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Study Design and Use of Inquiry Frameworks in Qualitative Research Published in Health Education and Behavior

Michelle c. kegler.

Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA 30322, USA. ude.yrome@relgekm

Ilana G. Raskind

Emory University, Atlanta, GA, USA

Dawn L. Comeau

Derek m. griffith.

Vanderbilt University, Nashville, TN, USA

Hannah L. F. Cooper

Rachel c. shelton.

Columbia University, New York, NY, USA

Qualitative methods help us understand context, explore new phenomena, identify new research questions and uncover new models of change. To better understand how researchers in health education and health behavior use qualitative methods, we reviewed qualitative papers published in Health Education and Behavior from 2000 to 2015. We identified 48 papers that met our inclusion criteria and extracted information on the qualitative inquiry framework, use of theory, data collection methods, sampling strategy, general analysis approach and reporting of results. Use of common qualitative inquiry frameworks was rare, with just one grounded theory study, five ethnographies and one case study. No studies were framed using phenomenological or narrative inquiry approaches. Theory was used most commonly to select sensitizing constructs for analysis (41.7%) and to inform development of data collection instruments (27.1%). Interviews were the most common data collection method (66.7%), with focus groups next most common (39.6%). Sampling was typically purposive (87.5%), although often not labeled as such. Almost all (95.8%) of the papers used quotes to illustrate themes and more than half (58.3%) used descriptors of magnitude (e.g., most, some) to report findings. The use of qualitative methods by health education and behavior researchers could be enriched with more intentional application of a broader range of inquiry frameworks. More deliberate application of a range of inquiry frameworks has the potential to broaden the types of research questions asked, application and generation of theory, study design, analytic strategies and reporting of results.

Introduction

For decades, researchers who apply social and behavioral sciences to public health have acknowledged the potential of qualitative methods to inform their work ( Backett, 1992 ; Broughton, 1991 ; Foster, 1987 ; Gerhardt, 1990 ; Glik, Parker, Muligande, & Hategikamana, 1986 ; Goodman, Steckler, Hoover, & Schwartz, 1993 ; Steckler, McLeroy, Goodman, Bird, & McCormick, 1992 ; Yach, 1992 ). Qualitative methods are key to understanding context; exploring new phenomena from multiple perspectives; generating, refining and extending theory; and guiding quantitative studies by illuminating new research questions or informing more nuanced or culturally appropriate measures ( Creswell & Poth, 2018 ; Hennink, Hutter, & Bailey, 2011 ; Miles, Huberman, & Saldana, 2014 ; Patton, 2015 ; Saldana, 2016 ; Saldana & Omasta, 2018 ). Qualitative methods can provide essential process evaluation data on facilitators and barriers to implementation, can elucidate models of change and logic model pathways, and provide evidence of policy and program impact through case studies and causal qualitative analysis ( Hennink et al., 2011 ; Patton, 2015 ).

In 1987, Health Education Quarterly (the former name of Health Education and Behavior ) published its first paper arguing for more qualitative research in health education ( Basch, 1987 ). A few years later in 1992, Health Education Quarterly published a theme issue that highlighted methods for combining qualitative and quantitative research ( Steckler et al., 1992 ). Although not labeled “mixed methods” at the time, Steckler and colleagues underscored the value of qualitative methods, both combined with quantitative methods and as a stand-alone paradigm. Recently, HE&B published a theme issue highlighting how qualitative methods can advance health equity ( Griffith, Shelton, Kegler, 2017 ). The Society of Public Health Education’s (SOPHE) practice journal, Health Promotion Practice , has published tools and support for qualitative research ( Lewis, 2015 ; Watkins, 2012 ). Recently updated health education competencies include both design of qualitative research and qualitative data analysis as necessary skills for master’s level practitioners ( National Commission for Health Education Credentialing, 2015 ).

As qualitative researchers, teachers of qualitative methods in MPH curricula, and members of HE&B’s editorial team, we have noticed great variability in how qualitative research is reported, from how qualitative inquiry frameworks are applied to explanations of the analytic process. This led us to question whether our field was using qualitative methods to their full capacity, whether we were building on existing methodological knowledge, and whether we could be more intentional in our application of qualitative methods. These observations and our curiosity were the catalyst for the review of qualitative articles reported on here. The current paper presents findings from a review of all qualitative papers published in HE&B between 2000 and 2015. As the flagship journal for SOPHE and a leader in shaping intellectual discourse in the field, we felt reviewing papers in HE&B would provide an appropriate gauge of how we in health education and health behavior are conducting and using qualitative research. We sought to learn what inquiry frameworks were commonly used and how they informed study design, use of theory, application of analytic strategies, and reporting of results.

Articles were eligible for inclusion if they exclusively used qualitative research methods (i.e. not mixed methods), and were published in HE&B between 2000 and 2015. PubMed was used to identify eligible articles using the search string “((qualitative) AND “Health education & behavior: the official publication of the Society for Public Health Education”[Journal]) AND (“2000”[Date - Publication]: “2015”[Date - Publication])”. Two investigators independently reviewed each title and abstract and labeled each article as “include”, “exclude”, or “review in full text”. Ultimately, 48 articles were included. Of the 56 articles excluded, 50 were excluded through the title and abstract review, and an additional 6 were excluded after full text review. The two investigators agreed on all but one determination, which was resolved through discussion, and ultimately included. The primary reason for exclusion was the use of mixed methods (n=32). Although not a formal systematic review as we only reviewed articles from one journal, Figure 1 presents the PRISMA flow chart.

PRISMA flow diagram.

Note . PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyse. From Moher, Liberati, Tetzlaff, Altman, and The PRISMA Group.

(2009). For more information, visit www.prisma-statement.org

The abstraction form was designed to assess the key methodological and analytic approaches used in each article. Topics and coding categories were adapted from the domains presented in O’Brien et al. ( O’Brien, Harris, Beckman, Reed, & Cook, 2014 ) and Tong et al.’s ( Tong, Sainsbury, & Craig, 2007 ) qualitative reporting standards, in combination with our pooled expertise in conducting and reviewing qualitative research. We also reviewed sampling and analytic strategies as described by Patton for possible categories ( Patton, 2015 ). A draft form was shared with all co-authors, whose feedback was incorporated into a final version comprised of 10 main sections: qualitative inquiry framework, sampling strategy, data collection methods, data management software, coding approach, analytic approach, reporting of results, use of theory, indicators of trustworthiness, and reflexivity. Tables 1–3 show the categories and codes used in abstraction for the data reported here.

Articles were divided among the six co-authors, and each article was double-coded. Two authors each coded half of the articles, the other four coded one-quarter. One member of each coding pair reviewed the completed abstraction forms and marked areas of disagreement. This coder corrected discrepancies easily resolved by re-reviewing the full text, and a third coder (not in the original coding pair) reviewed all other discrepancies. The final reconciled forms were entered into an Access database, and queries were generated to summarize the results for each topic. The results were shared with all co-authors for review, and then discussed as a group.

New topics of interest emerged from the first round of reviews, particularly related to the analysis. Two of the authors conducted a second round of review focused on common analytic pathways or trajectories including: the use of software in analysis, the use of matrices, how and when authors discussed achieving consensus on codes, the variation in use of the terms code versus theme, how themes were identified, and the process of grouping codes or themes. These findings are reported in a companion paper ( Raskind et al., 2018 ).

Qualitative Inquiry Framework

The articles were reviewed to determine if the research was based on a qualitative inquiry framework ( Table 1 ). Thirty-seven papers (77.1%) did not mention a qualitative inquiry framework. Five papers mentioned ethnography (10.4%), and one paper mentioned grounded theory (2.1%). The former was exemplified in a paper by Thompson and colleagues ( Thompson, Gifford, & Thorpe, 2000 ) who spent almost two years deeply engaged in an Aboriginal community in Australia to contextualize behavioral risk factors for diabetes within society and culture. The grounded theory paper described iterative interviews and focus groups with physically active African American women ( Harley et al., 2009 ). The authors developed the physical activity evolution model to explain the changes, both psychological and behavioral, involved in the process of becoming and staying physically active. Additional frameworks were referenced in only one paper such as community-based participatory research and mutual knowledge creation, and life history interview methods. Some of these terms are general approaches to research and others are often used to describe analysis methods; we considered them as inquiry frameworks when the authors used them to describe an overall approach to their research.

Qualitative Inquiry Frameworks and Use of Theory (n=48)

Use of Theory

Theory can be generated and refined through qualitative methods or it can be used to guide various phases of a study design. Of the papers we reviewed ( Table 1 ), the most common use of theory was to provide sensitizing constructs for analysis (41.7%). Cortes and colleagues, for example, described a study of the activation and empowerment process in the context of increasing Latino patient participation in mental health treatment decisions ( Cortes, Mulvaney-Day, Fortuna, Reinfeld, & Alegria, 2009 ). Results were organized by components of a published empowerment model. Theory was also used fairly often to inform development of data collection instruments (27.1%). Barnidge et al. (2011) used the sustainable livelihoods framework to identify structural factors that influence health in rural communities ( Barnidge, Baker, Motton, Fitzgerald, & Rose, 2011 ). The framework guided photo-elicitation interview questions, a start list of codes for analysis, and organization of the results. In two of the papers, theory informed the sampling approach and in one paper, theory was developed as a result of the analysis. Interestingly, a significant number of the papers did not mention theory or frameworks at all (35.4%). In some cases, however, theory was mentioned in the introduction and discussion sections, but the theory was not evident in the research process itself (16.7%).

Data Collection Methods

The most common data collection methods were one-on-one interviews ( Table 2 ), described in approximately two-thirds (66.7%) of the articles, and focus groups, described in approximately one-third of papers (39.6%). Several (10.4%) of the papers described observation in combination with interviews or other methods. The majority (78.1%) of interviews were conducted in-person; several papers (9.4%) reported conducting interviews via telephone and several did not specify the platform used (15.6%). Nearly two-thirds (62.5%) of the interviews were conducted using semi-structured interview guides.

Data Collection Methods and Sampling (n=48)

Sampling Approach

A large majority of studies (87.5%) used purposeful sampling techniques ( Table 2 ). Approximately one third (33.3%) of these studies explicitly labeled their sampling approach as either purposeful or purposive. The remaining studies, while not explicitly labeled by the authors as purposeful, described sampling approaches wherein the selection of participants or cases was clearly guided by the study purpose. The degree of detail provided regarding purposeful sampling techniques varied: many authors provided a rationale for their chosen approach (e.g. recruiting from sites frequented by the population of interest, or recruiting for demographic diversity within the population of interest), some authors cited specific types of purposeful sampling strategies (such as maximum variation, intensity, and snowball sampling), and some solely described participant eligibility criteria and listed locations where recruitment occurred. Other commonly described sampling strategies were convenience sampling (14.6%) and census approaches (14.6%). Papers were only coded as using convenience sampling if the term was explicitly stated by the author. Census approaches were most often used in the context of program or intervention evaluations (e.g. recruitment of all intervention participants).

Sample Size and Saturation

Study sample sizes varied widely. For studies using interview techniques, the median sample size was approximately 35, and ranged from 5 to 252 participants. The median number of focus groups conducted was approximately 10, and individual focus groups ranged in size from 2 to 13 participants. Less than one-third (29.2%) of the studies discussed data saturation, and there was wide variation in how it was addressed. A few studies provided detail on how they determined saturation, when it was reached, and how it informed the sampling strategy, while others only stated that it had been attained and provided a brief definition.

Data Analysis

Thematic analysis (22.9%) and content analysis (20.8%) were the most common analytic approaches named by authors ( Table 3 ). Grounded theory (16.7%) and the related approaches of constant comparison (10.4%) and open or axial coding (6.3%) were next most common, along with use of matrices (6.3%). Single and multiple case studies were also included, with just one of each method reported. Additional papers used the terms cases and matrices, but did not explicitly describe case study methods or use of matrices as their analytic approach. A variety of other approaches were named by authors, with none of them commonly used across the studies (e.g., thematic content analysis, ethnographic content analysis, compare and contrast method, framework analysis technique, coder categorizing technique, standard qualitative research methods).

Data Analysis Approach and Reporting of Results (n=48)

Reporting of Results

Table 3 presents how results were typically reported. Including quotes to support themes was most common by far (95.8%). Over half (58.3%) of the articles used semi-quantitative descriptors such as most , many , some , and a few when presenting themes. Another set of papers reported percentages or counts of respondents per theme (20.8%) or percentages or counts of mentions or text units (4.2%). Visual displays of the findings were uncommon (6.3%), as were conceptual models resulting from the analyses (2.1%).

In our review of qualitative research published in HE&B from 2000 to 2015, we found that qualitative inquiry frameworks were underutilized. The majority of studies included in our review were not explicitly guided by a qualitative inquiry framework. Our review showed that less than 25% of the articles explicitly stated that a qualitative inquiry framework had guided the research, and only 12.5% used a well-established approach such as ethnography or grounded theory to shape their studies. Ethnography, with its emphasis on culture, extended time in the field, ongoing observation, and building of rapport with community members, captures the emic perspective of groups and communities ( Hennink et al., 2011 ; Padgett, 2012 ). Several papers included in our review stated they used an ethnographic approach. These were generally characterized by data collection over time and/or multiple forms of data collection. Our review identified one paper in particular that exemplified this approach with significant time spent deeply engaged with a community ( Thompson et al., 2000 ). Grounded theory was mentioned more often as an analytic strategy rather than as an overarching inquiry framework. When used to describe the analysis, it often seemed synonymous with inductive coding. We did note one study ( Harley et al., 2009 ) that developed new theory using a grounded theory approach which typically involves an iterative process of data collection and analysis ( Hennink et al., 2011 ; Patton, 2015 ).

We did not find any papers that framed the research as phenomenology or narrative inquiry. Phenomenology, with its emphasis on the essence of a lived experience, requires the researcher to suspend their preconceived beliefs to explore how people make meaning of a particular event or phenomenon ( Creswell & Poth, 2018 ; Patton, 2015 ). The phenomenon is the target of study, such as experience of stigma or adoption of new guidelines within a federally qualified center. Many of the studies in our review were about a phenomenon, but curiously, this inquiry framework was rarely named. Narrative inquiry, based on stories from a small number of individuals who represent a typical or critical case, values lived experience as a critical foundation for knowledge and an important source of understanding ( Creswell & Poth, 2018 ; Padgett, 2012 ; Patton, 2015 ). Stories are often told using chronologies with temporal or episodic ordering. Life histories or life narratives fit within this approach. Again, no papers were explicitly framed as a narrative inquiry, although some studies used associated methods (e.g., life history interviews). Case studies were also rare in our review.

Explicit use of inquiry frameworks and deliberate use of associated analytic methods have considerable potential for theory-building. Grounded theory, which can help to illuminate how a process, action or interaction unfolds ( Charmaz, 2000 ; Corbin & Strauss, 1990 ; Creswell & Poth, 2018 ; Strauss & Corbin, 1994 ), may yield especially valuable insights for more effective change strategies at higher levels of the social ecologic model, such as changing organizational policies, altering neighborhood or community conditions that influence health, and influencing public policies at various levels of government. Case studies also have significant potential for theory development at the organizational, community and policy levels. As with the limited use of inquiry frameworks, we were surprised by the number of studies not explicitly grounded in existing theory. Qualitative methods have considerable potential to refine and extend our existing theories to new contexts or sub-cultures ( Hennink et al., 2011 ), which becomes increasingly important as we attempt to reduce disparities and acknowledge inequities in foundational conditions that contribute to health ( Shelton, Griffith, & Kegler, 2017 ).

Most of the studies we reviewed employed widely used qualitative sampling and data collection approaches. As expected, the majority used purposeful sampling techniques. While not always explicitly labeled as such, most authors provided an explanation for their chosen approach, illustrating how case selection followed from, and was aligned with, the stated study purpose. Of note, few studies named the type of purposeful sampling technique used, such as maximum variation, critical case, theory-based, deviant case, typical case, stratified purposeful, or random purposeful ( Creswell & Poth, 2018 ; Miles et al., 2014 ; Patton, 2015 ). A more deliberate and thoughtful approach to sampling may deepen our use of qualitative methods beyond description of a population or phenomenon.

Additionally, only a minority of authors discussed data saturation, a surprising result given the centrality of the principle to many qualitative sampling strategies and analytic processes ( Guest, Bunce, & Johnson, 2016 ; Sandelowski, 1995 ). Further, many of the articles that did discuss data saturation provided little information on how, when, and why it was assessed, and its implications for the research process. As saturation may be defined and applied differently depending upon the research goals ( O’Reilly & Parker, 2013 ), the limited detail provided made it difficult to assess whether the approach taken was well aligned with the study design and purpose.

Nearly all studies used interviews or focus groups as their primary mode of data collection; very few used observation techniques. Rooted in cultural anthropology, observation can provide in-depth understanding of the context within which behaviors occur, and elucidate how environments are experienced and perceived by the population of interest. These strengths are naturally aligned with social ecological approaches to understanding health behavior, making observation a potentially untapped resource for health researchers. Other data collection methods and sources, such as documents and artifacts were generally rare, as were open-ended conversational interviews.

The most common approach to reporting was to present themes with illustrative quotes. While reporting was limited to what is acceptable in peer-reviewed journals such as HE&B , we were struck by the lack of visual displays of data given the relatively common use of qualitative software with these features. This may be related to our tendency to describe phenomenon with themes supported by quotes, and lack of training on the value of visual displays, or perhaps skepticism about the validity (or credibility) of showing connections between concepts using qualitative approaches. Authors often reported results using semi-quantitative descriptors such as “most” or “many.” While useful as an indicator of salience, other approaches are to highlight the wide range of perspectives or nuances uncovered through the research. Again, a more systematic use of inquiry frameworks would broaden options for how to report results, with increased use of stories, case studies, conceptual models and data displays. Other approaches for organizing and reporting should also be considered, such as chronology, critical incidents, and processes ( Patton, 2015 ).

Limitations

This review has a number of limitations. Many of the papers we reviewed were written before consensus had emerged on how to report qualitative research. Consequently, authors were inconsistent in what they reported in the article and they likely received little additional guidance during the review process. This is not meant to be a critique of the authors of the papers we reviewed, but rather to reflect on what these papers mean for how we should use and report qualitative methods going forward. Additionally, HE&B decreased allowable word count during the time period covered by this review which may have also affected the level of detail provided in the papers. Our analysis is dependent on what was reported in the papers and it may be that some of our conclusions do not reflect how the study was actually conducted. Lastly, although we developed the abstract form collectively and it appeared to work well when pilot tested, we achieved low levels of consensus on some of the domains and chose not to report them here (i.e., Patton’s (2015) types of purposive sampling methods such as comparison-focused versus group-focused and his analytic strategies such as indigenous typology and analyst-generated concepts).

Implications

Gaining insight into how various determinants of health are experienced and understood by the people whose health we seek to promote is fundamental to health education. Interdisciplinary programs such as those in health education and behavior often cover qualitative methods with a semester-long course, which is occasionally supplemented by independent readings or apprenticeship. Several of the major inquiry frameworks are embedded in disciplinary traditions such as sociology, education, anthropology, history and philosophy. Our less-established and interdisciplinary field may benefit from concerted efforts to embed, or at least strategically apply, these frameworks to our training programs and our research. For example, when developing course syllabi, faculty could deliberately assign readings that exemplify a range of inquiry frameworks, even outside of qualitative courses. Or, we could actively seek colleagues from the traditional social sciences to join our research teams or guest lecture in our classes.

Consideration of the paradigms that underlie our research may also shed light on our methodologic choices. Much of the training in health education and behavior is consistent with a positivist paradigm that serves as the foundation for experimental and quantitative research in the social sciences, with an emphasis on objectivity, internal validity, hypothesis-testing and generalizability ( Patton, 2015 ; Hennink et al., 2011 ). Qualitative research, in contrast, is generally consistent with a constructivist paradigm which purports there are multiple realities that are social constructed ( Hennink et al., 2011 , Creswell & Poth, 2018 ; Saldaňa & Omasta, 2018 ). Some qualitative scholars ( Creswell & Poth, 2018 ; Patton, 2015 ) describe a pragmatic paradigm that is flexible and not committed to a particular philosophy or paradigm allowing for research methods to vary depending on the research question. The rise of mixed methods as a valued approach in health education and behavior is consistent with a pragmatic paradigm. Thus, our tradition of a positivist and/or pragmatic paradigm may contribute to a hesitancy to fully embrace inquiry frameworks deeply grounded in a constructivist paradigm. To help guard against this, journal editors and reviewers could reflect on their approach to reviewing qualitative research (e.g., not automatically rejecting qualitative papers with small sample sizes) and guard against inappropriate positivist thinking and language (e.g., quantifying results, discussing lack of generalizability as a limitation), both in submitted manuscripts and in reviews.

Practical considerations may also explain our modest use of inquiry frameworks. For example, qualitative inquiry frameworks such as ethnography typically include extensive time in the field. This timeframe is not generally feasible in public health research where qualitative methods are often used to support or contextualize quantitative data or inform future hypothesis-driven studies and where study timelines are dictated by grant funding. Given these constraints, it may be that we need to acknowledge the usefulness of a pragmatic paradigm that can accommodate the interdisciplinary nature and practical considerations of our field, and pursue opportunities to innovate and publish new methods such as combining ethnography with community-engaged research in which community members serve as co-investigators and bring their understanding of the community culture to every phase of the research process or make more use of “rapid” ethnography as long as the essence of the approach is not lost ( Hernandez et al., 2017 ; Needle et al., 2003 ).

Going forward, we recommend the explicit stating, use and integration of qualitative inquiry frameworks in health education and behavior research. The use of an established framework justifies research decisions and provides transparency. A more deliberate application of a range of inquiry frameworks has the potential to broaden the types of research questions asked, application and generation of theory, study design, analytic strategies and reporting of results. Additionally, as we embrace a social ecologic approach in our intervention and descriptive research, qualitative methods for theory-building may prove useful in understanding how to create and sustain change within organizations, communities and complex systems.

Contributor Information

Michelle C. Kegler, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA 30322, USA. ude.yrome@relgekm .

Ilana G. Raskind, Emory University, Atlanta, GA, USA.

Dawn L. Comeau, Emory University, Atlanta, GA, USA.

Derek M. Griffith, Vanderbilt University, Nashville, TN, USA.

Hannah L. F. Cooper, Emory University, Atlanta, GA, USA.

Rachel C. Shelton, Columbia University, New York, NY, USA.

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Narrative Inquiry, Phenomenology, and Grounded Theory in Qualitative Research

• First Online: 27 October 2022

Cite this chapter

• Rabiul Islam 4 &
• Md. Sayeed Akhter 5  

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Narrative inquiry, phenomenology, and grounded theory are the basic types of qualitative research. This chapter discusses the three major types of qualitative research—narrative inquiry, phenomenology, and grounded theory. Firstly, this chapter briefly discusses the issue of qualitative research and types. Secondly, it offers a conceptual understanding of narrative inquiry, phenomenology, and grounded theory including their basic characteristics. Finally, the chapter provides an outline of how these three types of qualitative research are applied in the field.

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Islam, R., Sayeed Akhter, M. (2022). Narrative Inquiry, Phenomenology, and Grounded Theory in Qualitative Research. In: Islam, M.R., Khan, N.A., Baikady, R. (eds) Principles of Social Research Methodology. Springer, Singapore. https://doi.org/10.1007/978-981-19-5441-2_8

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Article Contents

Introduction, narrative, storytelling and program evaluation, the context: a community intervention trial to promote the health of recent mothers, illustrating the analytic approach: the unique insights from narrative, two examples of stories from the cdo data set, concluding remarks.

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Researching practice: the methodological case for narrative inquiry

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Therese Riley, Penelope Hawe, Researching practice: the methodological case for narrative inquiry, Health Education Research , Volume 20, Issue 2, April 2005, Pages 226–236, https://doi.org/10.1093/her/cyg122

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Research interest in the analysis of stories has increased as researchers in many disciplines endeavor to see the world through the eyes of others. We make the methodological case for narrative inquiry as a unique means to get inside the world of health promotion practice. We demonstrate how this form of inquiry may reveal what practitioners value most in and through their practice, and the indigenous theory or the cause-and-consequence thinking that governs their actions. Our examples draw on a unique data set, i.e. 2 two years' of diaries being kept by community development officers in eight communities engaged in a primary care and community development intervention to reduce postnatal depression and promote the physical health of recent mothers. Narrative inquiry examines the way a story is told by considering the positioning of the actor/storyteller, the endpoints, the supporting cast, the sequencing and the tension created by the revelation of some events, in preference to others. Narrative methods may provide special insights into the complexity of community intervention implementation over and above more familiar research methods.

When preventive intervention programs are described, they tend to focus on the technology of the intervention without informing us about how the context in which it was implemented affected the technology. We learn little about the many compromises, choice points and backroom conversations that allowed it to take the form it took. [( Trickett, 1998 ), p. 329].

The history of health promotion has been one of developing and testing increasingly sophisticated theories to inform and strengthen the effectiveness of actions taken by the front-line workers. Theories of health promotion have been developed for multiple levels of analysis (individual, group, organizational, community, etc.) ( Glanz et al. , 1990 ) and for a variety of settings (schools, workplaces, hospitals, etc.) ( Poland et al. , 2000 ). Large-scale, whole-community prevention trials have been conducted purporting to test particular state-of-the-art theories in cancer control and heart disease prevention ( Thompson et al. , 2003 ). Studies of interventions typically include process evaluations, which allow investigators to comment on the extent to which what took place actually matched what was planned ( Flora et al. , 1993 ).

What we hear less about, however, is the private contexts of practice as Trickett describes above and ways of viewing the ‘problem’ at hand other than those preconceived by the intervention's designers. Evaluators who use qualitative methods may get closer to this ( Patton, 1990 ). ‘Key informant’ interviews have become increasingly used to gain insight into the factors that have helped or hindered program development or might explain why programs appear to work in some contexts, but not in others ( Goodman et al. , 1993 ). Even so, this literature contains examples of studies where interviews held at the end of the program still have failed to give investigators confidence about what really happened and why ( Tudor-Smith et al. , 1998 ). Investigators who have engaged practitioners in interviews about the nature of their practice have also commented on how difficult it is for people, in retrospect, to articulate aspects of what they do and think ( Hawe et al. , 1998 ). Thus, many aspects of practice remain elusive.

In this paper we suggest that narrative methods may give new and deeper insights into the complexity of practice contexts. By narrative inquiry, we mean the use of personal journals by and serial interviews with fieldworkers during their implementation of a health promotion intervention. Narrative methods may also allow us to better understand the mechanisms through which health programs are transported and translated. In doing so, the natural or indigenous theory of an intervention may be revealed, i.e. the cause-and-consequence thinking of practitioners, which may or may not match the theory supposed to be tested by the intervention. We use a case study from a whole-community intervention trial to illustrate how we are using these methods. The results of the analysis are not presented here.

Narrative inquiry has a long, strong and contested tradition. There are a range of approaches to narrative inquiry, emanating from diverse disciplines such as psychology, sociology, medicine, literature and cultural studies ( Riessman, 1993 ; Mishler, 1995 ). As a result, the process of interpreting stories is now a point of scholarly investigation in itself, because there is no one unifying method ( Riessman, 1993 ; Mishler, 1995 ; Schegloff, 1997 ; Manning et al. , 1998 ). Approaches differ on the core questions of why and how stories are told. That is, the nature of the storytelling occasion and therefore the knowledge claims that can be made about the problem under investigation.

‘Story’ and ‘narrative’ are words often used interchangeably, but they are analytically different. The difference relates to where the primary data ends and where the analysis of that data begins. Frank ( Frank, 2000 ) points out that people tell stories, but narratives come from the analysis of stories. Therefore, the researcher's role is to interpret the stories in order to analyze the underlying narrative that the storytellers may not be able to give voice to themselves. For example, in a narrative study of people who are unemployed, Ezzy ( Ezzy, 2000 ) explored the role that broader social forces play in how people tell stories about their job loss. He described two narratives: the heroic and tragic job loss narratives. The heroic narrative gives prominence to the role of a person's individual agency and autonomy, whereas the tragic job loss narrative is one is which the person is a victim of institutional or social forces beyond their control. These narrative structures provide insights into how people come to understand their unemployment and the type of action or inaction they take as a result.

The word ‘narrative’ is used extensively in health research. It commonly refers to the field of illness narratives, such as accounts of cancer from the patient's perspective ( Frank, 1998 ). The use of words like ‘narrative’ and ‘story’ became more popular in health promotion in the early 1990s as part of an increased emphasis on reflective practice and methods of program evaluation which gave more control to research participants. For example, Dixon argued that storytelling methods were ideally suited to community development projects because the creation of the project's meaning or public representation is placed more in the control of participants, as opposed to external researchers ( Dixon, 1995 ). Storytelling has developed as a training and practice development technique for knowledge development in health promotion ( Centre for Community Development in Health, 1993 ; Labonte et al. , 1999 ).

Thus health promotion was part of what Chamberlayne et al. ( Chamberlayne et al. , 2000 ) referred to as the ‘biographical turn’ in the social sciences. That is, they were part of the larger move towards methods that tap into the personal and social meanings that are considered to be the basis of people's actions. Incorporated within these methods are mechanisms for critical reflection which conceive the individual as the primary sense-making agent in the construction of his/her own identity ( Blumer, 1969 ; Giddens, 1984 , 1991 ; Schwandt, 1998 ). Reflective writing also became a feature within the context of professional development literature ( Schon, 1999 ), and also in education ( Orem, 2001 ), business ( Hartog, 2002 ) and medicine ( Webster, 2002 ).

In our case, narrative inquiry is providing insight into the mechanisms by which community development officers facilitate transformative change among people and organizations, as part of their role to implement a new community-level intervention. We are using narrative inquiry alongside a fleet of methods including self-completed questionnaires, interviews, observation, document analysis and network analysis of inter organizational collaboration patterns ( Hawe et al. , 2004 ).

The intervention, PRISM (Program of Resources, Information and Support for Mothers), is a coordinated and comprehensive primary care and community-based strategy to promote maternal health after childbirth. The study involved 16 local government areas in the state of Victoria, Australia and approximately 20 000 women. The rationale for the intervention and the evidence on which it is based are described by the PRISM designers ( Gunn et al. , 2003 ; Lumley et al. , 2003 ). The intervention is anchored and facilitated in each of the eight intervention communities by a full-time community development officer (CDO) working with a local steering committee for 2 years.

The diaries and interviews

The data are in the form of field diaries and in-depth interviews. Each CDO maintained a field diary over the 2 years of their employment. CDOs were invited to record in it their feelings, thoughts, frustrations, plans and hopes. Agreement to be involved in program documentation was a part of their employment contract with the PRISM research team. Nevertheless the CDOs' agreement to write diaries with the authors (the ‘EcoPRISM team’) was confidential and entirely independent of the PRISM research team. The average field diary consists of approximately 40 000 words of verbatim reflection.

The interview data comprise 34 interviews (in total) undertaken at strategic points of intervention implementation with each CDO. The interviews provided the opportunity for CDOs to talk about what they may have found tedious or difficult to write down. The interviews explored emerging themes within the data. The interviews were tape recorded and transcribed. They were undertaken both over the telephone and face-to-face.

Creating and sustaining the right research conditions for collecting this data was paramount. Unless we could create the right conditions, the CDOs may tell us only part of their story, what they think we want to hear or indeed nothing at all. These conditions encompassed:Creating these conditions in order to gather data in an ethical and principled manner required the researcher (T. R.) to position herself closely with the CDOs. CDOs spent approximately 90 min a week working on program documentation.

Flexibility in how the data were recorded. Some CDOs had electronic diaries. Some were hand written. Some were emails and others were a combination of the three. A couple of CDOs changed recording methods over time.

Adjusting recording methods to suit field conditions.

Empathy to the challenges CDOs faced in implementing the intervention and in their research relationship with us.

Participation in project dissemination. Co-authoring of papers and conference presentations about the project with CDOs.

Trust within the research relationship. By this we mean trust that we would maintain confidentiality and trust that we would represent the CDOs' story accurately.

How narrative analysis differs from thematic analysis

Thematic analysis is common in health promotion research. It involves the open coding of data, i.e. the building of a set of themes to describe the phenomenon of interest by putting ‘like with like’ ( Morse and Field, 1995 ). The researcher looks for patterns in the data, labels them and groups them accordingly ( Strauss, 1987 ). This approach to analysis can stop at the stage of simple listing of themes [e.g. ( Gordon and Turner, 2003 )]. If the development of themes is led by the researcher's a priori interests, some researchers have preferred to use the term ‘template’ analysis ( Crabtree and Miller, 1999 ). On the other hand, if the themes are derived inductively from the data itself then the thematic analysis may be considered to be more close to a grounded theory analysis [e.g. ( Kalnins et al. , 2002 )]. In practice, many researchers in health promotion conduct thematic analyses that reflect both the ideas they bring to the data set beforehand (from the research questions) as well as being open to ‘new’ themes in the data.

Narrative analysis differs from thematic analysis in two interconnected ways. First, narrative analysis focuses more directly on the dynamic ‘in process’ nature of interpretation ( Ezzy, 2002 ). That is, how the interpretations of the CDOs might change with time, with new experiences, and with new and varied social interactions. So, integration of time and context in the construction of meaning is a distinctly narrative characteristic ( Simms, 2003 ). This is something that Ricoeur calls the ‘threefold present’ in which the past and the future co-exist with the present in the mind of the narrator, through memory in the first case and expectation in the second. A thematic analysis might document different themes arising at different stages of the intervention. However, how time drives or potentially transforms the interpretation is integral to the construction of narratives. It is central to the development of narrative types ( Schutz, 1963a , b ), as we describe later.

Second, narrative analysis begins from the stand point of storyteller, or in our case CDO. From here we analyze how people, events, norms and values, organizations, and past histories and future possibilities, are made sense of and incorporated into the storyteller's interpretations and subsequent actions. That is, narrative analysis contextualizes the sense-making process by focusing on the person, rather than a set of themes. This is an important methodological distinction. In analyzing the CDO diaries we attempt to stand in the CDOs' shoes and experience events as they do. As situations, people and events change over time, our vantage point remains the same. In this way we gain unique insights into how they interpret the world. Thematic analysis, in contrast, de-contextualizes the data (e.g. by ‘cutting and pasting’ themes together) to examine the meta or broader issues. Narrative inquiry shares with discourse analysis both a concern for how broader institutional values and cultural norms are expressed in language, and the belief that language is a form of action ( Potter and Wetherell, 1987 ). However, narrative analysis adds further insights into ‘contexts of practice’ because it studies the world through the eyes of one storyteller and applies a theory of time.

Key features of narrative inquiry

Narrative inquiry attempts to understand how people think through events and what they value. We learn this through a close examination of how people talk about events and whose perspectives they draw on to make sense of such events. This may reveal itself in how and when particular events or activities are introduced, how tension is portrayed, and in how judgments are carried out (e.g. the portrayal of right and wrong).

A narrative approach looks closely at the sentences constructed by the storyteller and the information and meaning they portray. The following categories have been adapted from Young ( Young, 1984 ). Are the sentences descriptive? That is, a sentence or paragraph that sets the scene, but has no temporal role in the story. Are they consecutive ? Is there a logic to where the sentence fits into the story? Are they consequential to the story? That is, they have causal implications. If the sentences are evaluative , do they show something of the attitude of the CDO? These sentences give meaning to the story. If they are transformative , they express a change in how the storyteller evaluates something, such as an epiphany.

Narrative inquiry captures how people make sense of the world. This ‘thinking through’ events is presented in the recording of events, such as the extent of detail given. It is also captured in the form of internalized soliloquies ( Athens, 1994 ; Ezzy, 1998 ). These are the conversations one has with oneself or imagined others.

Narrative analysis focuses on who is mentioned in the telling of events (and who is absent) and the role they have in the telling of events. Gergen and Gergen ( Gergen and Gergen, 1984 ) refer to these people as the supporting cast of a person's narrative. As a supporting cast member, they have a purpose or reason for existing in the story. The manner in which the supporting cast are discussed in the field diaries may range from factual accounting of events, to theorizing what that supporting cast member is thinking or doing. Most importantly, who is mentioned in the field diary reveals the people or organizations that are most significant to the CDO in their practice.

Thinking about the context of the storytelling is another important feature of narrative inquiry. Frank ( Frank, 2000 ) refers to the storytelling relation . By this he means that data emerges from within the relation between the teller, the listener and the context of the telling of the story. Storytelling can be a political occasion. Narrative inquiry takes as a given that people may exclude details of events or exaggerate aspects of stories ( Ezzy, 2000 ). What is of analytical interest to the narrative researcher is why these exclusions or exaggerations exist.

On the basis of careful examination of the data, why and how the story is being told, who the supporting cast are and the nature of the storytelling occasion, one can determine the narrative's plot or what the story is about. The plot of a persons' narrative is the organizing theme ( Ezzy, 1998 ) that brings coherence to the telling of events. Events are understood according to the plot. As a result, we can see and understand how a person makes sense of the world.

Finally, the point of the story considers both the organizing theme and the form of the narrative. Form refers to the flow of the narrative over time. Common prototypes are stable, progressive and regressive narratives ( Gergen and Gergen, 1988 ). A stable narrative is one in which the person's evaluations of situations and events remains the same over the course of time. A regressive narrative is one in which these evaluations get worse with time. A progressive narrative is one in which the person's evaluations improve over time. These broad narrative forms are represented in Frye's ( Frye, 1957 ) forms of literary narrative: the tragedy, the comedy, the happy ending, the satire, the romantic saga, etc. It is the inter-relationship of the organizing theme and form that creates what is called ‘coherent directionality’ in the narrative. This means how it makes sense over time.

A complete narrative analysis takes all CDOs and all their stories. It is beyond the scope of this paper to present this in totality here. Instead, to illustrate the insights we are gaining through narrative inquiry, we present two examples of stories below. Table I outlines the narrative approach applied to these two examples. We have also demonstrated the type of themes we could derive from the same quotations if we were to undertake two kinds of thematic analysis, either guided by an a priori interest in program implementation or not. This is presented in Tables II and III .

Example of narrative analysis of two stories

Thematic analysis of two stories: example led by a priori interests

Thematic analysis of two stories: example based on text (free codes) for both stories

The cinema story

I do a lot of my best project work after hours in the supermarket. Friday evening after work was very fruitful in this way. Good conversations with three young mums interested in the project, one who inspired me weeks ago to set up classes at the swimming pool—and then I bumped into the local cinema owner. I had asked him some time ago to think about piloting a Cry Baby program at his cinema, but hadn't got back to him to check. At the bakery counter he said yes! So next week we'll get together to discuss upcoming films, a launch for the first Cry Baby session…

Catching the hairdresser

Ring Sally the hairdresser—catch her at last. She seems interested (though privately always consider that when people are hard to catch and not returning calls it suggests that they may well end up not contributing— my personal theory that, in the end, people contribute to any activity in inverse proportion to the amount of effort involved in contacting them in the first place) so send her again details of Project and [voucher] contract.

As demonstrated in Table I narrative analysis can be applied to short, very specific stories. We have applied these steps to the entire CDO data set in order to identify the main plots to each of the CDO narratives. Then, through a process of comparison between each of the narratives, a narrative typology or model of ideal types (of narratives) has been created, understood from a phenomenological point of view ( Schutz, 1963a , b ). This means comparing each of the organizing themes for similarities and differences regarding their interpretative framework. By placing each narrative theme under scrutiny, we find that some plots are very similar in nature (form and theme), while others stand out as different. In this way we hope to be able to put forward some of the defining characteristics of practice in the context we have researched, that is, experienced community development practitioners working within the context of a community intervention trial.

The assumption that we bring to this work is that a better understanding of intervention dynamics and indigenous theory may lead to fewer failed community interventions ( Thompson et al. , 2003 ). Because our PRISM trial collaborators are conducting a traditional process evaluation ( Lumley et al. , 2003 ), focused on the program elements, we will be able to determine how a different way of describing intervention unfolding sheds additional light on the ‘black box’ of the intervention. Our interpretations will also be linked to the burgeoning field of implementation analysis ( Ottoson et al. , 1987 ; Bauman, 1991 ; Bammer, 2003 ). This field argues that we need to move beyond mechanistic ways of viewing interventions [e.g. ( Flora et al. , 1993 )] to encompass new methods better suited to the complexity of the personal, organizational and community change processes that interventions purport to bring about.

A primary weakness of narrative inquiry is that it is retrospective. So the length of time required for analysis and presentation of results can be a disincentive. For this reason, fine-tuning narrative methods is a major challenge for future work. Hence, we relied on thematic analysis in order to feedback data that might be timely and important for fine-tuning the intervention in progress ( Riley et al. , 2004 ). However, the narrative analysis takes us much further into the private world of the practitioner and helps us (re)think what the intervention represents. It helps us understand the intensely personal investments being made by CDOs in the project. This is revealed in the CDO's placement of ‘self’ in the narrative. We learn about the progressive or regressive trade-offs, risks and rewards. This provides the social context to allow us to better interpret project dynamics and tensions. For example, the stakes involved when different opinions arose regarding how far PRISM could be adapted to suit local context ( Riley et al. , 2004 ).

Riger ( Riger, 1989 ) argues that some of the most important (but typically untold) stories within community interventions are about the power dynamics, i.e. what gets said publicly about the intervention and why. Our analysis thus far privileges the perspective of the CDO. However, another data set in our study, key informant interviews held in each community at the end of the intervention, will allow us to challenge or confirm these views. This includes members of the steering committees (i.e. some of the ‘supporting cast’).

Narrative analysis requires an in-depth engagement with and understanding of the participant's experience. As a result, there is a blurring of interpretive boundaries between the analyst and the research participant. Such a blurring results in two distinct criticisms of narrative analysis. One is that the analyst can play too strong an interpretative role without sufficient links back to empirical data ( Atkinson, 1997 ). The other criticism is that the analyst plays too weak an interpretive role. Atkinson ( Atkinson, 1997 ) argues that within some forms of narrative analysis there is a lack of analytical attention to social context and interaction, subsequently celebrating, rather than analyzing, the research participant's stories. Researchers are likely to be open to such criticism when unable to define and defend the interpretive framework that is being applied to interrogate the data.

Narrative inquiry encourages the analyst to consider what is in the data set and also what is not there, such as missing characters or alternative viewpoints. This makes the systematic ‘coding’ of data extremely difficult ( Rice and Ezzy, 1999 ) and affirms the importance of a guiding set of analytical principles with which to interrogate the data. Introspective reflexivity is critical in this regard ( Finlay, 2003 ). By this we mean that researchers must interrogate the dynamic created between the researcher and ‘the researched’ and devise accountability mechanisms. In this way the researchers' location and representation within the study is a key component of both data collection and analysis and we have drawn on insights from ethnography in this regard ( Michalowski, 1997 ; Reinharz, 1997 ; McCorkel and Myers, 2003 ). The challenges arising from our research context have been explored in a series of presentations and publications we have pursued with CDOs ( Riley and Hawe, 2000 , 2001 , 2002 ; Riley et al. , 2001 ; Sanders et al. , 2001 ). For an exploration of the ethical challenges we faced, see Riley et al. ( Riley et al. , 2004 ).

Our data set is unique. We know of no other large-scale intervention studies using narrative methods to understand practice contexts. CDOs told us that, overall, writing about their experience helped. It enabled their viewpoints to be articulated and better heard. We hope that by describing our narrative approach we will encourage other researchers to investigate the opportunity provided by narrative inquiry in everyday practice and in intervention study contexts.

We are indebted to the CDOs (Wendy Arney, Deborah Brown, Kay Dufty, Serena Everill, Annie Lanyon, Melanie Sanders, Leanne Skipsey, Jennifer Stone and Scilla Taylor) for their willingness to engage with us and to share their reflections on their use of diaries. The PRISM research trial team is Judith Lumley, Rhonda Small, Stephanie Brown, Lyn Watson, Wendy Dawson, Jane Gunn and Creina Mitchell. Our thanks to them for the opportunity to participate as collaborators in the trial. The EcoPRISM study is funded by the National Health and Medical Research Council, Australia. P. H. is a Senior Scholar of the Alberta Heritage Foundation for Medical Research, Canada and holds the Markin Chair in Health and Society at the University of Calgary.

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Author notes

1VicHealth Centre for the Promotion of Mental Health and Social Wellbeing, School of Population Health, University of Melbourne, Carlton, Victoria 3053, Australia (Formerly at the Centre for the Study of Mothers' and Children's Health, LaTrobe University, Bundoora, Victoria 3086, Australia), 2Department of Community Health Sciences, University of Calgary, Calgary, Alberta T2N 4N1, Canada and 3School of Public Health, LaTrobe University, Bundoora, Victoria 3086, Australia

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Christine Oliver

Systemic psychotherapist, organisational consultant, teacher and writer.

• About Christine Oliver
• Organisational Consultancy
• Management Development & Training
• Systemic Psychotherapy
• The Collapsed Chair Consultation : Making Moments Of Significance Work
• Reflexive Inquiry : A Framework for Consultancy Practice
• Complexity, Relationships, and Strange Loops: Reflexive Practice Guide
• Working With Appreciation In Managerial Practice
• Appreciative Inquiry As Aesthetic Sensibility
• Situated Knowledge Management
• Systemic Eloquence
• Managing Difficult People

Introduction

As an organisational consultant drawing on systemic traditions I aspire to help organisations create coherence between their vision, strategy and action. By the same token, coherence is an important context for my own practice. I find myself comparing, connecting and distinguishing my experiences as a consultant, moving between frames, tools and practices and back again and developing a thread of narrative as I go. This book on reflexive inquiry (RI) represents an attempt to articulate that narrative and will hold value in so far as it can inspire others to act productively in specific situated moments. I am grateful for the opportunity to make a pattern of my experience. In taking up this opportunity, my own practice, at least, has developed.

Reflecting on the theme of coherence, I realise the usefulness of experiences of incoherence to my own learning as a practitioner in organisational contexts. I have attempted to cultivate the ability to notice points of disconnection and to connect them to wider contexts that help disconnection to make sense. This consciousness has facilitated the potential for new frames and tools, providing, in turn, contexts for future dissonances. My work with appreciative inquiry (AI) is an example where an experience of incoherence has been fruitful in helping me challenge and change my frames and practices to construct (from where I stand) a more coherent pattern. I am grateful to writers and practitioners of AI who have inspired these developments (Anderson et al., 2001; Barge and Oliver, 2003; Cooperrider, 1998; Cooperrider and Whitney, 1999).

AI has become a prevalent consultancy methodology discourse for working with organisational change and, for some, has become aligned with systemic practice (Anderson et al, 2001). The impetus for this book comes from both the practical development of this methodology in my work as a consultant, and the translation of that work in teaching and writing contexts – teaching on the MSc in Systemic Organisation and Management at Kensington Consultation Centre, London, writing various papers for conferences and publication (Barge & Oliver, 2003) and two recent chapters on AI in edited books (Oliver, 2002 in Meisner & Voetmann, Oliver, in press). An increasing need to develop AI methodology to fit the contexts I work in helped me to understand some theoretical (and practical) disconnections implicit in the methodology itself. I moved through various representations (for example, Critical Appreciative Inquiry, Oliver, in press) to a position of thinking that reflexive inquiry could provide the possibility of both transcending the polarisation of positive and negative embedded in appreciative inquiry while incorporating something of its value. RI will thus be employed as a set of principles and tools in presenting my particular approach to consultancy in working with organisational development.

This approach is inspired by systemic practice in psychotherapy and organisational studies. While a systemic account encourages the practitioner to engage with and develop the complexity of life and not marry one’s hypothesis , I detect a discomfort in some representations of systemic thought with the critical and the decisive voice, privileging the empowerment of the voice of the other in a way that can create systemic imbalance (e.g. see Anderson et al, 2001). My own 1996 paper Systemic Eloquence , was an attempt to posit reflexivity as the core practice, with systemic eloquence as the space in which situated decisions could be made about the appropriate form of communication required, whether appreciative, challenging, critical, decisive, supportive or inquiring. My thinking now is that paper did not go far enough in making a case for reflexivity as a core practice. This book offers more of a basis for that position where it connects a related set of principles to a repertoire of practice.

In developing the methodology of RI, I will be offering models and tools constituting practical theory in my work with organisations. In using the term practical theory I am moving away from the traditional academic dualism separating theoretical constructs from their applications. Instead, I am aiming to demonstrate the opportunities for organisation development and learning which arise from examples of RI theory-in-practice.

In Part 1 of the book, the RI frame will be set out. Five core principles will be offered to set a theoretical and ethical context for the tools for constructing and coordinating conversation that can be said to make up RI practice.

In Part 2, these principles and tools will come to life when enacted in organisational and community development contexts. Work will be described with a religious community and in a non-governmental organisation (NGO) where the development of reflexive practice became vital for existence. All organisations embody unique patterns of meaning and action thus the learning from work with one can never be translated ‘lock stock and barrel’. However, the methodologies and tools which are set out in Part 1 will be shown in action in case studies. This will demonstrate the potential for these tools to construct new patterns of feeling, meaning and action that provide scope for ways forward in complex, uncomfortable and sometimes stuck situations.

Part 3 will draw out some implications of the principles, arguments, models and tools presented for undertaking research. It will be argued that RI provides unique possibilities for research. A case example will be offered which shows a rich connection between consultancy and research processes.

Part 4 will conclude and look to the potential for future development. In particular, it will share recent ideas in development about looped patterns. References Anderson, H., Cooperricler, D., Gergen, K. J., Gergen, M., McNamee, S., & Whitney, D. (2001). The Appreciative Organization. Taos, New Mexico: Taos Institute.

Barge, J. K., & Oliver, C. (2003). Working with appreciation in managerial practice. Academy of Management Review, 28(1): 124—142.

Cooperrider, D. L. (1998). What is appreciative inquiry? In: S. A. Hammond & C. Royal (Eds.), Lessons from the Field: Applying Appreciative Inquiry. Piano, TX: Practical Press.

Cooperrider, D. L., & Whitney, D. (1999). Appreciative Inquiry. San Francisco: Berrett-Koehler.

Oliver, C., & Barge, J. K. (2002). Appreciative inquiry as aesthetic sensitivity: co-ordination of meaning, purpose and reflexivity. In: C. Dalsgaard, T. Meisner, & K. Voetman (Eds.), Change: Appreciative Conversations in Theory and Practice. Denmark: Psykoiogisk Forlag.

Oliver, C. (2005). Critical appreciative inquiry: reworking a consultancy discourse. In: E. Peck (Ed.), Organisational Development in Healthcare. Oxford: Radcliffe.

" Reflexive Inquiry " offers a way for us, as organisational members and consultants, to handle the tensions of a life immersed in organisational relations, structures, rules, policies, and procedures. This book provides us with an array of practices we might use with client systems seeking development while avoiding the urge to prescribe a new method for consultancy. Oliver has struck a chord identifying reflexive inquiry as the centerpiece of our work. When we invite our clients (as well as ourselves) into the sort of relational examination that reflexive inquiry spawns, we give full attention to the communication practices that create our identities, our organizations, and our lives. I am sure this volume will be rich with resources for us all. Sheila McNamee, Professor of Communication, University of New Hampshire, USA

All of us who are working with systemic, communication, and constructionist ideas will welcome the publication of this book. My term-of-choice for the framework presented here is "maturity." It brings together several strands of work (appreciative inquiry, systemic practice, CMM), productively extending them in a practice centered on reflexivity. Perhaps the most impressive aspect of this book is that it both extends the work of the community of practice in which it is located and is accessible to those not already involved in it. Readers new to this community of practice will find a high ratio of new information and ideas, but the information is presented in an engaging manner with sufficient illustrations from actual cases to enable comprehension and adoption of new ways of working. W. Barnett Pearce. Professor, Human and Organization Development Program, Fielding Graduate Institute

Appreciative inquiry and shared values: A case study

• November 2018
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