Background
In the field of HIV research, implementation science has become an essential organizing framework. It compels academics, practitioners, and community members to collaborate and creatively strategize how to incorporate evidence-based public health interventions and practices within appropriate community and clinical settings.
But what does implementation science look like in the everyday world? And how can the insights of social sciences, and the research approach of institutional ethnography, help inform the implementation of testing programs for HIV and other sexually transmitted and blood borne infections (STBBI)?
To better understand implementation science, we explore how best to study questions around how, where, and for whom evidence-based interventions are taken up in public health practice.[1]
The role of institutional ethnography
Institutional ethnography (IE), a critical research strategy originated by Dr. Dorothy E. Smith [2], has a role to play in HIV implementation science.
Traditionally, institutional ethnographers approach HIV research from a critical point of view; for example, asking questions about institutional access from the standpoint of people living with HIV. Unlike other empirical forms of social research, institutional ethnographers pay attention to the mechanics of how people go about their daily work, or “organizational work processes.” To do so, they look at how specific documents, such as policies, strategic plans, manuals, or decision support tools, organize or coordinate the work of individuals in particular sites.
This approach can help to identify and map the kinds of everyday organizational processes that go into the making and sustaining of HIV/STBBI programming, as well as potential barriers to their implemention. As such, this approach can provide insights into HIV implementation science on the ground.
Case study: GetCheckedOnline
GetCheckedOnline (GCO) is an internet-based testing service that allows users to to test for STBBI without visiting a clinician. GCO is a “virtual clinic” of the provincial STBBI testing services offered by the BC Centre for Disease Control. The service is currently available in 6 communities across British Columbia.
By applying institutional ethnography to our understanding of how GCO currently works and how it can be scaled up and sustained in more communities, researchers gain an appreciation of the demanding efforts required to get these kinds of services off the ground and meet real-world challenges.
Through IE, we can observe what people actually do as part of their everyday work and how GCO implementers put existing policies and regulations into practice. For example, from our interviews to date we have learned that the work of maintaining GCO client data integrity and security has shifted over time in response to changing users’ needs and demands.
Conclusion
Speaking generally, IE allows us to seethe broader healthcare context within which STBBI programming is situated. One may say that “context” is the pink elephant in the room: everyone agrees it’s important, but no one concurs on how best to research and account for it.
Institutional ethnography does not aim to offer the sociological silver bullet, but rather a criticial research approach that identifies the ways in which the work of specific individuals is linked up—often through the use of shared documents that circulate from site to site—to the work of others in other places.
The focus here is on large scale practices of ruling and a commitment to social justice. In a nutshell, it allows us to ask how different legislative and political environments shape or limit effors to implement novel HIV/STBBI testing services and what we can do best meet community needs.
For more information
[1] To read the abstract of Daniel Grace’s presenation at the 28th Annual Canadian Conference on HIV/AIDS Research, titled “Advancing HIV Implementation Science Research: Using Institutional Ethnography to Examine an Online Sexual Health Service”, visit: https://www.cahr-acrv.ca/wp-content/uploads/2019/04/CAHR-2019-Abstract-Book.pdf
[2] For an overview video of institional ethnography from Dr. Dorothy Smith please see: https://www.youtube.com/watch?v=MOO9fLT9r-Q