Download the methodological case for narrative inquiry

HEALTH EDUCATION RESEARCH
Theory & Practice
Vol.20 no.2 2005
Pages 226–236
Advance Access publication 12 October 2004
Researching practice: the methodological case for
narrative inquiry
Therese Riley1 and Penelope Hawe2,3
Abstract
Research interest in the analysis of stories has
increased as researchers in many disciplines
endeavor to see the world through the eyes of
others. We make the methodological case for
narrative inquiry as a unique means to get
inside the world of health promotion practice.
We demonstrate how this form of inquiry may
reveal what practitioners value most in and
through their practice, and the indigenous
theory or the cause-and-consequence thinking
that governs their actions. Our examples draw
on a unique data set, i.e. 2 two years’ of diaries
being kept by community development officers
in eight communities engaged in a primary care
and community development intervention to
reduce postnatal depression and promote the
physical health of recent mothers. Narrative
inquiry examines the way a story is told by
considering the positioning of the actor/storyteller, the endpoints, the supporting cast, the
sequencing and the tension created by the
revelation of some events, in preference to
others. Narrative methods may provide special
1
VicHealth Centre for the Promotion of Mental Health
and Social Wellbeing, School of Population Health,
University of Melbourne, Carlton, Victoria 3053, Australia
(Formerly at the Centre for the Study of Mothers’
and Children’s Health, LaTrobe University, Bundoora,
Victoria 3086, Australia), 2Department of Community
Health Sciences, University of Calgary, Calgary, Alberta
T2N 4N1, Canada and 3School of Public Health, LaTrobe
University, Bundoora, Victoria 3086, Australia
Correspondence to: T. Riley;
E-mail: [email protected]
insights into the complexity of community intervention implementation over and above more
familiar research methods.
Introduction
When preventive intervention programs are described, they tend to focus on the technology
of the intervention without informing us about
how the context in which it was implemented
affected the technology. We learn little about the
many compromises, choice points and backroom
conversations that allowed it to take the form it
took. [(Trickett, 1998), p. 329].
The history of health promotion has been one of
developing and testing increasingly sophisticated
theories to inform and strengthen the effectiveness
of actions taken by the front-line workers. Theories
of health promotion have been developed for
multiple levels of analysis (individual, group, organizational, community, etc.) (Glanz et al., 1990)
and for a variety of settings (schools, workplaces,
hospitals, etc.) (Poland et al., 2000). Large-scale,
whole-community prevention trials have been conducted purporting to test particular state-of-the-art
theories in cancer control and heart disease prevention (Thompson et al., 2003). Studies of interventions typically include process evaluations,
which allow investigators to comment on the extent
to which what took place actually matched what
was planned (Flora et al., 1993).
What we hear less about, however, is the private
contexts of practice as Trickett describes above and
ways of viewing the ‘problem’ at hand other than
those preconceived by the intervention’s designers.
Health Education Research Vol.20 no.2, Ó Oxford University Press 2005; All rights reserved
doi:10.1093/her/cyg122
Narrative inquiry
Evaluators who use qualitative methods may get
closer to this (Patton, 1990). ‘Key informant’ interviews have become increasingly used to gain insight into the factors that have helped or hindered
program development or might explain why programs appear to work in some contexts, but not in
others (Goodman et al., 1993). Even so, this
literature contains examples of studies where interviews held at the end of the program still have failed
to give investigators confidence about what really
happened and why (Tudor-Smith et al., 1998).
Investigators who have engaged practitioners in
interviews about the nature of their practice have
also commented on how difficult it is for people, in
retrospect, to articulate aspects of what they do and
think (Hawe et al., 1998). Thus, many aspects of
practice remain elusive.
In this paper we suggest that narrative methods
may give new and deeper insights into the complexity of practice contexts. By narrative inquiry, we
mean the use of personal journals by and serial interviews with fieldworkers during their implementation of a health promotion intervention. Narrative
methods may also allow us to better understand the
mechanisms through which health programs are
transported and translated. In doing so, the natural
or indigenous theory of an intervention may be
revealed, i.e. the cause-and-consequence thinking
of practitioners, which may or may not match the
theory supposed to be tested by the intervention.
We use a case study from a whole-community
intervention trial to illustrate how we are using
these methods. The results of the analysis are not
presented here.
Narrative, storytelling and program
evaluation
Narrative inquiry has a long, strong and contested
tradition. There are a range of approaches to narrative inquiry, emanating from diverse disciplines
such as psychology, sociology, medicine, literature
and cultural studies (Riessman, 1993; Mishler,
1995). As a result, the process of interpreting stories
is now a point of scholarly investigation in itself,
because there is no one unifying method (Riessman,
1993; Mishler, 1995; Schegloff, 1997; Manning
et al., 1998). Approaches differ on the core questions
of why and how stories are told. That is, the nature of
the storytelling occasion and therefore the knowledge claims that can be made about the problem
under investigation.
‘Story’ and ‘narrative’ are words often used
interchangeably, but they are analytically different.
The difference relates to where the primary data
ends and where the analysis of that data begins.
Frank (Frank, 2000) points out that people tell
stories, but narratives come from the analysis of
stories. Therefore, the researcher’s role is to interpret the stories in order to analyze the underlying
narrative that the storytellers may not be able to
give voice to themselves. For example, in a narrative
study of people who are unemployed, Ezzy (Ezzy,
2000) explored the role that broader social forces
play in how people tell stories about their job loss.
He described two narratives: the heroic and tragic
job loss narratives. The heroic narrative gives
prominence to the role of a person’s individual
agency and autonomy, whereas the tragic job loss
narrative is one is which the person is a victim of
institutional or social forces beyond their control.
These narrative structures provide insights into
how people come to understand their unemployment
and the type of action or inaction they take as a
result.
The word ‘narrative’ is used extensively in health
research. It commonly refers to the field of illness
narratives, such as accounts of cancer from the patient’s perspective (Frank, 1998). The use of words
like ‘narrative’ and ‘story’ became more popular in
health promotion in the early 1990s as part of an increased emphasis on reflective practice and methods
of program evaluation which gave more control to
research participants. For example, Dixon argued
that storytelling methods were ideally suited to
community development projects because the creation of the project’s meaning or public representation is placed more in the control of participants, as
opposed to external researchers (Dixon, 1995).
Storytelling has developed as a training and practice
development technique for knowledge development
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T. Riley and P. Hawe
in health promotion (Centre for Community Development in Health, 1993; Labonte et al., 1999).
Thus health promotion was part of what Chamberlayne et al. (Chamberlayne et al., 2000) referred
to as the ‘biographical turn’ in the social sciences.
That is, they were part of the larger move towards
methods that tap into the personal and social
meanings that are considered to be the basis of
people’s actions. Incorporated within these methods
are mechanisms for critical reflection which conceive the individual as the primary sense-making
agent in the construction of his/her own identity
(Blumer, 1969; Giddens, 1984, 1991; Schwandt,
1998). Reflective writing also became a feature
within the context of professional development
literature (Schon, 1999), and also in education
(Orem, 2001), business (Hartog, 2002) and medicine (Webster, 2002).
The context: a community intervention
trial to promote the health of recent
mothers
In our case, narrative inquiry is providing insight
into the mechanisms by which community development officers facilitate transformative change
among people and organizations, as part of their
role to implement a new community-level intervention. We are using narrative inquiry alongside
a fleet of methods including self-completed questionnaires, interviews, observation, document analysis and network analysis of inter organizational
collaboration patterns (Hawe et al., 2004).
The intervention, PRISM (Program of Resources, Information and Support for Mothers), is
a coordinated and comprehensive primary care and
community-based strategy to promote maternal
health after childbirth. The study involved 16 local
government areas in the state of Victoria, Australia
and approximately 20 000 women. The rationale
for the intervention and the evidence on which it is
based are described by the PRISM designers (Gunn
et al., 2003; Lumley et al., 2003). The intervention
is anchored and facilitated in each of the eight
intervention communities by a full-time community
228
development officer (CDO) working with a local
steering committee for 2 years.
The diaries and interviews
The data are in the form of field diaries and in-depth
interviews. Each CDO maintained a field diary over
the 2 years of their employment. CDOs were
invited to record in it their feelings, thoughts,
frustrations, plans and hopes. Agreement to be
involved in program documentation was a part of
their employment contract with the PRISM research team. Nevertheless the CDOs’ agreement to
write diaries with the authors (the ‘EcoPRISM
team’) was confidential and entirely independent
of the PRISM research team. The average field
diary consists of approximately 40 000 words of
verbatim reflection.
The interview data comprise 34 interviews (in
total) undertaken at strategic points of intervention
implementation with each CDO. The interviews
provided the opportunity for CDOs to talk about
what they may have found tedious or difficult to
write down. The interviews explored emerging
themes within the data. The interviews were tape
recorded and transcribed. They were undertaken
both over the telephone and face-to-face.
Creating and sustaining the right research conditions for collecting this data was paramount.
Unless we could create the right conditions, the
CDOs may tell us only part of their story, what they
think we want to hear or indeed nothing at all.
These conditions encompassed:
Flexibility in how the data were recorded. Some
CDOs had electronic diaries. Some were hand
written. Some were emails and others were
a combination of the three. A couple of CDOs
changed recording methods over time.
Adjusting recording methods to suit field conditions.
Empathy to the challenges CDOs faced in
implementing the intervention and in their research relationship with us.
Participation in project dissemination. Coauthoring of papers and conference presentations about the project with CDOs.
Narrative inquiry
Trust within the research relationship. By this
we mean trust that we would maintain confidentiality and trust that we would represent the
CDOs’ story accurately.
Creating these conditions in order to gather data in
an ethical and principled manner required the researcher (T. R.) to position herself closely with the
CDOs. CDOs spent approximately 90 min a week
working on program documentation.
Illustrating the analytic approach: the
unique insights from narrative
How narrative analysis differs from
thematic analysis
Thematic analysis is common in health promotion
research. It involves the open coding of data, i.e. the
building of a set of themes to describe the phenomenon of interest by putting ‘like with like’ (Morse
and Field, 1995). The researcher looks for patterns
in the data, labels them and groups them accordingly (Strauss, 1987). This approach to analysis can
stop at the stage of simple listing of themes [e.g.
(Gordon and Turner, 2003)]. If the development of
themes is led by the researcher’s a priori interests,
some researchers have preferred to use the term
‘template’ analysis (Crabtree and Miller, 1999). On
the other hand, if the themes are derived inductively
from the data itself then the thematic analysis may
be considered to be more close to a grounded theory
analysis [e.g. (Kalnins et al., 2002)]. In practice,
many researchers in health promotion conduct
thematic analyses that reflect both the ideas they
bring to the data set beforehand (from the research
questions) as well as being open to ‘new’ themes in
the data.
Narrative analysis differs from thematic analysis
in two interconnected ways. First, narrative analysis
focuses more directly on the dynamic ‘in process’
nature of interpretation (Ezzy, 2002). That is, how
the interpretations of the CDOs might change with
time, with new experiences, and with new and
varied social interactions. So, integration of time
and context in the construction of meaning is
a distinctly narrative characteristic (Simms, 2003).
This is something that Ricoeur calls the ‘threefold
present’ in which the past and the future co-exist
with the present in the mind of the narrator, through
memory in the first case and expectation in the
second. A thematic analysis might document different themes arising at different stages of the intervention. However, how time drives or potentially
transforms the interpretation is integral to the construction of narratives. It is central to the development of narrative types (Schutz, 1963a,b), as we
describe later.
Second, narrative analysis begins from the stand
point of storyteller, or in our case CDO. From here
we analyze how people, events, norms and values,
organizations, and past histories and future possibilities, are made sense of and incorporated into the
storyteller’s interpretations and subsequent actions.
That is, narrative analysis contextualizes the sensemaking process by focusing on the person, rather
than a set of themes. This is an important methodological distinction. In analyzing the CDO diaries we
attempt to stand in the CDOs’ shoes and experience
events as they do. As situations, people and events
change over time, our vantage point remains the
same. In this way we gain unique insights into how
they interpret the world. Thematic analysis, in
contrast, de-contextualizes the data (e.g. by ‘cutting
and pasting’ themes together) to examine the meta
or broader issues. Narrative inquiry shares with
discourse analysis both a concern for how broader
institutional values and cultural norms are expressed in language, and the belief that language
is a form of action (Potter and Wetherell, 1987).
However, narrative analysis adds further insights
into ‘contexts of practice’ because it studies the
world through the eyes of one storyteller and
applies a theory of time.
Key features of narrative inquiry
Narrative inquiry attempts to understand how
people think through events and what they value.
We learn this through a close examination of how
people talk about events and whose perspectives
they draw on to make sense of such events. This
may reveal itself in how and when particular events
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T. Riley and P. Hawe
or activities are introduced, how tension is portrayed, and in how judgments are carried out (e.g.
the portrayal of right and wrong).
A narrative approach looks closely at the sentences constructed by the storyteller and the information and meaning they portray. The following
categories have been adapted from Young (Young,
1984). Are the sentences descriptive? That is,
a sentence or paragraph that sets the scene, but
has no temporal role in the story. Are they consecutive? Is there a logic to where the sentence fits into
the story? Are they consequential to the story? That
is, they have causal implications. If the sentences
are evaluative, do they show something of the
attitude of the CDO? These sentences give meaning
to the story. If they are transformative, they express
a change in how the storyteller evaluates something, such as an epiphany.
Narrative inquiry captures how people make
sense of the world. This ‘thinking through’ events
is presented in the recording of events, such as the
extent of detail given. It is also captured in the form
of internalized soliloquies (Athens, 1994; Ezzy,
1998). These are the conversations one has with
oneself or imagined others.
Narrative analysis focuses on who is mentioned
in the telling of events (and who is absent) and the
role they have in the telling of events. Gergen and
Gergen (Gergen and Gergen, 1984) refer to these
people as the supporting cast of a person’s narrative. As a supporting cast member, they have
a purpose or reason for existing in the story. The
manner in which the supporting cast are discussed
in the field diaries may range from factual accounting of events, to theorizing what that supporting
cast member is thinking or doing. Most importantly, who is mentioned in the field diary reveals the
people or organizations that are most significant to
the CDO in their practice.
Thinking about the context of the storytelling is
another important feature of narrative inquiry.
Frank (Frank, 2000) refers to the storytelling relation. By this he means that data emerges from
within the relation between the teller, the listener
and the context of the telling of the story. Storytelling can be a political occasion. Narrative inquiry
230
takes as a given that people may exclude details of
events or exaggerate aspects of stories (Ezzy,
2000). What is of analytical interest to the narrative
researcher is why these exclusions or exaggerations
exist.
On the basis of careful examination of the data,
why and how the story is being told, who the
supporting cast are and the nature of the storytelling
occasion, one can determine the narrative’s plot or
what the story is about. The plot of a persons’
narrative is the organizing theme (Ezzy, 1998) that
brings coherence to the telling of events. Events are
understood according to the plot. As a result, we
can see and understand how a person makes sense
of the world.
Finally, the point of the story considers both the
organizing theme and the form of the narrative.
Form refers to the flow of the narrative over time.
Common prototypes are stable, progressive and
regressive narratives (Gergen and Gergen, 1988). A
stable narrative is one in which the person’s
evaluations of situations and events remains the
same over the course of time. A regressive narrative
is one in which these evaluations get worse with
time. A progressive narrative is one in which the
person’s evaluations improve over time. These
broad narrative forms are represented in Frye’s
(Frye, 1957) forms of literary narrative: the tragedy,
the comedy, the happy ending, the satire, the
romantic saga, etc. It is the inter-relationship of
the organizing theme and form that creates what is
called ‘coherent directionality’ in the narrative. This
means how it makes sense over time.
Two examples of stories from the CDO
data set
A complete narrative analysis takes all CDOs and
all their stories. It is beyond the scope of this paper
to present this in totality here. Instead, to illustrate
the insights we are gaining through narrative inquiry, we present two examples of stories below.
Table I outlines the narrative approach applied to
these two examples. We have also demonstrated the
type of themes we could derive from the same
Narrative inquiry
Table I. Example of narrative analysis of two stories
Steps taken in our narrative analysis
Cinema story
Catching the hairdresser
Examine narrative segments (sentences
and paragraphs), focusing on whether
they are descriptive, consequential,
evaluative or transformative in nature.
Words like ‘good’, ‘best’, ‘inspired’ and
use of exclamation marks tell us that the
CDO evaluates this positively and she is
proud of what she is saying. The pace of
the sentences conjures up excitement.
Focus on why the story is being told the
way it is, i.e. examine the narrative text in
terms of the types of words or phrases
chosen by the CDO. How do they
describe events or actions?
Aspects of this event have been in the
diary previously. It has involved slow
little ‘jabs’, the classic strategy of seeding
ideas into the hearts and minds of
others. The story is being told from
a partial endpoint perspective (i.e.
a breakthrough). The feel is one of an
impending monumental change. The
progressive bit-by-bit telling of this story
possibly conveys that the CDO wants us
to savor the process and ‘chase’ as much
as she does. But the (ultimate) event has
not happened yet. How will she describe
it if it fails?
This story is being told almost as soon as
it happens. The CDO wants to share
success quickly. It possibly shows close
association (trust) with the researcher/
reader because the CDO is willing to
reveal the effort and risks she is taking
while, in reality, the ultimate reward is
still not guaranteed. That is, a more
protective strategy on her part would be
one that only told us this story once it
was ‘over’ and success was definite. (The
subtext of the alternative scenario being
that if it failed we would never know.)
Success is built on personal relationships.
We are told how the CDO lives in or near
the community in which she works. This
aspect of her biography impacts directly
on program implementation. Having
a conversation at the bakery counter
may be less threatening than going to
someone’s office. A CDO in this context
can do a lot of the behind the scenes work
that is critical to community
development. This is a high-risk, highstakes environment, however, as her
involvement and investment is so
personal.
These sentences are largely evaluative
and conjure up suspicion that the
hairdresser will not participate in the
scheme (i.e. ‘seems’ interested). We are
made aware of the effort the CDO has
already put in to catching the hairdresser
‘at last.’ Paying attention to the phrase,
‘at last’ is an example of how past
experience (the time element) is
embedded in narrative analysis.
The CDO is demonstrating her capacity
to evaluate situations and anticipate
outcomes. Her theory is well articulated
and we get the sense it is based on
experience. She is anticipating failure.
She uses brackets which indicates
deliberation and higher-level processing,
i.e. this is not a rushed or thoughtless
observation. Use of the word ‘ring’ rather
than ‘rang’ takes us directly to the critical
moment as it happened. This is a good
example of an internalized soliloquy.
Examine the storytelling occasion. In
doing so locate ourselves as researchers
in the process of narrative construction.
Are we only being made privy to some
stories and not others? Why? When? Are
some stories completed in differing
contexts?
Explore how the process of meaning
making interacts with broader
institutional or cultural norms or events.
What stories are difficult to tell due to
tacitly understood processes of social
sanctioning?
We are being told of the time it takes to
contact and engage with local businesses
in order to gain vouchers for the scheme.
We are being told this through the
description of what it takes to NOT get
vouchers, i.e. time spent on likely failure.
She is deliberate about showing her
reflective skills. Is she preparing us for
failure the way she is preparing herself?
We are told of the CDO’s theory on the
causal relationship between how easy
people are to contact and their likely
involvement in the program. This theory
denotes past experience that can predict
future success or failure. Yet the CDO
sends the material to the hairdresser
anyway. Why are we being told that she
is acting against her better judgment?
Why is she telling us how hard she is
trying?
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T. Riley and P. Hawe
Table I. Continued
Steps taken in our narrative analysis
Cinema story
Catching the hairdresser
Identify the point of the story. Identify
the sequence of events and evaluations
that create the direction and form of the
plot.
The plot is ‘classic’ community
development, i.e. the success that comes
from slow work over time What we are
witness to here is the ‘harvest’ that
follows. The story shows that the CDO
prizes informality, conducting business
on neutral ground, her personal contacts
and the importance of doing things
slowly to match local enthusiasm and
interests.
The plot is about wisdom and how
a CDO applies her experience and
knowledge to predict program nonparticipation. While we do not know if
the hairdresser ultimately participated in
the program, the story shows us how
tasks assigned to CDOs, as part of the
intervention, do not always make sense
when placed in the context of real people
in social interaction.
quotations if we were to undertake two kinds of
thematic analysis, either guided by an a priori
interest in program implementation or not. This is
presented in Tables II and III.
The cinema story
This is an ongoing story from one CDO about her
efforts to get an environment change in her local
cinema. Specifically, she was trying to get support
for the introduction of ‘cry baby’ sessions. ‘Cry
baby’ sessions are film screening times (typically in
the mornings) where parents are encouraged to
bring their babies without fear of being hushed up
or asked to leave if the child cries. The story so far
has seen the CDO approach to local cinema to ask if
he would consider running a ‘cry baby’ session.
I do a lot of my best project work after hours in
the supermarket. Friday evening after work was
very fruitful in this way. Good conversations with
three young mums interested in the project, one
who inspired me weeks ago to set up classes at
the swimming pool—and then I bumped into the
local cinema owner. I had asked him some time
ago to think about piloting a Cry Baby program
at his cinema, but hadn’t got back to him to
check. At the bakery counter he said yes! So next
week we’ll get together to discuss upcoming
films, a launch for the first Cry Baby session...
Catching the hairdresser
This is a story about the difficulties experienced by
a CDO in approaching local business to offer
232
vouchers for new mothers. The voucher scheme
was designed by PRISM to offer mothers discounts
on activities or products that encouraged them to
have time for themselves, away from the demands
of motherhood. In the story so far, this CDO has
spent many hours writing to and visiting local
business to solicit vouchers.
Ring Sally the hairdresser—catch her at last. She
seems interested (though privately always consider that when people are hard to catch and not
returning calls it suggests that they may well end
up not contributing— my personal theory that,
in the end, people contribute to any activity in
inverse proportion to the amount of effort involved in contacting them in the first place) so
send her again details of Project and [voucher]
contract.
Analysis
As demonstrated in Table I narrative analysis can
be applied to short, very specific stories. We have
applied these steps to the entire CDO data set in
order to identify the main plots to each of the CDO
narratives. Then, through a process of comparison
between each of the narratives, a narrative typology
or model of ideal types (of narratives) has been
created, understood from a phenomenological point
of view (Schutz, 1963a,b). This means comparing
each of the organizing themes for similarities and
differences regarding their interpretative framework. By placing each narrative theme under
scrutiny, we find that some plots are very similar
Narrative inquiry
Table II. Thematic analysis of two stories: example led by a priori interests
Research question
Cinema story
Catching the hairdresser
Factors affecting program
implementation
Contexts of work—seeding ideas
and follow-up
Informal setting
This data demonstrate that as contexts of work
expand (to include non-work settings) so to the
opportunities for informal encounters with
community members to seed ideas for program
participation and to follow up on previous
conversations.
Practitioner autonomy—time allocated to
program tasks
‘Task-time’ decision making
This data highlight the tension between time
allocated to program tasks and a practitioners
autonomy to determine how their time is spent.
The data infer that decisions regarding task-time
allocation are not within the practitioners’
control.
Table III. Thematic analysis of two stories: example based on text (free codes) for both stories
Categories
Subcategories
Examples from the data
Informal work contexts
places
times
mothers
‘I do my best project work at the supermarket’
‘Friday afternoon after work was very fruitful’
‘Good conversations with three young mums interested
in the project, one who inspired me weeks ago to set up
classes at the swimming pool’
Positive response from cinema owner ‘I had asked him...
Cry baby session’
‘She seems interested... [voucher] contract’
‘when people are hard to catch....first place’
Community actors
businesses
Effort in involving community
uncertain response from hairdresser
time invested for outcome
in nature (form and theme), while others stand out
as different. In this way we hope to be able to put
forward some of the defining characteristics of
practice in the context we have researched, that is,
experienced community development practitioners
working within the context of a community intervention trial.
Concluding remarks
The assumption that we bring to this work is that
a better understanding of intervention dynamics and
indigenous theory may lead to fewer failed community interventions (Thompson et al., 2003).
Because our PRISM trial collaborators are conducting a traditional process evaluation (Lumley
et al., 2003), focused on the program elements, we
will be able to determine how a different way of
describing intervention unfolding sheds additional
light on the ‘black box’ of the intervention. Our
interpretations will also be linked to the burgeoning
field of implementation analysis (Ottoson et al.,
1987; Bauman, 1991; Bammer, 2003). This field
argues that we need to move beyond mechanistic
ways of viewing interventions [e.g. (Flora et al.,
1993)] to encompass new methods better suited to
the complexity of the personal, organizational and
community change processes that interventions
purport to bring about.
A primary weakness of narrative inquiry is that
it is retrospective. So the length of time required
for analysis and presentation of results can be
a disincentive. For this reason, fine-tuning narrative
methods is a major challenge for future work.
Hence, we relied on thematic analysis in order to
feedback data that might be timely and important
for fine-tuning the intervention in progress (Riley
et al., 2004). However, the narrative analysis takes
us much further into the private world of the
practitioner and helps us (re)think what the intervention represents. It helps us understand the
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intensely personal investments being made by
CDOs in the project. This is revealed in the CDO’s
placement of ‘self’ in the narrative. We learn about
the progressive or regressive trade-offs, risks and
rewards. This provides the social context to allow
us to better interpret project dynamics and tensions.
For example, the stakes involved when different
opinions arose regarding how far PRISM could be
adapted to suit local context (Riley et al., 2004).
Riger (Riger, 1989) argues that some of the most
important (but typically untold) stories within community interventions are about the power dynamics,
i.e. what gets said publicly about the intervention
and why. Our analysis thus far privileges the perspective of the CDO. However, another data set in
our study, key informant interviews held in each
community at the end of the intervention, will allow
us to challenge or confirm these views. This includes
members of the steering committees (i.e. some of the
‘supporting cast’).
Narrative analysis requires an in-depth engagement with and understanding of the participant’s
experience. As a result, there is a blurring of
interpretive boundaries between the analyst and
the research participant. Such a blurring results in
two distinct criticisms of narrative analysis. One is
that the analyst can play too strong an interpretative
role without sufficient links back to empirical
data (Atkinson, 1997). The other criticism is that
the analyst plays too weak an interpretive role.
Atkinson (Atkinson, 1997) argues that within some
forms of narrative analysis there is a lack of
analytical attention to social context and interaction, subsequently celebrating, rather than analyzing, the research participant’s stories. Researchers
are likely to be open to such criticism when unable
to define and defend the interpretive framework that
is being applied to interrogate the data.
Narrative inquiry encourages the analyst to
consider what is in the data set and also what is
not there, such as missing characters or alternative
viewpoints. This makes the systematic ‘coding’ of
data extremely difficult (Rice and Ezzy, 1999) and
affirms the importance of a guiding set of analytical
principles with which to interrogate the data.
Introspective reflexivity is critical in this regard
234
(Finlay, 2003). By this we mean that researchers
must interrogate the dynamic created between the
researcher and ‘the researched’ and devise accountability mechanisms. In this way the researchers’
location and representation within the study is a key
component of both data collection and analysis and
we have drawn on insights from ethnography in this
regard (Michalowski, 1997; Reinharz, 1997;
McCorkel and Myers, 2003). The challenges arising from our research context have been explored in
a series of presentations and publications we have
pursued with CDOs (Riley and Hawe, 2000, 2001,
2002; Riley et al., 2001; Sanders et al., 2001). For
an exploration of the ethical challenges we faced,
see Riley et al. (Riley et al., 2004).
Our data set is unique. We know of no other
large-scale intervention studies using narrative
methods to understand practice contexts. CDOs
told us that, overall, writing about their experience
helped. It enabled their viewpoints to be articulated
and better heard. We hope that by describing our
narrative approach we will encourage other researchers to investigate the opportunity provided by
narrative inquiry in everyday practice and in intervention study contexts.
Acknowledgements
We are indebted to the CDOs (Wendy Arney,
Deborah Brown, Kay Dufty, Serena Everill, Annie
Lanyon, Melanie Sanders, Leanne Skipsey, Jennifer
Stone and Scilla Taylor) for their willingness to
engage with us and to share their reflections on their
use of diaries. The PRISM research trial team is
Judith Lumley, Rhonda Small, Stephanie Brown,
Lyn Watson, Wendy Dawson, Jane Gunn and
Creina Mitchell. Our thanks to them for the opportunity to participate as collaborators in the trial. The
EcoPRISM study is funded by the National Health
and Medical Research Council, Australia. P. H. is
a Senior Scholar of the Alberta Heritage Foundation for Medical Research, Canada and holds the
Markin Chair in Health and Society at the University
of Calgary.
Narrative inquiry
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Received on February 16, 2004; accepted on August 12, 2004