Learning to Look, Learning to See Using Ethnography to Develop Cultural Sensitivity Features
Features  |   March 01, 2003
Learning to Look, Learning to See
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Development / Cultural & Linguistic Diversity / Attention, Memory & Executive Functions / Features
Features   |   March 01, 2003
Learning to Look, Learning to See
The ASHA Leader, March 2003, Vol. 8, 6-15. doi:10.1044/leader.FTR1.08052003.6
The ASHA Leader, March 2003, Vol. 8, 6-15. doi:10.1044/leader.FTR1.08052003.6
Ten years ago at the University of Washington, we began talking about how to provide culturally sensitive services in our professions. As diversity became a more familiar topic, we were faced with these questions: How do we move from talking about cultural diversity to learning specific skills? How do we go beyond “general awareness” of culture to “cultural sensitivity”?
To answer these questions, we developed a project for undergraduate students to explore cultural variables through research. We chose to focus on ethnographic research, a methodology for observing behaviors in context and understanding them in terms of culture. We hoped that the process of doing ethnographic research would excite the students about research, teach them usable skills, and increase their interest in other cultures.
The outcomes of the project went beyond our expectations. To share our experience and help individuals learn and apply the methodology in clinical settings, we present this brief introduction—in the form of a tutorial—to the ethnographic research methodology we found to be so powerful. It is our hope that readers will adapt the material for their own pedagogic, clinical, or research needs.
Ethnography: An Overview of Elements
Ethnography is a qualitative research method appropriate for studying culture as defined by cultural practices—that is, actions that can be observed. These actions reflect what is routine, normative, and valued by a group of people. As a procedure for interpretation of what can be observed, ethnography is an ideal framework for examining culture.
Ethnographic research focuses on gathering data through naturalistic observation. The ethnographer’s goal is to observe as much as possible about a situation, avoiding early hypotheses that might bias the observations. Following detailed objective observation, with attention to subjective beliefs, the observer attempts to interpret and explain the data to reach conclusions. The primary elements of ethnographic methodology include participant observer, thick description, interpretation, and conclusions.
Participant observer refers to the fact that the observer always becomes part of the context and thus, to some degree, a participant. Typically, the goal is to be as passive and unobtrusive as possible to avoid influencing the behavior of others, although more active participation also may occur.
Thick description refers to the detailed, rich account of what is observed. The observer keeps field notes, which are a log of objective and subjective comments. Objective notes describe the setting, participants, materials, and activities as they unfold before the observer. The subjective notes, written in brackets, include feelings and personal thoughts. All of the senses need to be engaged for the thick description, so that a detailed picture can be drawn and the context fully captured. The complete thick description constitutes the raw data for the research.
For example, one might observe a mother watching her child in a treatment session. An objective description might say, “The mother looks directly at the child and therapist who are reading a book together. Her eyes are wide open; she leans forward.” Subjective information would add to this: “[The mother appears interested, engaged. Perhaps she is attempting to learn therapeutic strategies].”
Interpretation is examination of the raw data for themes and patterns. The observer comes to the ethnographic observation with a general question or topic in mind. This question, driven by knowledge from the literature, leads to a filter through which the observer interprets the raw data by looking for themes and patterns related to the topic of interest. For example, in child language, an observer interested in pragmatics might want to examine a preschool child’s ability to enter peer groups. After completing observations, the observer would examine the thick description for behaviors that signal patterns in “peer entry” behaviors (e.g., waiting and hovering, using a nonlinguistic strategy as a prop to enter a peer group, and/or using a linguistic strategy to enter a peer group).
Conclusions are the final element of the ethnographic methodology. Following interpretation, the observer gathers together patterns and themes and draws conclusions. These form a summary of the interpretation and should speak directly to the question that drove the observation in the first place.
Application: The Project and Our Work With Students
As part of a year-long project involving multicultural study, four undergraduate students conducted a qualitative research study using ethnographic methodology. The students focused on families with young children who were receiving services at an early intervention center (speech-language and motor treatments). Through preliminary observations and background reading, the students formulated the research question: “How do parents participate in treatment sessions?” In other words, the students asked, “What behaviors do we see that we recognize as participation?” Note that the question was not about culture per se. The expectation was that this topic would be influenced by culture. Subjects for their study were two Anglo American families and four Mexican American families. We use examples from this study throughout the tutorial to illustrate the different components of the methodology.
Tutorial: Learning the Methodology
Following are steps we designed for our students to practice and implement ethnographic methodology. These steps do not follow classic procedures for ethnographic research, but provide a foundation for individuals new to the methodology. The tutorial is organized in three parts: developing observation skills (practice and implementation), moving to interpretation, and conclusions (bringing in culture).
Developing Observation Skills: Practice
  • Arrange a context for observation. Practice with both live and videotaped contexts. A live context is vivid, full of competing sights and sounds as well as emotional tensions. It gives a direct connection to what you are observing and makes more real your role as observer-participant. Videotaped observations separate you from the context, but they let you observe and write without disturbing your subjects. Consider working with a partner and using videotaped events to learn the skills. After you both complete the observations, review your thick descriptions to identify similarities and differences. Help each other monitor language for objective descriptions. If subjective impressions start to creep in as unbracketed observations, ask, “What did I see that made me feel/think that way?”

  • Start by observing broadly on a topic of interest rather than narrowing your perspective to a specific question. Train yourself as an observer to be as free of preconceived notions as possible. Be open to seeing anything that might be there, not just things you would expect to see. For example, you could plan to observe “how children interact on the playground” or “how spouses [of clients] respond during feedback sessions.” Our students chose to investigate “how parents participate during treatment sessions.” These are broad topics, not hypotheses. They serve to focus the observation, but not to limit or bias it.

  • Observe for at least 15 minutes at once. Plan to observe continuously. This will help you observe meaningful events and develop the skills of maintaining attention, using objective language, and recognizing subjective impressions. It is also instructive to experience how tiring continuous looking and writing can be.

  • Begin your thick description. Start by describing or drawing the environment, the participants, and the physical arrangement of people in the context. Remember, you are describing behaviors in relation to the context , so having a clear record of the context is important. Continue your thick description with objective and subjective notes. Write continuously, without screening thoughts, revising, or worrying about details of grammar or spelling.

  • Focus on what you see and hear (objective notes). Remember to use specific language that describes behaviors of individuals in context. For example, imagine a mother who is standing to the side of a room, apart from activity between a clinician and a child. An objective description might say, “Mother stands with her arms crossed, against the side wall, away from child and therapist; mother glances away for short times but then looks again at child.” This is quite different from the statement, “Mother is not interested in treatment,” which is an interpretation and judgment, neither of which can be directly observed.

  • Stay alert to your thoughts, feelings, and reactions (subjective notes). Subjective impressions are an important kind of data in ethnography. Put subjective impressions in brackets. The goal is not to suppress or exclude these thoughts, but to distinguish them from the objective observations. Later, you will use both the objective observations and subjective impressions to interpret the data. Subjective impressions might include “I wonder if this mother is sick today,” “Mother appears to really trust this clinician,” and “It must be hard for mom to have to wait for the interpreter every time.”

Developing Observation Skills: Implementation
When you have completed multiple observations for practice and have become adept with the thick description, you are ready to begin implementation. Choose a topic or question and identify contexts for observation. Collect thick descriptions from your context of interest to serve as raw data for interpretation. The number and length of observations will vary according to what you are studying. Implementation of the thick description should parallel the practice: focus on what you see and hear (objective notes) and stay alert to your thoughts, feelings, and reactions (subjective notes).
Moving to Interpretation
To assist students, we developed a series of steps that led from the thick description to the interpretation.
1. Summarize each observation and identify variables. Look through your observations and reflections for behaviors and comments that stand out as interesting. Recurrent behaviors become variables of interest. Identifying variables became an important step leading to interpretation of patterns and themes. Variables were identified as follows:
  • After each observation session, the students listed the key behaviors and impressions that emerged from their thick descriptions. For a given observation, they looked for highlights or repeated entries regarding behaviors and impressions, such as, “Mother watched child continuously; answered clinician’s questions with short responses; talked to interpreter quietly, without interpreter translating into English [mother seemed interested but reserved].”

  • By looking across the reviews of the different observations, students noted entries they made repeatedly, and they labeled the behaviors as variables. For example, they always described where a parent sat in relation to the child and clinicians, and they named this variable “space.” They always noted whether a parent looked at the child and/or clinician and what the expression was, and they named this variable “facial.” They observed that some parents acted in ways that related to the treatment (handing a child a scoop to use with beans), and some acted in ways that related to being a parent (wiping a nose). They named these variables, respectively, “action-treatment” and “action-parenting.” They noted the frequency and extent of talking by the parent, and they named this variable “verbalization.”

2. Make a summary sheet of your variables and organize the data. Create a form for the variables you identified. Write a description by each variable that captures the behavior observed. For example, by the variable “space,” students wrote, “Mom sat at a distance during most of session” or “Mom sat close to child and clinician except during walking practice.” For the variable “verbalizations,” they wrote, “Mom answered questions with short responses; never initiated” or “Mom gave elaborate answers to questions and introduced new topics.” Not all observations had equal numbers of comments; for example, during some observations, there were no “action-treatment” descriptions.
3. Form your interpretation by looking for themes that emerge from the variables. Themes are patterns that emerge from the thick descriptions, incorporating both objective and subjective notes, and comprising the observer’s interpretation. For example, our students noted a pattern that spoke of high engagement/high involvement in a session. It involved the variables space, facial, action-treatment, and verbalizations (sitting close, looking and smiling consistently in session, initiating actions-treatment, initiating questions, providing elaborated responses). This pattern was called “active participation.” The students noted another pattern that spoke of lower engagement/lower involvement in the session (sitting at a moderate or far distance, looking intermittently and smiling only occasionally, having no action-treatment behaviors and only a few short verbalizations in response to questions). This pattern was called “low participation.” A third pattern also emerged, which involved high engagement as shown by space and facial variables but lower involvement as shown by action-treatment or verbalization variables. This pattern was called “quiet participation.”
Conclusions: Bringing in Culture
Up to now we have made little mention of culture, despite our interest in using ethnography to improve cultural sensitivity. The essence of our approach was to complete observations without reliance on information about culture in order to avoid expectations that could bias perceptions. Now, following interpretation, was the time to bring in culture. Examining culture became part of conclusions , the final element of the ethnographic methodology.
Remember that our students were interested in “how parents participate” (what behaviors signaled participation). The students anticipated that participation would be influenced by culture, but they refrained from stating expectations about Mexican American vs. Anglo American parents. Instead, they completed thick descriptions and identified patterns. Then they asked, “How might the different patterns we observed among the families be affected by culture?”
This was the time to bring in knowledge about culture and to ask how a family’s cultural experience might shape a participation style. For example, depending on culture, a family may not be concerned about the pace of a child’s development or may not wish to involve an outsider in family matters. These attitudes could make it uncomfortable for a family to be in a clinical environment and participate actively. A family may regard the clinician as an authority and thus may avoid participating out of respect for the clinician’s role. By relating cultural knowledge to the specific observations, the students saw how the parents’ behavior was a complex expression encompassing culture and experience and that the meaning behind behavior was not immediately apparent.
Final Thoughts
Why were we so excited about the project? What emerged that led us to want to share the methodology? The answers to these questions lie in the two different ways the methodology yielded benefits. First, and perhaps to be expected in light of the research foundation, was the way structure assisted the students. The methodology gave the students a systematic way to focus attention within complex contexts, organize and interpret data, and ask questions about cultural influences. Using the ethnographic methodology taught the students how to study behaviors in real contexts, leading to variables that were important clinically and likely to be influenced by culture.
Second, and germane to the issue of cultural sensitivity, was the learning process itself. To learn thick description, students had to practice using objective language and to separate what they saw and heard from what they thought or felt in response to the events. This taught them to be good observers, to rely first on objective information, and to refrain from judgments or premature interpretations that could be fueled by subjective opinion. They learned about how their personal history, including culture, influenced their expectations, beliefs, and observations. They saw how easy it was to perceive events from their own cultural filter, and how a conscious effort was needed to change that filter. As a result, they made visible their biases, challenged their assumptions, and avoided easy interpretations. They became highly respectful of the importance of careful thick description before interpreting what they saw.
As the students completed their project, we saw the culmination of their work in how carefully they used language to describe what they saw and how seriously they took the need for clear interpretation. They understood that behavior could have different meanings depending on one’s cultural perspective, and that misinterpretation and bias could alter research results or clinical decision-making. We saw the students’ changes as evidence that the training in ethnographic methodology had become a vehicle for the development of cultural sensitivity.
Judith R. Stone-Goldman and Lesley B. Olswang are members of the department of speech and hearing sciences at the University of Washington. Their project was supported in part by a grant from ASHA Projects on Multicultural Activities. The authors also acknowledge grant participants Stephanie Bor, Kari Hunnicutt, Setsuko Murakami, and Katie Vornbrock, as well as graduate assistants Megan Black and Leslie Parker, and extend thanks to the families and therapists at Children’s Therapy Center in Kent, WA. Contact Stone-Goldman by e-mail at jsg@u.washington.edu.
Summary Sheet

A summary sheet developed for interpretation, showing variables and description from one observation.

  • Variable, Description
  • Space, Mom sat close by above - on mat table above S., SLP, OT
  • Facial, Quiet expression, some smiles, eyes on S. intensely
  • Body, Oriented toward S. and activity
  • Verbal: parent initiated, Brought up issue about glasses (S. throws them off at home)
  • Verbal: parent response, Answered questions with simple responses. Responded to interpreter.
  • Verbal: mutual engagement, Clapped along with SLP and gave praise at same time (“muy bien”)
  • Actions: treatment, Showed picture when given book by SLP
  • Actions: parenting, Straightened S.’s glasses, rubbed back, soothed, talking to her in quiet Spanish
  • Actions: other, --
  • Interpreter, Present; talking directly to mom sometimes
  • Environment, Large room, other family in corner; quiet
  • Type of treatment, Speech and occupational therapy (OT); play-based co-treatment
  • Diagnosis, Seizure disorder; developmental delays (speech, motor, cognitive)
  • Other, Family here 11 months from Mexico; monolingual Spanish
Thick Description

Below is a thick description excerpt from a treatment session involving a 34-month-old child (S.), mother, speech-language pathologist (SLP), occupational therapist (OT), and interpreter.

mom sitting at right of mat table

  • mat table

SLP child OT (S.) interpreter

SLP and OT [Occupational therapist] working with S. by mat table; mom sitting right above S. S. knocks glasses off at home. OT looks to see if elastic band fits. OT tells S. to stand longer, S. cries [it does seem like a really long time for her]. Mom strokes her back, murmurs Spanish words. Interpreter says something to Mom but doesn’t translate. OT says, “OK, time to sit.” S. sits facing SLP, who has book with pictures. SLP starts song about picture—a boat. S. uses a quiet voice to attempt to sing. After song, Mom claps along with SLP and says, “muy bien” and SLP says “bravo” [is that Spanish?—she said it before too]. Mom shows S. picture for next song. [I wonder if Mom would join in more if there were a Spanish song]…

What Is Ethnography?

As speech-language pathologists and audiologists, we are trained observers of communication behavior. Our training has traditionally taught us to compare our observations to a set of behaviors that we’ve categorized as “normal.” “Normal,” however, is relative. What may be considered within the norm for one group of people may not be “normal” for another group. Ethnographic research allows us to document what “normal” looks like for a given community.

Ethnography is a qualitative research methodology, as well as the product of such a methodology. When we undertake an ethnographic approach to describing communication within a given community, we are referring to the exploration or description of who communicates with whom, how, to accomplish what, and under what circumstances. The intent is to identify commonly accepted conventions for communication within that community. By its nature, ethnography is both descriptive and subjective, but is still deemed valuable, because it can provide natural, spontaneous, and realistic data. It allows us to develop a clear picture of what’s valuable, relevant, and important to our clients.

Ethnographic research can be used to show the differences between reality and the expectations or assumptions of those outside of a specified community. The approach to this research can be emic, which allows us to gain an understanding of others’ culture by providing an “insider’s perspective,” or etic, which describes behaviors as those outside a community view them.

Critical to an ethnographic approach is the notion that the researcher is documenting or describing what exists, without making judgments about the validity of those behaviors. Care must be taken to make sure the investigator understands that bias can be introduced simply by observing, so it is often necessary that the researcher become an accepted part of the community in order to effectively collect data. It is also critical to note that the observer is not looking for anything in particular, but simply looking. The ethnographic process generally includes defining the community, gaining acceptance, identifying the cultural variables to be studied, identifying viable informants and conducting interviews, and then interpreting the data.

As the diversity of our client base continues to grow, our service delivery models need to be increasingly responsive to cultural differences. Professionals in our discipline must grow more capable in alternative approaches to acquiring data—such as ethnography—as a means of increasing cultural competence and our ability to provide appropriate services to all clients.

—Vicki Deal-Williams

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March 2003
Volume 8, Issue 5