A Companion to Medical Anthropology. Группа авторов

that focuses the process. Methods become the active connection between theory and analysis. The “who” element is the sampling process (Trotter 2012). It is the systematic process for selecting the individuals and groups that are going to tell their important cultural stories and provide the basic findings that can result in some type of problem-solving applied action. The “what” dimension is the cultural domain (area of everyday life) that people are describing. The “where and when” elements of anthropological methods are the physical and temporal contexts that surround the individuals and their actions. The anthropological “how” of applied anthropology methods is a complex mix of interviewing, observations, participation, explanation, validation, and cultural learning that allows the anthropologist to match what people say and do, when they say and do it, and where these activities occur with the theory that will explain it. And finally, the “why” dimension of ethnographic methods is the opportunity for all of the participants (researchers and researched) to explain, interpret, and clarify what is happening from each stakeholders’ point of view.

There is a vast literature on human field research design, site entry, methodology, informant relationships, and the personal effects of field studies on the researcher. Older references tend to contain practical advice that is slowly being lost for new generations of more theoretically driven ethnographers. Newer works tend to assume knowledge of these classics, and expend their efforts refining theory, describing advanced methods, or defending the descriptive nature of ethnographic techniques in an increasingly quantified world. One of the earliest works describing the practical art and the science of ethnographic field studies comes from the Proceedings of the Royal Anthropological Institute of Great Britain and Ireland (Urry 1972). but also includes Kroeber’s, Anthropology Today (Kroeber 1953) which defined a significant portion of the continuing anthropological research focus for generations of ethnographic studies. However, the period circa 1970 is clearly the benchmark era for systematic methods development in US anthropological studies. This time period also coincides with the rapid emergence and impact of applied medical anthropology in the United States. The link between foundational methods training and successful application is clear. Classic works from that time describe the ethnographic research process, its effects on the researcher, and the practical conditions one could expect to encounter in the field. Examples are Epstein’s Craft of Social Anthropology (Epstein 1967), the Glazer and Strauss (1967) text, The Discovery of Grounded, and Spradley and McCurdy’s (1972) The Cultural Experience: Ethnography in Complex. These works mark the initial formalization of ethnographic studies. Other “circa ‘70” books provide behind the scenes details about field research; a necessary complement to works which describe theory and methodology, but leave out the human factor. One edited volume, Marginal Natives: Anthropologists at Work (Freilich 1977), contains a detailed history of field work theory and research designs. Other classics of this period include works with practical advice for fieldwork survival by Rosalie Wax (1971) Doing Fieldwork: Warnings and Advice; Beteille and Maden’s Encounter and Experience, Personal Accounts of Fieldwork (Beteille and Maden, eds. 1975), which contain advice about overcoming the problems of doing research in foreign countries. In a more generic vein, a seminal text which links ethnographic research with larger theoretical concerns during this time period is the Pelto’s (1978) Anthropological Research: The Structure of Inquiry. Revisions in formal approaches to ethnographic research methods, training, and theory then begin to appear on about a ten-year cycle. Jumping forward to the present, the most commonly used ethnographic methodological texts are Bernard’s (2011) Research Methods in Anthropology: Qualitative and Quantitative Approaches and Le Compte’s and Schensul (1999, 2010) Ethnographer’s Toolkit, which is a multi-authored resource set for designing and conducting ethnographic research, including essential ethnographic methods. Specific theory and methods combinations are also extensively explored in the Journal of Field Methods, which provides up-to-date discussions of both midrange (testable) anthropological theory and methods.¹ These works have provided applied medical anthropologists with a substantial literature that is currently used in successful grant writing and the development of high impact applied projects.

      Examples of Midrange Theory in Application

Many applied medical anthropology projects deliberately and appropriately utilize a diverse set of mid-range anthropological theories which allow them to (1) describe the cultural models of health and illness which provide a framework for understanding individual and group knowledge and beliefs; (2) monitor both the stability and the change in behavior; (3) identify the key social contexts in which cultural beliefs and values are turned into action; (4) establish the intervening conditions that either allow for change (protective forces) or prevent change (barriers); (5) understand the cultural–environmental and the political economy of health; (6) provide a theoretical framework for determining the decision making and sustainable actions of the group and identify the conditions that are necessary for sustained maintenance of behavioral change for individuals; (7) identify the symbolic and communication conditions imposed by cultural systems that relate to health behavior and behavioral change; and (8) either initiate or restructure culturally competent and effective interventions at the individual and group level. The following sections provide some examples of these approaches and their link to larger theoretical models.

      Connections between the Internal and the External (Cognitive and Psychological Approaches)

      The research on aspects of the internal–external connections between thought and behavior has developed predominantly within psychological anthropology and cognitive anthropology, although other approaches have also played a part in this area of midrange theory development. The midrange theories that appear to be in the most common use include Cultural Models, Cultural Beliefs Systematic Comparison, and Cultural Cognition (domain analysis). Some specific examples of the use of a cultural models or cultural health beliefs models include research on building culturally congruent prevention systems which are more than models; they are actual structural programs that test the models and their gender sensitivity for use in intervention programs (Weeks et al. 1996).

      Cultural Domain Analysis provides an arena within which midrange theories have been successfully applied to both research questions and the development of HIV and drug interventions among other applied efforts. These approaches can provide excellent models for providing culturally competent, and locally motivated information prevention information, as in the case of a Puerto Rican study of what individuals wanted to know about substance abuse and AIDS education from risk reduction programs. They can also provide key information for qualitative–quantitative bridges to find predictors of risk perception, as seen in the work of Singer et al. (1996) among women drug users.

Systematic explorations of mental health and other illness domains have been pursued through the use of three interlocked cognitive anthropology methods. These are techniques for (1) exploring the content and limit of cultural domains (e.g., freelistings, sentence frame completion, contrast sets); (2) techniques for establishing the structural and cognitive relationships among the elements of cultural domains (e.g., pile sorts, dyad and triad tests, Q sorting, matrix profile analysis); and (3) techniques for establishing the cultural consensual framework for these systems of knowledge and belief (Trotter 1991, 1995). These techniques are amenable to being used in a standard pre-test/post-test design to analyze changes in cultural models or cognition over time as a result of intervention or culture change. Many of these techniques provide a format for systematic ethnographic rapid assessment. They also provide a methodological basis for bridging between ethnographic and standard survey or experimental (quantitative) research designs, since they are typically analyzed using both qualitative (description of meaning) and quantitative (cluster analysis, multidimensional scaling, correspondence analysis) algorithms. As an example, Trotter and Potter (1993) conducted an HIV risk pile sort with Navajo teenagers, using a list of risks that had been generated in focus groups and ethnographic interviews with Navajo cultural consultants. The project was offered as a service component of the Flagstaff Multicultural AIDS Prevention Program, and it explored the ways that the teenagers related the risks in their lives (including alcohol, drug, and HIV-related risks) to other risks (violence, school problems, sexuality). The results of the project demonstrated that the students were linking risks within