1. The inescapable role of theory in qualitative research Qualitative Health Research Collaboration Tuesday 12 th May 2009 Dr Stacy M Carter

2. http://www.flickr.com/photos/martynr/54132892/

3. http://www.flickr.com/photos/kmevans/466730651/

4. Theory: uses and processes  To give us a perspective on the world  To connect us to centuries of intellectual tradition so we don’t feel so alone   To suggest areas of substantive relevance (but beware of variable analysis)  To inspire abduction  To provide a framework for interpretation  As something that we produce in our work  TO HELP US TO ‘DISCUSS’ (ever noticed how thin and boring and repetitive and unrelated to the results ‘Discussions’ can be in qualitative health research?)

5. http://www.flickr.com/photos/levoodoo/3196040941/

6. One way I use theory all of the time: Interactionism as a perspective on the world

7. What are some of the implications of this?  I never (at least not any more) write about peoples’ ‘beliefs’ or ‘attitudes’ as though they are static things inside their heads that I can suck out and put in a jar  I focus more (and increasingly) on action and process and talk rather than on ‘experience’  I try to write about how people interacted, not just ‘what they said’  I presume that people are actively constructing meaning and responding in accordance with their interpretations (i.e. I actively reject a behavioural vision of people as cultural dopes)

8. But I use theory in other ways as well… a study…

9. A study based on narrative interviews with people who had lymphoma Three bodies of theory brought into play 1.Interactionism as a perspective (which shaped my coding process) 2. Actor Network Theory (brought in via induction and abduction) 3. Bioethics frameworks (brought in as a framework for interpretation)

10. Doing everything we possibly can Giving up Coding for actions constructed in talk (as a result of interactionist perspective) i.e. central place of AGENCY in people’s accounts

11. Why so important to have agency? This led us to question the discursive starting point – and to notice active cancer [the lymphoma is] an aggressive thing… constantly pumping away getting rid of the chemo Cancer isn’t human, but it seems to have agency… What might sociological theory be able to tell us about the agency of human and non-human actors?

12. Actor network theory (ANT)

13. Non-human actants (cells) Abby: [after the transplant] the stem cells … just automatically go straight to your spine, ’cause they just know where to go … naturally … and hopefully [the stem cells will] produce … proper cells, angry cells, to fight the cancer.

14. Colin: I am not making bone marrow as I am supposed to make … My body is not functioning and it is not making bone marrow… Non-human actants (bodies)

15. Evelyn: …cancer is just a malignant cell [that] your normal cell cannot defeat… the bad cells, push them back, that is what the chemo, I reckon chemo is doing …suppress it, suppress it, go away, go away Non-human actants (technologies)

16. A dynamic network of human and non-human actants The narrators –Patients –Carers Other patients Friends and family Practitioners –Orthodox medicine –CAM LYMPHOMA Cells Bodies Technologies Mapped four locations in which this network of actants acted (health system, everyday world, the ‘self’, the body)

17. Relative absence of respect and support for agency in bioethics frameworks Importance of respect and support for agency in patient’s talk about treatment But also: danger inherent in demanding that all actors ‘do everything they possibly can’ questions about how respect and support for agency is constructed – should we necessarily prioritise it over other principles or values? Bioethics as a context for interpretation

18. 1.Narratives initiated by a highly agentic lymphoma 2.Extreme agency of the lymphoma required ‘doing everything we possibly can’ 3.‘Doing everything we possibly can’ = a complex of actions (detailed from the data) in a complex and changing network of human and non-human actors (lymphoma, patients, carers, friends, family and various health professionals, cells, technologies, and bodies). 4.Actions done by networks, agency cumulative across actants 5.Four locations: body, health system, everyday worlds, narrator’s self (different actors dominant in different locations) Resulting theory (a)

19. 1.Dichotomised alternative = ‘giving up’ (rescinding one’s agency - morally perilous) 2.Patients overwhelmed by their illness or treatment forgiven (not ‘giving up’ but ‘overwhelmed’) 3.Doctors forgiven for withdrawing treatment only if constructed as having nothing more they could possibly do Resulting theory (b)

20. SI/ANT SI/Bioethics SI/ANT SI/ANT/ Bioethics  Situation initiated by a highly agentic lymphoma  Required doing everything we possibly can (agency), not giving up (morally perilous rescinding of agency)  Network of human and non-human actants in four locations  Actions constructed according to judgments about agency -> agency important for bioethics The resulting theory & the existing theory it drew on

21. http://www.flickr.com/photos/levoodoo/3196040941/