Reflexivity is a difficult concept for students to grasp. Using the study below can be a good way to help students understand how and why reflexivity is used in qualitative studies.

Note: this task has been developed for the “old” syllabus.

Task #1: Making Predictions

  • Explain the aim of the study summarized below. Student’s think-pair-share about what research method they would use and why.
  • Discuss as a class and then have students read the summary to see if they were “right.”

Task #2: Understanding reflexivity


Task #3 Application: Reflexivity

  • How could have the researcher in the following study been reflexive?
  • Why is reflexivity a relevant consideration in this study?

Task #4 Application: Other points

  • Students work together to come up with a list of relevant points to make about the study in regards to the following key methods and concepts in qualitative research:
    • Participant observation method
    • Considerations (in setting up and/or carrying out the observation)
    • Data analysis
    • Triangulation
    • Ethical considerations
    • Participant expectations
    • researcher bias
    • Credibility
    • Reflexivity

Their points could be related to:

    • How?
    • Why?
    • Limitations?
      • If students need more guidance, they can refer to the list of practice exam questions listed later in this post.

Down and Out in New York City (Romeo, 2005)

People living in poverty find it difficult to access health care resources (e.g. medical treatment, Doctor’s appointments, vaccinations, health insurance, etc.) Based on her experiences as a nurse, June Romeo became interested in studying the difficulties poor and marginalized people might have when it comes to accessing health care and she had ” long been concerned about inequities in the allocation and distribution of health care resources. She “…began to wonder what it was like from the other vantage point: the recipient of care.” Thus, the aim of her study was to learn about what it was like for poor and marginalized people to try to access health care resources.

Romeo used participant observation by dressing as a homeless person and visiting 9 hospitals in NYC that were designed to help the underinsured and uninsured people. She visited these clinics every year, for five years, dressed as a homeless person. On each visit, she complained that “my head hurts real bad and I see sort of fuzzy…”

The way she was treated in these hospitals was consistent throughout the period of observation. In 7 of the 9 hospitals, she was disrespected and humiliated. She found that her questions about how long she had to wait weren’t answered, the check-ups weren’t very thorough, there were no diagnostic tests offered to try to find out what was wrong and there was no suggestion about when to return for a follow-up. Only 2 of these 7 clinics offered any treatment (which was Tylenol).

Romeo also gathered data by talking with homeless people on the streets and in the clinic waiting rooms during her observation periods. She talked with one man, Samuel, who was suffering from gangrene in his feet and the previous night in his shelter he was held done by other men and his clothes literally taken off his back.  Romeo writes that all the way  on her way back to the hotel “thought about Samuel and she “still think(s) about him today and wonder(s) what finally became of him.”

One conclusion Romeo made from the study was that doctors and nurses working in healthcare for poor and marginalized people often have the assumption that poor people have health problems caused by their behaviour (e.g. being drunk or using drugs). She also felt that these people are treated like they don’t have feelings and sometimes like they don’t exist at all. She concedes that it is a difficult line of work to care for these people, but professionalism needs to be maintained and “…being aware of one’s biases, knowing one’s limitations, and recognizing burn-out is crucial for caregivers to the indigent and poor.”

Reference: Romeo, June Hart. Down and Out in New York City: A Participant-Observation of the Poor and Marginalized. Journal of Cultural Diversity. Winter2005, Vol. 12 Issue 4, p152-160. 9p.


Practice Exam Questions

  • Explain the role of reflexivity in this study.
  • Discuss the use of participant observation in this study.
  • Explain two considerations relevant to carrying out the observation.
  • Explain how the researcher could have analyzed the data from this observation.
  • Explain the effect of triangulation on the credibility/trustworthiness of this study.
  • Discuss ethical considerations relevant to this study.
  • Explain possible effects of participant expectations and/or researcher bias in this study.
  • To what extent can findings can be generalized from this study?

We’re working on a Paper 3 digital revision resource that we hope can be made available in time for the May 2018 exams.


Why are qualitative methods used?

This study does a good job of highlighting the strengths and limitations of a participant observation. On the one hand, Romeo was able to experience first hand what it felt like to be treated like you were invisible and had no feelings because you were poor and trying to seek healthcare treatment. She gained an understanding and an insight of the subjective experience of this phenomenon that would have been difficult or impossible to gain with other methods.

However, we also see the potential for researcher bias to influence the credibility of the study. Romeo went into the observations with a particular concern about the “inequities in the allocation and distribution of health care resources.” She also conducted these observations by herself, with no other researcher to triangulate findings and observational notes. We can also see how it might be difficult to maintain objectivity. For example, the story of Samuel is quite touching and it obviously had an effect on Romeo; could this impact her observations and reporting of her experiences? There aren’t definitive answers to these questions, but they’re the types of questions we need to ask when assessing any research methodology.