On culture in qualitative research: The development of a locally focused interviewing technique
By Jonathan Yahalom
This dissertation employed a variety of qualitative research methods to demonstrate the way in which family caregivers from Teotitlán del Valle, a rural indigenous community in the state of Oaxaca, Mexico, experience and attend to elders with Alzheimer’s disease. Scholars in medical anthropology have argued that illness is a dense signifier of social life (e.g., Gaines, 1992; Kleinman, 1980; Nichter, 2008; Pigg, 1995) and that symptoms associated with Alzheimer’s disease manifest in different ways, depending on cultural outlooks and values (e.g., Ballenger, 2006; Cohen, 1998; Henderson & Traphagan, 2005; Leibing, 2002). This study adds to these findings by showing how the challenges that accompany elders with Alzheimer’s disease serve as a prism for understanding broader community changes associated with neoliberalism, and by taking a narrowed focus on caregiving to argue that this form of life is pivotal for negotiating them.
Teotitlán is a Zapotec-speaking community of 5,500 persons in Oaxaca, one of the poorest states in Mexico. Oaxaca’s indigenous peoples have a long history of political marginalization, which continues into the present day, rendering individuals on the periphery of national and global agendas. Further, Mexican-Indigenous persons face social and systemic discrimination, have difficulty obtaining employment, and are offered paltry healthcare options. Teotitlán is but one community among many in the state of Oaxaca that faces these conditions, and many members have chosen to seek opportunities elsewhere such that migration to the U.S. is now a defining feature of local life (Stephen, 2007). Hence, although Teotitlán prides itself as maintaining local traditions, social customs like family and political structure are significantly changing. Studying how elders are cared for by family members provides a rich vista onto these societal developments.
The following research questions are addressed in this study:
- How is what we have termed Alzheimer’s disease locally understood in Oaxaca, Mexico?
- How does Alzheimer’s disease reconfigure local practices of caregiving for elders?
- How are broader social issues negotiated through this reconfiguration?
This project’s unique approach to data collection was developed in response to three challenges faced during fieldwork:
- Access — Alzheimer’s was believed to not exist. Gaining access to an insular community was an ongoing challenge. Teotitecos prefer to speak in Zapotec, maintain community-specific laws and religious practices, and honor two-year free labor contracts (cargos). Teotitecos are typically closed to members outside of the community and feel a moral imperative to safeguard local tradition as they view it endangered in the context of social change.
Indeed, even my research topic highlighted this issue. Most people professed to be vaguely familiar with Alzheimer’s disease but alleged that it that it is something that exists elsewhere. As one acquaintance very early in fieldwork stated, “People do not have Alzheimer’s disease because they don’t need to worry about paying the rent, and other [forms of] stress experienced over there [e.g., other metropolitan settings like Oaxaca City, Mexico City and the U.S.].” This statement became a refrain during my fieldwork — not only among laypersons, but also endorsed by community leaders, traditional healers and biomedical doctors. This provided more information about what was occurring on a local level than what was believed to be happening outside — it revealed how concepts about well-being are imbued with moral claims, and how they stand for a symbol of the global changes transpiring at a local level.
- Household as primary social unit. In comparison to U.S.-based settings, Oaxacans consider themselves with regards to their family households, and not as individual whose interests collide with their families. It was more ecologically valid to collect data in the context of households, yet unclear how such data could be acquired.
- Epistemological difficulties. My intent to acquire data through interviews also highlighted epistemological difficulties. Indeed, one of the biggest paradoxes in qualitative research is the way in which interviews are at once understood to arrive at the subjective or personal experience of participants, while interviews are also known to be shaped by the event of interviewing. Research has overlooked the way that language is not a channel that directly transmits subjective experience. Rather, language is more accurately understood as a joint production between speakers (Suchman & Jordan, 1990). As Packer (2010) writes, “the interviewee's subjectivity [and what is expressed during the interview] is an effect of the... interview, not a preexisting, independent personal experience that is the content expressed in what is said” (p. 99, emphasis in original). This challenges the very premise of acquiring data through interviewing.
Locally focused interviewing — Towards a novel research method
In the process of leveraging a partnership with a community member, I managed to develop a new interview method called “locally focused interviewing” that responds to each of these challenges. The term “focused” carries a double-significance, standing at once for methods drawn from focus group interviews, and for focus on Zapotec culture definitive of local life.
- Focus group interviews. The first component of this method draws on interview techniques from focus group literature regarding how to maximize group discussion (Carey & Smith, 1994). This allowed me to gain household (and not individual) data that was ecologically valid, and investigate how members of the household negotiated meaning together — and avoid assuming that what is communicated is a direct expression of a participant’s experience. To this end, I developed a set of open-ended interview questions that were to be discussed among caregivers, and elicited contrasting or divergent opinions. My research assistant was then trained to ask participants to provide concrete examples of when, why and how events occurred; this encouraged participants to not just describe facts, but to share stories of their personal experience.
- Focus on Zapotec dialogue. The second component of this method centered on my research assistant and his ability to foster group discussion in Zapotec. This simultaneously helped respond to linguistic barriers, but more importantly provided greater access to the insular community. This component implements what is considered “local” about this interview technique, fostering conversation amongst locals within a given community and minimizing intervention from foreign individuals.
My research assistant’s role as group moderator was central to this approach. He waited for me to ask basic questions, and then held in-depth conversations with family members about their opinions. He developed insight regarding when to ask probing follow-up questions–asking for clarification, questioning why a decision was made, or requesting more detail regarding how things are experienced–and then briefly summarized answers to maintain the flow of the conversation. After each interview we met to translate and transcribe the audio recordings. This provided another opportunity to reflect on how to improve our technique.1
Significance of the project
- Contributions to research methods. This approach to data collection helped foster rich information regarding the social production of the meaning of caregiving–not between participants and researcher, but among participants and a community representative. It provides a theoretically sophisticated response to epistemological dilemmas in qualitative research theory. Lastly, it introduces a new ecologically valid research method to the literature.
- Contributions to geriatric and cross-cultural psychology. Locally, this study provides the first analysis on aging in an indigenous Mexican setting. It sheds light on systemic factors that contribute to suffering among elders and caregivers, documents how age-related dementia is medically (under) treated, and provides guidance about how suffering may be ameliorated by attending to broader community dynamics. Cross-culturally, this study provides lessons for the fields of clinical psychology and psychiatry. Revealing cultural dimensions of Alzheimer’s disease issues a reminder about the importance of attending to culture in clinical practice, that providers must be cautious not to impose their own view about age-related conditions when working across cultures. Further, this study encourages U.S. readers to consider how meanings of dementia must be read with regards to their cultural horizon–constituted by specific values, hopes, and anxieties–and not simply an objective reading of neuropathology. Psychiatry and psychology are cultural practices, even as these disciplines come to rely more heavily upon empirical quantitative methods.
Ballenger, J.F. (2006). Self, senility, and Alzheimer's disease in modern America: A history. Baltimore: Johns Hopkins University Press.
Carey, M.A., & Smith, M.W. (1994). Capturing the group effect in focus groups: A special concern in analysis. Qualitative health research, 4(1), 1552-7557.
Cohen, L. (1998). No aging in India: Alzheimer's, the bad family, and other modern things. Berkeley, California: University of California Press.
Gaines, A.D. (1992). Ethnopsychiatry: The cultural construction of psychiatries. In A. Gaines (Ed.), Ethnopsychiatry: The cultural construction of professional and folk psychiatries (pp. 3-49). Albany, New York: SUNY Press.
Henderson, J.N., & Traphagan, J.W. (2005). Cultural factors in dementia: Perspectives from the anthropology of aging. Alzheimer Disease & Associated Disorders, 19(4), 272-274.
Kleinman, A. (1980). Patients and healers in the context of culture: An exploration of the borderland between anthropology, medicine, and psychiatry. Berkeley, California: University of California Press.
Leibing, A. (2002). Flexible hips? On Alzheimer's disease and aging in Brazil. Journal of Cross-Cultural Gerontology, 17(3), 213-232.
Nichter, M. (2008). Global health: Why cultural perceptions, social representations, and biopolitics matter. Tucson, Arizonia: University of Arizona Press.
Packer, M. (2010b). The science of qualitative research. Cambridge, Massachusetts: Cambridge University Press.
Pigg, S. L. (1995). The social symbolism of healing in Nepal. Ethnology, 34(1), 17-36.
Stephen, L. (2007). Transborder lives: Indigenous Oaxacans in Mexico, California, and Oregon. Durham, North Carolina: Duke University Press.
Suchman, L., & Jordan, B. (1990). Interactional troubles in face-to-face survey interviews. Journal of the American Statistical Association, 85(409), 232-241.
2 Transcribing not only unpacked what occurred during interviews–to witness the way caregiving was discussed by family members and with my research assistant–but it also provided an opportunity to further question a member of the community about the broader significance of the data I was gathering. Often, my research assistant encountered a word or concept that had no equivalent translation. He either tried to find a phrase using a combination of Spanish and English words or, more often, paused to explain concepts that were too difficult to capture in a single phrase. For example, one participant used the Zapotec word “anim,” which roughly translates to “soul.” I learned that this translation is only approximate because it is used specifically to describe a soul of the deceased. The Zapotec word “garlieng” is used to describe the soul of a living person.)