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Ethnography and participant observation have long made important contributions to social scientific understandingsof aging and the life course. For instance, classic and contemporary field studies have examined aging in urban enclaves; charted how culture and identity shape growing older; shown how institutions designed to serve elders are organized; and explained how aging is shaped by and reveals broader patterns of social inequality. Yet the prominence of field research lags behind other methodological approaches to studying aging. This chapter explains why a fuller integration of participant observation and ethnography is not only useful, but necessary, for advancing social scientific understandings of aging and the life course. Specifically, it: (1) explains why ethnographic approaches are fundamental to contemporary social science; (2) articulates the goals and uses of participant observation as a social scientific method; (3) illustrates how ethnography and participant observation can advance key topics in aging; (4) provides examples of classic and contemporary ethnographies of aging that do so; and (5) offers suggestions for encouraging high-quality future field studies on aging and the life course.

The specter of positivism looms large in both the discussion and the practice of sociological research. Ethnographic traditions such as grounded theory and the extended case method have long emphasized how their approaches provide a critical alternative to the typically quantitative approaches grounded in the conventional scientific tradition (CST) descendent from positivism. In contrast, this chapter takes a different approach by showing how and why an approach to participant observation drawing on behavioralist principles serves a necessary and irreducible role in the realist variable-based approach that has succeeded positivism as the standard for mainline social science. However, addressing CST concerns about validity, generalization, and replication involves more than a symbolic gesture toward these issues or critiques of other methods. Participant observers must employ a rigorous approach to multisite sampling, leverage comparison, and employ reproducible observational techniques to systematically analyze continuity and variation in human behavior. While acknowledging that this can be difficult in the current intellectual environment, this chapter argues that the payoff is substantial—when done well this form of ethnography provides unparalleled resources for observing causal mechanisms in situ, producing robust models that link micro-, meso-, and macro-level social processes, and reducing inferential error in explanations of behavioral patterns.

Following the argument for the importance of comparative participant observation for approaches descendent from the conventional scientific tradition (CST), this chapter outlines how the behavioralist foundations summarized in chapter 1 translate to procedures and techniques for charting causal mechanisms in comparative ethnographic research. The chapter begins by examining the practices and techniques of the behavioralist approach in detail and describes the mode of research design, sampling, data collection, analysis, and explanation associated with this approach, giving examples from prior empirical works. The chapter then turns to longstanding concerns about ethnographic reliability and replication and explains how this approach addresses them. In doing so, it shows how behavioralist criteria align with, and diverge from, other methodological approaches to the collection, analysis, and extension of ethnographic data. The chapter concludes by explaining the contributions that can be made by repositioning participant observation within the spectrum of approaches to understanding causal processes in the social sciences.

In this chapter, eminent ethnographer and cognitive sociologist Aaron Cicourel shares insights gleaned from using ethnographic methods for the past six decades. In conversation with Corey Abramson, Cicourel addresses a number of important issues about both the practice of comparative ethnography and the academic contexts in which it takes place. Cicourel argues for attentiveness to an often-overlooked strength of comparative ethnography—the way cross-site ethnographic comparisons can be used to chart not just variation, but comparatively invariant aspects of human behavior in a way that captures real-time, localized behavior and language use. Cicourel explains how his approach consequently draws upon diverse traditions ranging from cognitive linguistics to behavioral ecology to produce a more integrated form of comparative sociology that encompasses multiple levels of social and physical reality. In the process, Cicourel proceeds to voice his current position on topics including approaches to comparison, ecological validity and levels of analysis, language use, the historical connection of his approach to ethnomethodology, team science in contemporary academia, analogical and digital approaches to inquiry, the role of theory, and what he hopes future ethnographers will learn from his career.

This introductory chapter examines the methodological and practical challenges that comparative ethnographers face. It begins by discussing both the promises and potential pitfalls of comparative field research. It then moves to an examination of how ethnography’s unusually diverse set of traditions provides both unique challenges and possibilities for comparative social science. The chapter proceeds to chart the various ways in which ethnography’s historically diverse traditions translate into divergent approaches to comparison in contemporary research. This is followed by an overview of the structure of the volume, which explains how each of our contributors’ chapters advances comparative ethnographic methodology. The chapter concludes with a discussion of why acknowledging, maintaining, and utilizing ethnographic pluralism, rather than pushing for a single catch-all approach, can benefit both individual scholars and the field of ethnographic methodology more broadly.

This volume is guided by the goal of productive pluralism—the simple notion that even though ethnographic approaches may be partially incompatible with one another, the field as a whole benefits from diverse contributions to understanding social life. Beyond a mutual tolerance that leaves ethnographers in their silos, such a pluralism supports sustained scholarly dialog to clarify points of disagreement as well as illuminate opportunities for collaborative problem-solving. To this end, this volume has included works from prominent scholars representing various traditions to articulate what, why, and how they engage in ethnographic comparison. This concluding chapter contextualizes the contributions of the authors, pointing to both divergences and (perhaps) surprising synergies in the ways they approach ethnography. The chapter begins by considering the basic questions of how and why the contributors perform comparison. Having summarized the approaches, the authors discuss specific comparisons of research processes, research products, and the criteria used for evaluating both. The chapter concludes by suggesting how these synergies open the possibility for a chance to address further concerns in comparative methodology.

PURPOSE: Patients with advanced cancer and oncologists deliberate about early-phase (EP) trials as they consider whether to pursue EP trial enrollment. We have limited information about those deliberations and how they may facilitate or impede trial initiation. This study describes these deliberations and their relationship to trial initiation. PATIENTS AND METHODS: We collected longitudinal, ethnographic data on deliberations of patients with advanced cancer at two academic medical centers. We used constant comparative and framework analyses to characterize the deliberative process and its relationship to trial initiation. RESULTS: Of 96 patients with advanced cancer, 26% initiated EP enrollment and 19% joined a trial. Constant comparative analysis revealed two foci of deliberation. Setting the stage focused on patient and physician support for EP trial involvement, including patients’ interest in research and oncologists’ awareness of trials and assessment of patient fit. Securing a seat focused on eligibility for and entrance to a specific trial and involved trial availability, treatment history, disease progression, and enrollment timing. Patients enrolled in a trial only when both stages could be successfully navigated. CONCLUSION: Ethnographic data revealed two foci of deliberation about EP trial enrollment among patients with advanced cancer. Physician support played a consequential role in both stages, but enrollment also reflected factors beyond the control of any specific individual. Insights from this study, combined with other recent studies of trial enrollment, advance our understanding of the complex process of EP trial accrual and may help identify strategies to improve rates of participation.

This article argues the advance of computational methods for analyzing, visualizing and disseminating social scientific data can provide substantial tools for ethnographers operating within the broadly realist ‘normal-scientific tradition’ (NST). While computation does not remove the fundamental challenges of method and measurement that are central to social research, new technologies provide resources for leveraging what NST researchers see as ethnography’s strengths (e.g. the production of in situ observations of people over time) while addressing what NST researchers see as ethnography’s weaknesses (e.g. questions of sample size, generalizability and analytical transparency). Specifically, we argue computational tools can help: (1) scale ethnography, (2) improve transparency, (3) allow basic replications, and (4) ultimately address fundamental concerns about internal and external validity. We explore these issues by illustrating the utility of three forms of ethnographic visualization enabled by computational advances – ethnographic heatmaps (ethnoarrays), a combination of participant observation data with techniques from social network analysis (SNA), and text mining. In doing so, we speak to the potential uses and challenges of nascent ‘computational ethnography.’

Purpose The treatment decisions of melanoma patients are poorly understood. Most research on cancer patient decision-making focuses on limited components of specific treatment decisions. This study aimed to holistically characterize late-stage melanoma patients’ approaches to treatment decision-making in order to advance understanding of patient influences and supports. Methods (1) Exploratory analysis of longitudinal qualitative data to identify themes that characterize patient decision-making. (2) Pattern analysis of decision-making themes using an innovative method for visualizing qualitative data: a hierarchically-clustered heatmap. Participants were 13 advanced melanoma patients at a large academic medical center. Results Exploratory analysis revealed eight themes. Heatmap analysis indicated two broad types of patient decision-makers. “Reliant outsiders” relied on providers for medical information, demonstrated low involvement in decision-making, showed a low or later-in-care interest in clinical trials, and expressed altruistic motives. “Active insiders” accessed substantial medical information and expertise in their networks, consulted with other doctors, showed early and substantial interest in trials, demonstrated high involvement in decision-making, and employed multiple decision-making strategies. Conclusion We identified and characterized two distinct approaches to decision-making among patients with late-stage melanoma. These differences spanned a wide range of factors (e.g., behaviors, resources, motivations). Enhanced understanding of patients as decision-makers and the factors that shape their decision-making may help providers to better support patient understanding, improve patient-provider communication, and support shared decision-making.

When making health care decisions, patients and consumers use data but also gather stories from family and friends. When advising patients, clinicians consult the medical evidence but also use professional judgment. These stories and judgments, as well as other forms of narrative, shape decision making but remain poorly understood. Furthermore, qualitative research methods to examine narrative are rarely included in health science research. We illustrate how narratives shape decision making and explain why it is difficult but necessary to integrate qualitative research on narrative into the health sciences. We draw on social-scientific insights on rigorous qualitative research and our ongoing studies of decision making by patients with cancer, and we describe new tools and approaches that link qualitative research findings with the predominantly quantitative health science scholarship. Finally, we highlight the benefits of more fully integrating qualitative research and narrative analysis into the medical evidence base and into evidence-based medical practice.

Recent methodological debates in sociology have focused on how data and analyses might be made more open and accessible, how the process of theorizing and knowledge production might be made more explicit, and how developing means of visualization can help address these issues. In ethnography, where scholars from various traditions do not necessarily share basic epistemological assumptions about the research enterprise with either their quantitative colleagues or one another, these issues are particularly complex. Nevertheless, ethnographers working within the field of sociology face a set of common pragmatic challenges related to managing, analyzing, and presenting the rich context-dependent data generated during fieldwork. Inspired by both ongoing discussions about how sociological research might be made more transparent, as well as innovations in other data-centered fields, the authors developed an interactive visual approach that provides tools for addressing these shared pragmatic challenges. They label the approach “ethnoarray” analysis. This article introduces this approach and explains how it can help scholars address widely shared logistical and technical complexities, while remaining sensitive to both ethnography’s epistemic diversity and its practitioners shared commitment to depth, context, and interpretation. The authors use data from an ethnographic study of serious illness to construct a model of an ethnoarray and explain how such an array might be linked to data repositories to facilitate new forms of analysis, interpretation, and sharing within scholarly and lay communities. They conclude by discussing some potential implications of the ethnoarray and related approaches for the scope, practice, and forms of ethnography.

Despite the rapidly growing ranks of the elderly in America, the increasing racial and ethnic diversity of this population, and the large number of seniors who are poor, there are relatively few systematic investigations that examine the causes of racial differences in health care use specifically among elders living in poverty. This article addresses this issue by examining differences in patterns of having and using a physician among the elderly poor, the role that race plays and what might explain it. We demonstrate that even within this disadvantaged and medically engaged population there are persistent and significant racial differences in having and using a doctor. Specifically, we show: (1) Whites and women are more likely to have a regular doctor than men and African Americans; (2) Among those who have a doctor, whites and women also visit the doctor with greater frequency than other groups even at the same levels of health or illness; (3) After accounting for the varying levels and effects of social connectedness, racial differences in having a doctor essentially disappear; and (4) While differences in having a regular doctor can be accounted for using measures of social connectedness, substantial and robust racial and gender differences in doctor use remain. In the end, we provide an analysis that examines typical factors known to influence health care use, and find that while need, structural factors, perceptions of care, and social connectedness have a powerful effect on doctor visits, the racial variation in using a doctor cannot be explained away with the available measures.

In this article, I outline a framework for the sociological study of culture that connects three intertwined elements of human culture (cultural motivations, resources, and meanings) and demonstrates the concrete contexts under which each most critically influences actions and their subsequent outcomes. In contrast to models that cast motivations, resources, and meanings as competing explanations of how culture affects action, I argue that these are fundamental constituent elements of culture that are inseparable, interdependent, and simultaneously operative. Which element provides the strongest link to action, and how this link operates, must be understood as a function of the actor's position within wider social contexts. I argue that on average motivations have the most discernable link to action within a social strata, cultural resources provide the strongest link across strata, and meanings have the greatest direct influence when codified and sanctioned. I then offer a reframing and synthesis that reintegrates previously “competing” theories of culture into a more holistic context-dependent model of culture in action. Finally, I use evidence from prior empirical research, as well as new data from an ongoing ethnographic study of health behaviors among the aged, to show how various elements of culture are concretely linked to action in eight different social contexts. In doing so, I provide a roadmap for the transition out of the “either-or” logic underlying much of cultural theory and reemphasize the importance of the classical sociological concern for “when” and “how” various aspects of culture influence action and outcomes in concrete social contexts.

Aging is remarkably unequal. Who survives to grow old in America and the circumstances they face once there reflect durable racial, socioeconomic, and gender inequalities that structure our lives from birth. Yet within the field of social stratification and mainstream sociology proper, examinations of the rapidly growing population of older Americans are often relegated to a “gerontological” periphery. This essay posits that the failure to place aging as a core concern in stratification and inequality is a missed opportunity. We argue for the importance of reintegrating studies on the stratification of aging and explain why such a move is necessary. Specifically, we posit that (a) examining the aging population is necessary for understanding American inequality because aging is an outcome that is ubiquitous yet highly stratified; (b) aging and being seen as “old” in a youth-focused society are stratifying processes in their own right; and (c) later life provides for analytical comparisons that are illustrative of how key mechanisms of inequality structure and stratify. After examining insights provided by a new wave of research on the aging U.S. population, we revisit the implications for understanding inequality and stratification in a graying and unequal America.

This ethnographic study of “goal displacement” in an adult day care center explains how and why certain goals come to surpass others in the organizational practices of elder day care settings. Adult day care is often oriented towards providing family caregivers with respite rather than attempting to directly improve the lives of the elders themselves. Although the adult day care center studied (CADC) was ostensibly founded to care for and improve the lives of elders with dementia, the center instead focused on providing respite for family caregivers who depended on the center for relief from care-giving. I show how the goals that CADC could realistically pursue, and the population it ultimately came to serve, were limited by the larger structural setting in which the organization operated. CADC's dependence on a limited pool of external resources of questionable quality converged with the organizational demands of a difficult population in such a way that simply providing a safe and orderly environment strained the organization to the limit. Providing care that aimed to directly improve elders' lives was seen as unreasonable, because this would have required unavailable resources, personnel, and training. In contrast, helping family caregivers by adopting a “respite focus” was seen as reasonable and worthwhile. Thus, family caregivers came to supplant elders as the de facto clients of CADC. The goal of improving elders' lives remained, but only in brochures and ideology, not organizational practice. Still, this goal remained an important part of the organizational discourse of CADC, since widely shared cultural understandings of the type of care elders deserve, constrained the way the organization could present itself.

This article employs an original empirical analysis to contribute to scientific understandings of the relationship between social characteristics and perceptions of discrimination in healthcare encounters within and across racial categories in the U.S. Our analysis focuses on a diverse sample of 43,020 adults aged 18 to 85 drawn from the California Health Interview Survey (CHIS). We use a series of weighted descriptive statistics and logistic regression models to parse out factors associated with perceived discrimination and chart how they vary by race and ethnicity. Members of racial minorities were more likely to report perceptions of discrimination, and while the effect was somewhat mitigated by introducing patient and health-care system factors into our models, the race effects remained both statistically significant and of substantial magnitude (particularly for African Americans and Native Americans). Poor self-reported health and communication difficulties in the clinical encounter were associated with increased perceptions of discrimination across all groups. Further, among non-whites, increased education was associated with increased perceptions of discrimination net of other factors. These findings suggest efforts to reduce disparities in medical care should continue to focus on expanding the depth and quality of patient–provider interactions for disadvantaged racial groups, while also being attentive to other factors that affect perceived racial discrimination in healthcare encounters within and across racial groups., Highlights • Race shapes perceived discrimination net of other factors. • Some of the race effect can be accounted for by individual and system level factors. • Interactions with providers have a powerful effect on perceptions of discrimination. • The effect of factors such as education varies between racial groups.