Narrative Inquiry in Health Research Essay

Introduction

Since ancient times, human beings have recorded their time in stories. Marshack (1972), recounting the agricultural importance of marks in skeletal remains, which had been dated to the Mesolithic period (middle stone age), and refers to these bone notations as “storied.” Clandinin (2013) made allusions to people’s storied lives when asserting that “people shape their daily lives by stories […] they interpret their past in terms of these stories” (p. 13). A review of the earliest writings verifies that people seem to have used stories to answer important questions, such as “who is my neighbor?” “Why are we here?” “Why do we have to die?” “Why is there pain?” (Doan, 1994). In the Ghanaian context in particular, and in the larger African context in general, stories are the primary medium of transmitting knowledge. These stories make lives meaningful within cultures. Doan (1994) argues that it was the quality of meaningfulness, rather than factual truthfulness that gave the story credibility.

Narrative inquires such as Caine and Estefan (2011) remind us that stories are important; they sustain and remind people that lives are lived, told, retold, and relived in storied ways. Stories are what people know, how people know, and stories are how people live. Stories are people’s obligation to others, and stories create obligations for authors and researchers. This mode of thought goes back to Plato’s days when they search for “essences” – universally true principles apart from the subjective individual – over meaning began in the history of western ideas. Bruner (1986) has called this emerging stream “paradigmatic” as opposed to “narrative” knowing. According to Bruner (1986), the paradigmatic realm involves universal truth conditions; it is engaged with abstract and general theories and with empirical evidence. Its right place is the objective world. The narrative approach of thought is characterized by good stories that gain credence through their likeness; it is concerned with the particulars of experience; it chronicles events over time. The proper venue of the narrative mode is within the subjective world of meaning.

Following, the paradigmatic thought initiated by Plato, Descartes distrusts what he could not “prove,” and thus foreshadowed the rise of modernism. Western consciousness began to credit only the scientifically verifiable objective world as real. Hence, paradigmatic thought has created a worldview and a language of its own, a language that has become indispensable for describing what Bateson (1972) has called the world of the “non-living”. However, in contemporary years the voices of narrative have become ever louder. Scholars from a number of disciplines have noticed “the significant attention paid to language in this century, following from 19th-and early 20th-century philosophy (e.g. pragmatism, hermeneutics, and phenomenology) and linguistics (e.g. pragmatism and semiotics)” (O’Connor, 1998, p. 2). Gergen (1990) argues that this acknowledgment is the move from modernism to postmodernism.

What is a Narrative Inquiry?

The narrative inquiry focused on experience and Clandinin and Connelly (2004) observe that “Humans are storytelling organisms who, individually and collectively, lead storied lives, and the study of narrative is the study of the ways humans experience the world” (p. 44). This suggests that individuals’ lives have stories for narration. According to Clandinin and Caine (2013) narrative inquiry is a way of studying and understanding and experience. Therefore the authors argue that narrative inquiry ensues from an ontological view where the inquirer is concerned with inquisitiveness to find out about the way people are living and that which constitutes their experiences. Additionally, narrative inquiry is not emerging from realist, constructionist, or postmodern position as asserted by Riessman and Speedy (2007). Rather it arises from the understanding and the experience of the phenomenon. Thus narrative inquiry has ontological commitments that arise from the research puzzles and requires that experiences are constantly connecting; leading to changes in people as well as the context in which they interrelate. As narrative inquirers negotiate the context of interaction, they assume responsibility and obligation for, and towards their research participants.

Further, narrative inquiry is defined as an intimate study of an individual’s experience overtime time and in context(s) (Clandinin &Connelly, 1994, 2000). The individual’s experience as postulated by Dewey (1938) provides the philosophical underpinnings of narrative inquiry as well as grounding for the consideration of the three-dimensional narrative inquirers spaces to place, temporality, and sociality (Clandinin & Connelly, 2000).

Narrative inquiry consists of several methods. These include conversations, orally narrated stories, journals, notes, letters, and even autobiographies. These are documents and materials, which can provide an account of a person’s experience that attends to elements of time, geographic and social context. A researcher may use different materials about a participant in order to develop a narrative for the study. The methods and the process of a narrative inquiry are negotiated through a collaborative process between the participant and the researcher, which should result in “a mutually constructed story out of the lives of both the researcher and participant” (Clandinin & Connelly, 2004, p. 12). Therefore, Clandinin (2007) acknowledges that narrative inquiry is the “study of stories or narrative or description of series of events” (p. 4) emphasizing that the story is the basic unit that gives an explanation for human experience. Narrative inquiry is both a methodology and a phenomenon of study. As a methodology, Clandinin (2013) asserts that narrative inquiry is an “approach to the study of human lives conceived as a way of honoring lived experience as a source important knowledge and understanding. This is a way of studying an experience (the phenomenon of study) that brings the researcher and the participants together to travel on a common path of living, reliving, and telling their stories” (p. 44).

The narrative is suitable for health research and other social science fields. Different disciplines, in particular psychology and education, have used narrative techniques in order to get detailed accounts of events from their participants (Riessman, 2008).

Historical accounts of Narrative Inquiry

As stated above, people have used stories to provide accounts of their experiences in life. In fact, history shows that humans accounted for past development by using stories. Studies (Carr, 1986) from the past also indicate that people relied on storytelling to provide explanations for basic questions in their lives. People used stories to describe their cultures, and storytelling in different cultures earned credibility because of the meaningfulness it provided at the time.

Studies (Clandinin, 2006) resorted to narrative inquiry because it offered a suitable method of understanding what formal approaches could not account for when trying to understand experiences. In this way, narrative inquiry aimed to solve the inadequacy of other approaches in studying human psychology.

Scholars (Clandinin, 2007) from various disciplines have expressed interest in narrative inquiry, as narrative inquiry is critical and relevant for most studies. Some scholars have linked the development of narrative research to literary theory, or have taken a modernist approach to the use of narrative research. These arguments provide solid grounds for criticizing, understanding, and applying narrative inquiry in other fields. Social constructionism views narrative inquiry as a tool for social interaction that also accounts for cultural elements in narrative discourse.

Postmodernism originated during the 20th century to criticize the idea of common facts and the use of pragmatic approaches to understanding scientific issues. Construction of meaning is critical in any discipline. Narrative inquiry recognizes the inherent knowledge that only exists in humans. It notes that reality could have multiple perspectives, and one can only find the truth from social relations and events of life. Smith (1981) takes note in narrative inquiry that it should inquire into experiences and values of life, which always go together. Applied elements of narrative inquiry are present in several studies. Several disciplines have used this approach to gain insights into various changes that have affected the lives of people and society more broadly. The act of storytelling can reveal and make visible tacit knowledge in people. It can facilitate implicit interaction among people. Some scholars (Coles, 1989) have used narratives to explore and develop their identities, enhance learning, and facilitate understanding. Moreover, narrative can serve as an important element of decision-making and exchange of knowledge. People have used narratives to construct reality, communicate meaning, and exchange knowledge (Dewey, 1938). Still, stories (Lugones, 1987) that have cultural inclinations have been useful in constructing cultural identity and reinforcing belief systems.

The traditional research approaches have encouraged developments in research methods. For instance, social science and health researchers are contributing to the development of new research methodologies and methods based on narrative approaches. However, what researchers have not always acknowledged is that Registered Nurses and physicians, and others in the area of the health profession, such as psychologists, have dealt with stories that involve their clients. They have incorporated case histories, which rely on narrative details from clients to understand patients’ conditions. This history has shaped some of the developments in the area of qualitative research. Researchers (Crites, 1971) also go further and take into account participants’ behaviors as they narrate their experiences, as well as lay alongside all phases of a narrative inquiry as a three-dimensional inquiry space. What is important is that health practitioners can provide valuable insights to academics in the field and provide new grounds for research paradigms, which many researchers have adopted in their studies.

Changes in research methodologies have also led to the use of new research methods. Behaviorism and other models brought about concepts of measurable data. In the 1960s, studies (Caine, Estefan, & Clandinin, 2013) in psychology rekindled interests in narrative inquiry as studies in cognitive and human experiences gained momentum. In health care settings, clinical literature provides critical references to patients’ narratives and life experiences. In other cases, there are narrative psychotherapy accounts of patients’ experiences. Narrative therapy requires the patient’s discourses, which the practitioner considers as the true reflection of the patient’s identity. New methods that have been incorporated build on the learning in health care settings (i.e. art, photographs, memory box items, images of dreams).

The Process of a Narrative Inquiry

Narrative inquiry relies on different ways to inquire into experiences; always is this inquiry marked by relational responsibilities and an ethics of care. In most cases, narrative accounts are written that are written as interim accounts that reflect not only the diversity of experiences but also the different relationships that exist between researchers and participants. Researchers also examined narratives, using different literary techniques for understanding and combining different types of data with theoretical underpinnings (Riessman, 2008). The relevance of collecting, eliciting, and constructing narratives in research originates from advantages that researchers may get from the approach (Clandinin, 2013). Once interim research texts are created in narrative inquiry, researchers look across the accounts for resonant threads that reverberate amongst experiences of participants in any one study or possibly across multiple studies.

In narrative inquiry, researchers can use approaches to gather and inquire into experiences that account for phenomena, issues, challenges, and participants’ lives holistically. As opposed to other research approaches, which may restrict responses or ask participants specific questions, narrative inquiry seeks to explore and discover complex issues, identities, knowledge, and social aspects of participants within their cultural contexts (Sarris, 1993). This allows researchers to engage in natural language in their studies. As a result, they are able to achieve the richness of the participants’ points of view and draw valid conclusions about their own rights.

Researchers also often rely on particular discourses and metaphors that participants provide. Metaphorically, there are two distinctions when engaging with participants in the telling of stories: “miners” and “travelers” (Kvale, 1996, p. 3). The interviewer as a miner is searching to extract some knowledge hidden inside the participant. The traveler, conversely, is journeying through the other’s landscape gathering stories to retell when he or she arrives back home. The two metaphors—of the interviewer as a miner or as a traveler—represent different concepts of knowledge formation.

Generally, Kvale argues that the miner metaphor depicts a common understanding in modern social sciences of knowledge as “given”, whereas the traveler metaphor signifies a postmodern constructive understanding that involves a conversational approach to social research. “The miner metaphor brings interviews into the vicinity of human engineering; the traveler metaphor into the vicinity of the humanities and art” (Kvale, 1996, p. 5). Both Clandinin and Caine have demonstrated greater usage of the metaphor of the traveler in their work as they have traveled alongside their participants. These metaphors are excellent sources of understanding and analyzing social accounts that have affected individuals’ development and identity. In other words, narrating a story is a social process that inculcates people, events, experiences, places, and motivates participants to explore and present their diverse experiences.

Gergen (2004) reasons that stories can be “more or less flexible and responsive to the particulars of the context in which they are told” (p. 267). Still, Sarbin (2004) presents narratives as “an expressive behavior, embodied through an imaginative process in social interaction” (p. 5). In addition, other researchers may use different techniques to analyze and understand how narrative and life details intersect and speak to experience.

Utilizing a narrative inquiry approach holds the potential to generate rich and unique insights. These insights have various aspects, which influence the relationship between individuals and society. Literary analysts have employed different techniques in order to understand elements of narratives like plots and subplots. In addition, (Lorde, 1996) also use figurative language in order to understand the deep meanings of stories. These multiple ways of understanding narratives provide diverse methods for researchers to analyze all aspects of a narrative. They could make references to meanings, events, people, and other phenomena of interest to studies. Evaluative approaches allow researchers to understand why the participant is telling the story (Roy, 2008) and why stories are told in particular ways. These are complex approaches in a narrative inquiry. Lightfoot considers them as ‘double narrativity’, which is useful in understanding narratives not only within the context of the study (Daiute & Lightfoot, 2004). In such cases, participants can tell their stories in different ways to different people. Complexities in narrative inquiry allow researchers to explore sociobiographical elements that create the interaction between culture and personal experiences (Daiute & Lightfoot, 2004) Narrative inquiry researchers tend to use narrative inquiry to include intersubjectivity of participants as they construct meaning from a conversation.

Narrative Inquiry Processes

The researcher should provide accounts of his or her narrative research processes. In other words, he or she must provide a detailed explanation of how narrative inquiry contributes to the study. The interaction between the researcher and the participants is a fundamental area that needs clear illustration. There are inherent problems that the use of a narrative inquiry brings. Thus, researchers must provide the best ways of handling such challenges during the study. Any critical research process must entail data collection, analysis, and interpretation. The researcher must build these concepts around the research design (Elliott, 2006). Thus, any critical strategy must provide methods of analysis, ethical concerns, study coherence, and the use of different theoretical underpinnings to support the research process. The researcher must ensure that the research methodology is clear and not vague (Mill & Ogilvie, 2003).

Narrative inquiry requires collaboration between the researcher and the participant. The researcher listens and responds to the participant’s story and also engages in living alongside the participant (Clandinin & Connelly, 2000). There are three major areas that the researcher must present in a clear and logical manner. These include the relationship between the researcher and the participant, the development of the narrative account in both oral and written forms, and the inquiry approaches applied in the study.

First, the significance of the relationship between the researcher and the subject has remained an area of interest to many scholars (Caine, 2010). Aspects of time and space are imperative in narrative inquiry (Kerby, 1991). Both the researcher and the participant must create a sense of comfort during the process. A nonjudgmental approach and establishing a sense of equality between the researcher and the participant ensures that narrative inquiry avoids potential challenges (Poirier & Ayres, 1997). Thus, the researcher and the participant must create a rapport in order to understand accounts of the narrative. What follows is writing narrative, engaging with participants, co-composition of narrative accounts, and metaphorically looking across the accounts of diverse study participants.

The challenge normally arises when the researcher and the participant have different ways of interpreting similar events. In some cases, the participant and the researcher may question the interpretive authority of each other. In addition, the researcher and the participant may generate conflict about the appreciation of the experiences of the participant. Often the researcher and participant engage in ongoing negotiations and are able to attend to challenges, disagreements, and try and work through these together. It is important to make these tensions visible, as they make visible the relational qualities of a narrative inquiry. At the same time, the researcher needs to keep the reader in mind, particularly as the final research texts are written. The narrative should be a purposeful and ideological way of gaining insights into participants’ lives. Thus, it goes beyond reproducing participants’ stories. Narratives must be meaningful and useful to their readers.

Developing a narrative account is a basic process that the researcher must explore in order to organize the participant’s experiences alongside negotiations with the participants. The researcher has some obligation to interpret the collected information as part of the analysis (Trainor & Graue, 2013). However, both researcher and participant may recognize that interpretation of the narrative may not end with his or her work. In fact, the final research texts may attract criticism and open new avenues for further interpretation. These final texts thus lay the beginning for new wonders, new inquiries, and new possible relationships.

Conclusion

Narrative inquiry is a relational research methodology that is relevant in most fields. Narrative inquiry is both relevant and important health research and acknowledges that narratives shape people’s lives. Therefore, through engaging in a narrative inquiry, the researcher can gain important insights into the lives of their participants. Although, there are challenges associated with the narrative inquiry approach, particularly the negotiations of the research process including the narrative accounts of accounts, the researcher always attends carefully to their participants in ethical and loving ways.

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