Interrupted or invigorated?
Qualitative health research during the Covid-19 pandemic
Gemma Hughes and Sara Paparini from the Nuffield Department of Primary Care Health Sciences reflect on the work of the IRIHS group.
Members of the Interdisciplinary Research in Health Sciences (IRIHS) group gathered at an online workshop in January 2021 to consider how their work has changed during the pandemic. In the short time between planning the workshop and joining the Teams meeting on the day, the latest lockdown had been imposed in England in response to soaring numbers of Covid cases and deaths. Our attendance at the online workshop summed up 2020, a year of research interrupted. Interrupted by the mundane hindrances of WFH (working from home) with kids, families and pets and the life-changing experiences of isolation, illness and bereavement, our research has been challenged and changed. We connected online to discuss how we had adapted to the conditions imposed by the pandemic, the extent to which we had embraced new methods of undertaking qualitative research online and to start to identify theoretical work that could help account for and inform our future research practices. Some of our reflections on researching follow.
Adapting methods to continue with research
IRIHS researchers had to grapple with two kinds of challenges when the pandemic struck the UK: how to do qualitative health research in these conditions, and perhaps more importantly, whether to do planned research. NHS-based studies were paused to free up clinical capacity for surges of patients and research capacity to answer COVID-19 specific questions. IRIHS team members redeployed into clinical roles halted their own research. Others were left unable to proceed with their studies as planned as the typical methods of qualitative health research — ethnography, interviews, and focus groups — transformed from relatively low-risk activities to ones that were fraught with concerns about transmitting the virus. Some methods crumbled in the crisis, raising methodological problems and triggering profound questions of identity and purpose as long-term plans had to be let go.
Challenges played out daily in the to-and-fro of managing practicalities and facing more existential questions which arose not only from the threat of COVID-19 itself but from societal schisms the pandemic revealed in full colour. Lethal inequalities for Black and Asian people were exposed, and the world recoiled from the killing of George Floyd. Against this turbulent backdrop, work and home life merged for researchers trying to sustain their academic lives without their usual work or social support networks. The work required ranged from essential but mundane administrative work (updating paperwork for ethics committees, creating online consent processes) to grappling with more philosophical questions.
Adapting from face-to-face research to online methods sometimes paid off. Practically, lockdown made recruiting for some interviews easier. Whilst there were no opportunities to travel to observe participants’ homes or workplaces, interviews were easy to arrange and offered different kinds of interactions over longer periods — from advance emails arranging interviews to reflective afterthoughts. Conceptually, remote interviews offered an opportunity to deconstruct the processes of communication involved. Young homeless people engaged in Maryam Ahmadyar’s DPhil research on different terms that they would have done in person, offering an alternative rather than inferior way of generating data. Shifting rapidly from teaching in-person to a virtual learning environment for our team’s new MSc program was hard work, but an enlightening processes that offered new perspectives on the course materials and the balance between collective learning and self-study.
Addressing urgent research questions with online methods
Whilst some of our group were adapting methods to continue with planned research, others rapidly established new studies of different aspects of COVID-19 using digital tools. Digital studies led by IRIHS include evaluating the ‘Your Covid Recovery’ website and studying video consultations. Researching remote provision of care remotely raised technical and ethical challenges which, even with the requisite protocols in place, were not easily overcome. Observational data is readily accessed when researchers are present, problems with video or other technology are part and parcel of the dataset. But when remote consultations fail to take place, no data is produced for the remote researcher.
Trish Greenhalgh led the development of an early warning score for primary care, rapidly mobilising online Delphi panels (a method for working towards consensus and mapping areas of non-consensus) to develop a remote assessment (RECAP: REmote COVID-19 Assessment in Primary Care) for patients with suspected COVID-19. For this work to be timely, the pace had to be really pushed, reflecting the benefits of a rapid approach to qualitative research such as that pioneered by the Rapid Research Evaluation and Appraisal Lab (RREAL).
Examining online life
Taking a more reflexive approach to the experience of conducting online research and online life led us from epistemological questions (such as: how can we learn about people’s experiences through the medium of remote research? how can we know the best way to assess patients remotely?) to ontological questions (what is it to be online? What are the components of digital life? What is the infrastructure that enables us to connect remotely?). The experiences of conducting qualitative interviews by video stimulated reflections on the nature of reality, and of the nature of presence. Lucy Moore reflected on how video interviews create new ways of framing ourselves. We present and represent ourselves online in particular ways, creating new relationships with our real and imagined backgrounds. Thinking about Goffman’s representation of the self draws attention to the new forms of etiquette that are required to manage the technological glitches and delays whilst participating in the performance of social selves.
The experience of living life online warrants both theoretical and empirical investigation. Metaphors can help us think about these experiences. When we look at our screens we might think of them as like a window, providing a view into someone else’s world. The window can, like a dirty window which obscures our view, interrupt the interactions that would otherwise happen when we are physically co-present. We can also think about online meetings as taking place in a virtual space. Like any space, virtual rooms are shaped by power relations and produced from infrastructure. If we are to examine these phenomena, we need to theorise about the relationships between people and things, networks and infrastructure to understand how digital life emerges.
We have all been deeply affected by the pandemic. IRIHS researchers’ experiences have been diverse. Some found a period of enforced reflection and quietude in lockdown. Others were submerged in caring responsibilities, and yet others rapidly mobilised to address critical questions. We conclude that this period is not one that will simply pass, but one that will continue to shape how we investigate and experience the world on, and off, line.
With thanks to all the presenters, facilitators and note-takers from our workshop:
Claire Reidy, Jackie Walumbe, Maryam Ahmadyar, Anne Ferrey, Trisha Greenhalgh, Michelle van Velthoven, Alex Rushforth, Lucas Seuren, Lucy Moore, Sara Shaw, Mona Koshkouei, Jeremy Leslie-Spinks, Julian Treadwell, Melissa Little.
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