Conference Agenda

In this presentation I wish to review and discuss the challenges involved in introducing ethnography and conversation analysis in the habitual residential environments of persons with dementia to support valid assessment and quality care. I will refer to my experience promoting the ecological assessment of pragmatic competence and training dementia caregivers in assessment and intervention techniques grounded in everyday life. This work remits to methodological developments including the application of Conversation Analysis to impaired communication, the Ethnography of Communication Disorders and Person-Centered Dementia Care.
The challenges I will discuss include: Shifting attention from brainy and psychopathological concepts to the grounds of human interaction; putting people who are in a process of progressive cognitive deterioration in the centre of life and decision making; demonstrating the relevance of promoting their quality of life however close to death they may be; replacing complaints about the passivity of the powerful with initiative for self-activity; and promoting the scientific value of knowledge which is grounded on intersubjective experience.
These issues are relevant to my work today, after two years training professionals in these approaches and on the brink of moving to their specific application.

Evidence suggests that service users are rarely involved in decision-making concerning psychiatric care, and service providers may demonstrate excessive authoritarianism. The study aimed to develop three appropriate semi-structured interview protocols for mental health service users and providers as a data collection tool for researching decision-making practices in Latvia. The content of the semi-structured interview protocol was designed by taking into consideration scientific literature and research on a similar topic. Three different protocols were developed for specific groups of research participants. The main thematic areas of the protocol of interview questions are the personal experience of making decisions in psychiatric care, including difficulties, understanding, evaluation, implementation of the concept of the patient's decision-making ability in practice; the role of the patient, support person, and psychiatric professional in the decision-making process; expectations about the desired decision-making process. The empirical data will help to plan and develop patient-oriented health services.

Acknowledgements. The research project “Towards a human rights approach for mental health patients with a limited capacity: A legal, ethical and clinical perspective”, No. lzp-2020/1-0397 and “Strengthening of the capacity of doctoral studies at the University of Latvia within the framework of the new doctoral model, No.8.2.2.0/20/I/006”.

There is a rich body of research that apply qualitative methods to investigate how patients/service users experience mental illness and the treatment and support provided. Although crucial for understanding the life circumstances of people with mental illness, such research often lacks theoretical underpinnings to specify what meaning they ascribe to the notion of ‘experience’.

This paper aims to propose theoretical dimensions that can be used to guide and position qualitative studies of patient experiences. This is accomplished by discussing interview data from three projects carried out in different mental health contexts: closed hospital units, supported housing and services for patients under community treatment orders.

The paper will discuss and illustrate problems that arise when analysis is attempted without theoretical awareness of possible theoretical dimensions/aspects of experiences. Researchers then risk ending up with analyses that become naively data-driven and trivial in their results.

The paper will consider possible dimensions relevant for analyzing experiences. One such dimension would be temporality-spatiality-embodiment of experiences. Another dimension regards aspects of evaluation and morality, while a third contains emotional aspects. It is argued that the tentative dimensions discussed are useful both in constructing interview guides, in focusing analyses and also in organizing literature reviews.

Identity Structure Analysis (ISA) (Weinreich, 2004) integrates classical theories with narrative and discursive approaches. ISA defines identity as the totality of our constructs on our own selves, with a continuity between past and present experiences and future anticipations. ISA’s framework software, Ipseus includes a bipolar rating scale and relies on iterative multi-perspective ratings to measure one’s identifications, self-states, and conflicted areas. The discourses in the appraisals are shaped according to participants’ key domains of social interactions (entities) and to the themes (constructs), emerging in the interactions. Since its inception, ISA has been used to explore cultural and professional identities, as well as identity changes in clinical settings. Though ISA/Ipseus uses quantified identity parameters, it is customized to respondents’ discursive traditions. This ethnographic approach with a strong focus on language requires qualitative methods (e.g., observations, interviews, and a Delphi-method to reach expert consensus, etc.) to define the exact contents of the discourses. In this presentation, we focus on the qualitative steps that we used when designing our Lecturer Identity Instrument. These steps comprised discourse analysis on key strategic documents, autoethnography and a Delphi-method involving cross-cultural comparisons.