons over time
Figure 1. Average life expectancy
47.2
54.2
61.6
69.1
76.3
62.966.5
69.373.3
80.580 80.4 80.5 81.383.7
40
50
60
70
80
90
Birth 1 15 45 65
Age of woman
Exp
ecte
d ag
e at
dea
th
188819301999
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Comparisons by sub-group in population
Girls in developing countries are generally disadvantaged in the education system:
• less likely in secondary education than boys;• those in rural areas are particularly
disadvantaged;• but, today’s adolescent girl is 2 to 3 X more
likely to receive an education than her mother.
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Comparing at different levels
Example I comparison between countries
Example II comparison between regions
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Problems with epidemiological data
• Data sets differ between areas; • Data are collected for a different reason, often they do no
exactly address our research question;• Definitions of topic under research vary between areas;• Cultural differences in interpreting survey questions
introduces differences in the data sets;• Data sets are incomplete/ missing data;• Response rates to survey underpinning data sets varies;
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Overview
Traditional approaches to comparative research / cross-national studies.
Decentred Comparative Research
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Introduction / aim of BBD
The main goal of this international
project was to bring together
researchers located on both sides
of the Atlantic, who, until that
time, had almost exclusively
focused on issues pertaining to
maternity care within their own
academic disciplines and national
boundaries.
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Shaping a Network of Local Researchers
BBD brought together researchers from two
continents and 9 countries;
while some had done two-country
comparisons, BBD involved comparisons
of up to four countries at a time;
examining everything from the training of
maternity care providers to public policy,
to attitudes of women about desirable
care.
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What is main task of the state in the provision of maternity care?
?Culture & Society
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Main task of the state?
Americans replied: "To ensure that individual women have freedom of choice” and "to make choice available for childbearing women".
Europeans: "to ensure that the poorest women in society have access to a reasonable quality of maternity care" and "to ensure that all women have access to good maternity care".
... we were talking from our own culturally colored perspectives.
(DeVries et al. 2000: xvi)
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Cause or effect?
“We do not wish to discount the role of clients in
the creation of maternity care systems, but we
are keenly aware that opinions about health
care are as much a product as a cause of that
care.”DeVries et al. (2001) ‘What (and why) do women want?’
In: Birth by Design, Routledge, NY, p. 244.
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Comparative studies in maternity care
Structural: • organisation of health care, welfare state,
politics, law, economy, etc.
Cultural: • attitudes, general views, expectations of a
population, ‘the way things are done here’, etc.
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Lessons BBD
• When we began our work together, our natural inclination as sociologists was to look for structural explanations for the variation we discovered – the tradition in the field of medical sociology is to use differences in social structures to explain varied health care delivery systems.
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Lessons BBD
• Structural explanations were insufficient: they simply push the question back one level. For example, our research uncovered important differences in the power of professional groups to influence health care policy – differences that had significant influence on how maternity care was delivered.
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Problematising Terminology
Comparing like with like?
• Trained nurse-midwife
• Direct-entry midwife (NB: UK vs US meaning)
• Midwifery assistant / maternity care assistant
• Maternity benefits
• Economic migrant
• etc.
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Comparative studies
• Cross-national research helps one to look at problems from a different angle, questioning current practice, warn against side effects, etc. I.e. there exist ways of doing things which have not been considered in the UK (or Germany or Finland or …..) .
• Cognitive psychology recognises that cognition is a situated process and that knowledge is a collaborative, culture-bounded effort.
Comparative research
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Decentred method Ikey aspects:
• add context to seemingly context-free concepts. • challenge ethnocentrism in cross-national
research.• all contexts are perceived as problematic & in
need of explanation.
• team of scholars rooted in multiple communities.
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Decentred method II
BBD used decentred method to fashion a
multilevel framework that used meso level of
organization (i.e., health care organizations,
professional groups and other concrete
organizations) as an analytical point. Our
method departs from traditional comparative
health systems research that is mostly
conducted at the macro level.
Macro
Meso
Micro
Decentred comparative research – addresses the often
unacknowledged ethnocentrism of traditional
comparative research. Decentred cross-national
research draws on the socially-situated and distributed
expertise of an international
research team to develop key concepts & research
questions.
Decentred method III
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“International collaboration, if pursued more
systematically, is a strategy for individual
researchers to become more cosmopolitan
in their reflexivity….”
Decentred method IV
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Recent example
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Salway et al. (2011) I
Salway and colleagues adopted: “… frameworks that encompass both
national-level contextual specificity and universal patterns or trends [Hantrais 1999; Wrede et al. 2006].”
“We adopted approach that did not seek to impose standard concepts or measures (something we felt was neither conceptually nor operationally feasible) but rather to work with the national peculiarities of our three countries.”
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Salway et al. (2011) II
• We worked “with and against the established discourses …to understand …migrant/minority groups and the implications for maternal health. Such an approach offered potential for important new insights.
• BUT moving beyond accepted concepts and terms may create problems at a country-level. We … need to engage with local stakeholders and to generate research products that were meaningful and applicable to these actors; suggesting the importance of employing familiar concepts and terminology.”
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Final Note: Culture
Sharing a culture does not mean people are in agreement on specifics, only that they possess a similar understanding of how the world works.
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ReferencesBenoit et al., 2005, Understanding the social organisation of maternity care systems, Sociol Health
Illness 27: 722-37.
Collins et al. (2000) NHS reforms in UK & learning from developing country experience. J Man Med, 14: 87-99.
DeVries, R, et al. (eds..), 2001, Birth by Design: Pregnancy, Midwifery Care & Midwifery in North America & Europe, NY: Routledge. [ISBN 0-4159-23387]
Galtung, J., 1981, Structure, culture, and intellectual style, Soc Sci Information 20(6): 817-856.
Hantrais L (1999) Contextualisation in cross-national comparative research. Int J Soc Res Meth 2(2):93-108
Lieburg van MJ & Marland, H, 1989, Midwife regulation, education, and practice in the Netherlands during the Nineteenth Century. Medical History 33: 296-317
Lupton, D, 1994, Medicine as Culture: Illness, disease & the body in Western Societies, London: Sage
Payer, L., 1990, Medicine & Culture, London: Victor Gollancz Ltd.
Wrede, S., et al. (2006) Decentered Comparative Research: Context Sensitive Analysis of Health Care, Soc Sci & Med, 63: 2986-2997.
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Cross-cultural comparative research
methods workshop
Thank you!Edwin van Teijlingen