qualitative research on participant observation

Chapter 13. Participant Observation

Introduction.

Although there are many possible forms of data collection in the qualitative researcher’s toolkit, the two predominant forms are interviewing and observing. This chapter and the following chapter explore observational data collection. While most observers also include interviewing, many interviewers do not also include observation. It takes some special skills and a certain confidence to be a successful observer. There is also a rich tradition of what I am going to call “deep ethnography” that will be covered in chapter 14. In this chapter, we tackle the basics of observational data collection.

What is Participant Observation?

While interviewing helps us understand how people make sense of their worlds, observing them helps us understand how they act and behave. Sometimes, these actions and behaviors belie what people think or say about their beliefs and values and practices. For example, a person can tell you they would never racially discriminate, but observing how they actually interact with racialized others might undercut those statements. This is not always about dishonesty. Most of us tend to act differently than we think we do or think we should. That is part of being human. If you are interested in what people say and believe , interviewing is a useful technique for data collection. If you are interested in how people act and behave , observing them is essential. And if you want to know both, particularly how thinking/believing and acting/behaving complement or contradict each other, then a combination of interviewing and observing is ideal.

There are a variety of terms we use for observational data collection, from ethnography to fieldwork to participant observation . Many researchers use these terms fairly interchangeably, but here I will separately define them. The subject of this chapter is observation in general, or participant observation, to highlight the fact that observers can also be participants. The subject of chapter 14 will be deep ethnography , a particularly immersive form of study that is attractive for a certain subset of qualitative researchers. Both participant observation and deep ethnography are forms of fieldwork in which the researcher leaves their office and goes into a natural setting to record observations that take place in that setting. [1]

Participant observation (PO) is a field approach to gathering data in which the researcher enters a specific site for purposes of engagement or observation. Participation and observation can be conceptualized as a continuum, and any given study can fall somewhere on that line between full participation (researcher is a member of the community or organization being studied) and observation (researcher pretends to be a fly on the wall surreptitiously but mostly by permission, recording what happens). Participant observation forms the heart of ethnographic research, an approach, if you remember, that seeks to understand and write about a particular culture or subculture. We’ll discuss what I am calling deep ethnography in the next chapter, where researchers often embed themselves for months if not years or even decades with a particular group to be able to fully capture “what it’s like.” But there are lighter versions of PO that can form the basis of a research study or that can supplement or work with other forms of data collection, such as interviews or archival research. This chapter will focus on these lighter versions, although note that much of what is said here can also apply to deep ethnography (chapter 14).

PO methods of gathering data present some special considerations—How involved is the researcher? How close is she to the subjects or site being studied? And how might her own social location—identity, position—affect the study? These are actually great questions for any kind of qualitative data collection but particularly apt when the researcher “enters the field,” so to speak. It is helpful to visualize where one falls on a continuum or series of continua (figure 13.1).

qualitative research on participant observation

Let’s take a few examples and see how these continua work. Think about each of the following scenarios, and map them onto the possibilities of figure 13.1:

a nursing student during COVID doing research on patient/doctor interactions in the ICU
a graduate student accompanying a police officer during her rounds one day in a part of the city the graduate student has never visited
a professor raised Amish who goes back to her hometown to conduct research on Amish marriage practices for one month
(What if the sociologist was also a member of the OCF board and camping crew?)

Depending on how the researcher answers those questions and where they stand on the P.O. continuum, various techniques will be more or less effective. For example, in cases where the researcher is a participant, writing reflective fieldnotes at the end of the day may be the primary form of data collected. After all, if the researcher is fully participating, they probably don’t have the time or ability to pull out a notepad and ask people questions. On the other side, when a researcher is more of an observer, this is exactly what they might do, so long as the people they are interrogating are able to answer while they are going about their business. The more an observer, the more likely the researcher will engage in relatively structured interviews (using techniques discussed in chapters 11 and 12); the more a participant, the more likely casual conversations or “unstructured interviews” will form the core of the data collected. [2]

Observation and Qualitative Traditions

Observational techniques are used whenever the researcher wants to document actual behaviors and practices as they happen (not as they are explained or recorded historically). Many traditions of inquiry employ observational data collection, but not all traditions employ them in the same way. Chapter 14 will cover one very specific tradition: ethnography. Because the word ethnography is sometimes used for all fieldwork, I am calling the subject of chapter 14 deep ethnography, those studies that take as their focus the documentation through the description of a culture or subculture. Deeply immersive, this tradition of ethnography typically entails several months or even years in the field. But there are plenty of other uses of observation that are less burdensome to the researcher.

Grounded Theory, in which theories emerge from a rigorous and systematic process of induction, is amenable to both interviewing and observing forms of data collection, and some of the best Grounded Theory works employ a deft combination of both. Often closely aligned with Grounded Theory in sociology is the tradition of symbolic interactionism (SI). Interviews and observations in combination are necessary to properly address the SI question, What common understandings give meaning to people’s interactions ? Gary Alan Fine’s body of work fruitfully combines interviews and observations to build theory in response to this SI question. His Authors of the Storm: Meteorologists and the Culture of Prediction is based on field observation and interviews at the Storm Prediction Center in Oklahoma; the National Weather Service in Washington, DC; and a few regional weather forecasting outlets in the Midwest. Using what he heard and what he observed, he builds a theory of weather forecasting based on social and cultural factors that take place inside local offices. In Morel Tales: The Culture of Mushrooming , Fine investigates the world of mushroom hunters through participant observation and interviews, eventually building a theory of “naturework” to describe how the meanings people hold about the world are constructed and are socially organized—our understanding of “nature” is based on human nature, if you will.

Phenomenology typically foregrounds interviewing, as the purpose of this tradition is to gather people’s understandings and meanings about a phenomenon. However, it is quite common for phenomenological interviewing to be supplemented with some observational data, especially as a check on the “reality” of the situations being described by those interviewed. In my own work, for example, I supplemented primary interviews with working-class college students with some participant observational work on the campus in which they were studying. This helped me gather information on the general silence about class on campus, which made the salience of class in the interviews even more striking ( Hurst 2010a ).

Critical theories such as standpoint approaches, feminist theory, and Critical Race Theory are often multimethod in design. Interviews, observations (possibly participation), and archival/historical data are all employed to gather an understanding of how a group of persons experiences a particular setting or institution or phenomenon and how things can be made more just . In Making Elite Lawyers , Robert Granfield ( 1992 ) drew on both classroom observations and in-depth interviews with students to document the conservatizing effects of the Harvard legal education on working-class students, female students, and students of color. In this case, stories recounted by students were amplified by searing examples of discrimination and bias observed by Granfield and reported in full detail through his fieldnotes.

Entry Access and Issues

Managing your entry into a field site is one of the most important and nerve-wracking aspects of doing ethnographic research. Unlike interviews, which can be conducted in neutral settings, the field is an actual place with its own rules and customs that you are seeking to explore. How you “gain access” will depend on what kind of field you are entering. If your field site is a physical location with walls and a front desk (such as an office building or an elementary school), you will need permission from someone in the organization to enter and to conduct your study. Negotiating this might take weeks or even months. If your field site is a public site (such as a public dog park or city sidewalks), there is no “official” gatekeeper, but you will still probably need to find a person present at the site who can vouch for you (e.g., other dog owners or people hanging out on their stoops). [3] And if your field site is semipublic, as in a shopping mall, you might have to weigh the pros and cons of gaining “official” permission, as this might impede your progress or be difficult to ascertain whose permission to request. If you recall, many of the ethical dilemmas discussed in chapter 7 were about just such issues.

Even with official (or unofficial) permission to enter the site, however, your quest to gain access is not done. You will still need to gain the trust and permission of the people you encounter at that site. If you are a mere observer in a public setting, you probably do not need each person you observe to sign a consent form, but if you are a participant in an event or enterprise who is also taking notes and asking people questions, you probably do. Each study is unique here, so I recommend talking through the ethics of permission and consent seeking with a faculty mentor.

A separate but related issue from permission is how you will introduce yourself and your presence. How you introduce yourself to people in the field will depend very much on what level of participation you have chosen as well as whether you are an insider or outsider. Sometimes your presence will go unremarked, whereas other times you may stick out like a very sore thumb. Lareau ( 2021 ) advises that you be “vague but accurate” when explaining your presence. You don’t want to use academic jargon (unless your field is the academy!) that would be off-putting to the people you meet. Nor do you want to deceive anyone. “Hi, I’m Allison, and I am here to observe how students use career services” is accurate and simple and more effective than “I am here to study how race, class, and gender affect college students’ interactions with career services personnel.”

Researcher Note

Something that surprised me and that I still think about a lot is how to explain to respondents what I’m doing and why and how to help them feel comfortable with field work. When I was planning fieldwork for my dissertation, I was thinking of it from a researcher’s perspective and not from a respondent’s perspective. It wasn’t until I got into the field that I started to realize what a strange thing I was planning to spend my time on and asking others to allow me to do. Like, can I follow you around and write notes? This varied a bit by site—it was easier to ask to sit in on meetings, for example—but asking people to let me spend a lot of time with them was awkward for me and for them. I ended up asking if I could shadow them, a verb that seemed to make clear what I hoped to be able to do. But even this didn’t get around issues like respondents’ self-consciousness or my own. For example, respondents sometimes told me that their lives were “boring” and that they felt embarrassed to have someone else shadow them when they weren’t “doing anything.” Similarly, I would feel uncomfortable in social settings where I knew only one person. Taking field notes is not something to do at a party, and when introduced as a researcher, people would sometimes ask, “So are you researching me right now?” The answer to that is always yes. I figured out ways of taking notes that worked (I often sent myself text messages with jotted notes) and how to get more comfortable explaining what I wanted to be able to do (wanting to see the campus from the respondent’s perspective, for example), but it is still something I work to improve.

—Elizabeth M. Lee, Associate Professor of Sociology at Saint Joseph’s University, author of Class and Campus Life and coauthor of Geographies of Campus Inequality

Reflexivity in Fieldwork

As always, being aware of who you are, how you are likely to be read by others in the field, and how your own experiences and understandings of the world are likely to affect your reading of others in the field are all very important to conducting successful research. When Annette Lareau ( 2021 ) was managing a team of graduate student researchers in her study of parents and children, she noticed that her middle-class graduate students took in stride the fact that children called adults by their first names, while her working-class-origin graduate students “were shocked by what they considered the rudeness and disrespect middle-class children showed toward their parents and other adults” ( 151 ). This “finding” emerged from particular fieldnotes taken by particular research assistants. Having graduate students with different class backgrounds turned out to be useful. Being reflexive in this case meant interrogating one’s own expectations about how children should act toward adults. Creating thick descriptions in the fieldnotes (e.g., describing how children name adults) is important, but thinking about one’s response to those descriptions is equally so. Without reflection, it is possible that important aspects never even make it into the fieldnotes because they seem “unremarkable.”

The Data of Observational Work: Fieldnotes

In interview data collection, recordings of interviews are transcribed into the data of the study. This is not possible for much PO work because (1) aural recordings of observations aren’t possible and (2) conversations that take place on-site are not easily recorded. Instead, the participant observer takes notes, either during the fieldwork or at the day’s end. These notes, called “fieldnotes,” are then the primary form of data for PO work.

Writing fieldnotes takes a lot of time. Because fieldnotes are your primary form of data, you cannot be stingy with the time it takes. Most practitioners suggest it takes at least the same amount of time to write up notes as it takes to be in the field, and many suggest it takes double the time. If you spend three hours at a meeting of the organization you are observing, it is a good idea to set aside five to six hours to write out your fieldnotes. Different researchers use different strategies about how and when to do this. Somewhat obviously, the earlier you can write down your notes, the more likely they are to be accurate. Writing them down at the end of the day is thus the default practice. However, if you are plainly exhausted, spending several hours trying to recall important details may be counterproductive. Writing fieldnotes the next morning, when you are refreshed and alert, may work better.

Reseaarcher Note

How do you take fieldnotes ? Any advice for those wanting to conduct an ethnographic study?

Fieldnotes are so important, especially for qualitative researchers. A little advice when considering how you approach fieldnotes: Record as much as possible! Sometimes I write down fieldnotes, and I often audio-record them as well to transcribe later. Sometimes the space to speak what I observed is helpful and allows me to be able to go a little more in-depth or to talk out something that I might not quite have the words for just yet. Within my fieldnote, I include feelings and think about the following questions: How do I feel before data collection? How did I feel when I was engaging/watching? How do I feel after data collection? What was going on for me before this particular data collection? What did I notice about how folks were engaging? How were participants feeling, and how do I know this? Is there anything that seems different than other data collections? What might be going on in the world that might be impacting the participants? As a qualitative researcher, it’s also important to remember our own influences on the research—our feelings or current world news may impact how we observe or what we might capture in fieldnotes.

—Kim McAloney, PhD, College Student Services Administration Ecampus coordinator and instructor

What should be included in those fieldnotes? The obvious answer is “everything you observed and heard relevant to your research question.” The difficulty is that you often don’t know what is relevant to your research question when you begin, as your research question itself can develop and transform during the course of your observations. For example, let us say you begin a study of second-grade classrooms with the idea that you will observe gender dynamics between both teacher and students and students and students. But after five weeks of observation, you realize you are taking a lot of notes about how teachers validate certain attention-seeking behaviors among some students while ignoring those of others. For example, when Daisy (White female) interrupts a discussion on frogs to tell everyone she has a frog named Ribbit, the teacher smiles and asks her to tell the students what Ribbit is like. In contrast, when Solomon (Black male) interrupts a discussion on the planets to tell everyone his big brother is called Jupiter by their stepfather, the teacher frowns and shushes him. These notes spark interest in how teachers favor and develop some students over others and the role of gender, race, and class in these teacher practices. You then begin to be much more careful in recording these observations, and you are a little less attentive to the gender dynamics among students. But note that had you not been fairly thorough in the first place, these crucial insights about teacher favoritism might never have been made.

Here are some suggestions for things to include in your fieldnotes as you begin: (1) descriptions of the physical setting; (2) people in the site: who they are and how they interact with one another (what roles they are taking on); and (3) things overheard: conversations, exchanges, questions. While you should develop your own personal system for organizing these fieldnotes (computer vs. printed journal, for example), at a minimum, each set of fieldnotes should include the date, time in the field, persons observed, and location specifics. You might also add keywords to each set so that you can search by names of participants, dates, and locations. Lareau ( 2021:167 ) recommends covering the following key issues, which mnemonically spell out WRITE— W : who, what, when, where, how; R: reaction (responses to the action in question and the response to the response); I: inaction (silence or nonverbal response to an action); T: timing (how slowly or quickly someone is speaking); and E: emotions (nonverbal signs of emotion and/or stoicism).

In addition to the observational fieldnotes, if you have time, it is a good practice to write reflective memos in which you ask yourself what you have learned (either about the study or about your abilities in the field). If you don’t have time to do this for every set of fieldnotes, at least get in the practice of memoing at certain key junctures, perhaps after reading through a certain number of fieldnotes (e.g., every third day of fieldnotes, you set aside two hours to read through the notes and memo). These memos can then be appended to relevant fieldnotes. You will be grateful for them when it comes time to analyze your data, as they are a preliminary by-the-seat-of-your-pants analysis. They also help steer you toward the study you want to pursue rather than allow you to wallow in unfocused data.

Ethics of Fieldwork

Because most fieldwork requires multiple and intense interactions (even if merely observational) with real living people as they go about their business, there are potentially more ethical choices to be made. In addition to the ethics of gaining entry and permission discussed above, there are issues of accurate representation, of respecting privacy, of adequate financial compensation, and sometimes of financial and other forms of assistance (when observing/interacting with low-income persons or other marginalized populations). In other words, the ethical decision of fieldwork is never concluded by obtaining a signature on a consent form. Read this brief selection from Pascale’s ( 2021 ) methods description (observation plus interviews) to see how many ethical decisions she made:

Throughout I kept detailed ethnographic field and interview records, which included written notes, recorded notes, and photographs. I asked everyone who was willing to sit for a formal interview to speak only for themselves and offered each of them a prepaid Visa Card worth $25–40. I also offered everyone the opportunity to keep the card and erase the tape completely at any time they were dissatisfied with the interview in any way. No one asked for the tape to be erased; rather, people remarked on the interview being a really good experience because they felt heard. Each interview was professionally transcribed and for the most part the excerpts in this book are literal transcriptions. In a few places, the excerpta have been edited to reduce colloquial features of speech (e.g., you know, like, um) and some recursive elements common to spoken language. A few excerpts were placed into standard English for clarity. I made this choice for the benefit of readers who might otherwise find the insights and ideas harder to parse in the original. However, I have to acknowledge this as an act of class-based violence. I tried to keep the original phrasing whenever possible. ( 235 )

Summary Checklist for Successful Participant Observation

The following are ten suggestions for being successful in the field, slightly paraphrased from Patton ( 2002:331 ). Here, I take those ten suggestions and turn them into an extended “checklist” to use when designing and conducting fieldwork.

Consider all possible approaches to your field and your position relative to that field (see figure 13.2). Choose wisely and purposely. If you have access to a particular site or are part of a particular culture, consider the advantages (and disadvantages) of pursuing research in that area. Clarify the amount of disclosure you are willing to share with those you are observing, and justify that decision.
Take thorough and descriptive field notes. Consider how you will record them. Where your research is located will affect what kinds of field notes you can take and when, but do not fail to write them! Commit to a regular recording time. Your field notes will probably be the primary data source you collect, so your study’s success will depend on thick descriptions and analytical memos you write to yourself about what you are observing.
Permit yourself to be flexible. Consider alternative lines of inquiry as you proceed. You might enter the field expecting to find something only to have your attention grabbed by something else entirely. This is perfectly fine (and, in some traditions, absolutely crucial for excellent results). When you do see your attention shift to an emerging new focus, take a step back, look at your original research design, and make careful decisions about what might need revising to adapt to these new circumstances.
Include triangulated data as a means of checking your observations. If you are that ICU nurse watching patient/doctor interactions, you might want to add a few interviews with patients to verify your interpretation of the interaction. Or perhaps pull some public data on the number of arrests for jaywalking if you are the student accompanying police on their rounds to find out if the large number of arrests you witnessed was typical.
Respect the people you are witnessing and recording, and allow them to speak for themselves whenever possible. Using direct quotes (recorded in your field notes or as supplementary recorded interviews) is another way to check the validity of the analyses of your observations. When designing your research, think about how you can ensure the voices of those you are interested in get included.
Choose your informants wisely. Who are they relative to the field you are exploring? What are the limitations (ethical and strategic) in using those particular informants, guides, and gatekeepers? Limit your reliance on them to the extent possible.
Consider all the stages of fieldwork, and have appropriate plans for each. Recognize that different talents are required at different stages of the data-collection process. In the beginning, you will probably spend a great deal of time building trust and rapport and will have less time to focus on what is actually occurring. That’s normal. Later, however, you will want to be more focused on and disciplined in collecting data while also still attending to maintaining relationships necessary for your study’s success. Sometimes, especially when you have been invited to the site, those granting access to you will ask for feedback. Be strategic about when giving that feedback is appropriate. Consider how to extricate yourself from the site and the participants when your study is coming to an end. Have an ethical exit plan.
Allow yourself to be immersed in the scene you are observing. This is true even if you are observing a site as an outsider just one time. Make an effort to see things through the eyes of the participants while at the same time maintaining an analytical stance. This is a tricky balance to do, of course, and is more of an art than a science. Practice it. Read about how others have achieved it.
Create a practice of separating your descriptive notes from your analytical observations. This may be as clear as dividing a sheet of paper into two columns, one for description only and the other for questions or interpretation (as we saw in chapter 11 on interviewing), or it may mean separating out the time you dedicate to descriptions from the time you reread and think deeply about those detailed descriptions. However you decide to do it, recognize that these are two separate activities, both of which are essential to your study’s success.
As always with qualitative research, be reflective and reflexive. Do not forget how your own experience and social location may affect both your interpretation of what you observe and the very things you observe themselves (e.g., where a patient says more forgiving things about an observably rude doctor because they read you, a nursing student, as likely to report any negative comments back to the doctor). Keep a research journal!

Chapter 15: Participant observation

Darshini Ayton

Learning outcomes

Upon completion of this chapter, you should be able to:

Know when to use participant observation in qualitative research.
Create a participant observation guide.
Understand how to conduct participant observations.

What is participant observation?

Participant observation is the hallmark data-collection method in ethnography (see Chapter 9 ). 1 , 2 A major feature of this method is that the researcher is embedded in the context of the research to conduct fieldwork, and takes part in the daily life of the group. As an observer, the researcher studies the activities, events, rituals and interactions of the group or community, or its culture. 2 According to Bernard, ‘[p]articipant observation… puts you where the action is and lets you collect data… any kind of data that you want, narratives or numbers’. 3 (p343)

Participant observation is an umbrella term for methods that include observations, formal and informal interviewing and the collection of documentary data such as photographs and diaries. 1 , 2 Participant observation is an appropriate method when the research question seeks to understand group culture, behaviours, attitudes and the overall human experience of a particular context and in the reality of everyday life. It provides a holistic understanding of the phenomena under study. 2 Participant observation is a helpful first phase in data collection, and can be helpful in orienting the researcher to the setting, context, participants and behaviours. Researchers often find that participant observation provides the foundations for the research questions to be asked, and that this, in turn, informs the development of more structured data collection, such as interviews. 4

In ethnography, participant observation is the main form of data collection and hence it is done intensively (see Chapter 9 , Table 9.1). However, participant observation can be used in other forms of qualitative research to complement other forms of data collection. This type of participant observation is less intense.

The key features of participant observation are outlined as follows.

‘Insider’ viewpoint . The researcher seeks to gain a perspective of the phenomena under study. They might be an ‘insider’, which gives an emic perspective through shared experiences and membership of the group of people under study, or an ‘outsider’, which is an etic perspective, or that of a person external to the group. Hence, the researcher needs to participate in the life of the group to observe and experience the meanings and interactions of the group, and to explore the meaning of the lifeworld of the group. Participation by the researcher may be passive or active, depending on their role in the group, which ranges from marginal (etic) to membership (emic) roles. 5

Unstructured data . The researcher may not know what data they might encounter on any given day. While they may record observations across key dimensions (see Table 15.1), they need to be ready to record insights, ask questions and listen actively as events, activities and interactions occur. 1 When participating in activities or events, the researcher needs to listen and note (mentally or by writing unobtrusively) what is being said, and to prompt conversation where appropriate when further information may be relevant to the research topic.

Field notes . The researcher typically may take short written notes or mental notes while conducting their observations. Once the researcher exits the field they write up their observations, including where possible verbatim quotes, key phrases, the number of people who were present, maps of the space and details of interactions. It is recommended that field notes are written up promptly before details are forgotten. 6 Where appropriate, the researcher might use a device to record their observations and transcribe them at a later stage.

How to undertake participant observation

Know when the phenomenon happens . Before starting participant observation, it is important to know what and who is to be observed, and when these events, activities, processes and behaviours are likely to occur. Consider whether it is a one-off event or something that happens regularly, and when, where and how things may be occurring. Are multiple locations and times relevant? Often, it is best to start broad if unsure and then to narrow the focus over time as the researcher gains familiarity with the setting, people and phenomena. 4

Gaining access to the setting . How the researcher gains access to the setting of participant observation can vary. If the researcher is known to the people in the setting, this may be easy to navigate through letters of permission and consent from leaders. However, if the researcher is an outsider to the setting, they may need to approach gatekeepers and build relationships with stakeholders before permission may be granted to enter the setting. 6

Explaining the presence of the researcher . There are three main approaches in terms of explaining what the research is doing in the research setting. The first is to let everyone in the setting know about the presence and intention of the observer–researcher. This is known as ‘overt participant observation’ 7 , which reduces the risk of running into ethical problems. However, connection, trust and rapport with people in the setting may take longer to develop because people know that the researcher is there to observe their behaviours and conversations. In some situations, disclosing to everyone that research is being conducted may not be practical. 4

The second approach, known as ‘semi-covert participant observation’ 7 is when the researcher lets some people know about their presence as an observer–researcher. For example, gatekeepers and leaders at the setting may be told while others may not know that observations and research are being undertaken. This poses the risk of people who know about the research disclosing this information to others in the setting, which in turn can lead to mistrust of the researcher. Ethical issues in this approach are trickier to manage, particularly regarding informed consent. 4

The third approach is when the researcher does not disclose to anyone in the setting that they are undertaking observations and research; this is ‘covert participation observation’. 7 This approach poses the highest risk in terms of ethical issues, as people have the reasonable expectation of privacy and confidentiality, and covert observations may compromise their dignity and wellbeing. The extent to which covert participant observation is a concern also depends on how public or private the research setting is. There may also be safety concerns for the researcher, who may be accessing risky settings and may be required to adopt a persona that goes against their natural tendencies. Hence, the risks and benefits of covert participant observations need to be well considered. The benefits of covert participant observation include that the researcher might gain access to a setting that may be off limits for research studies, and the method reduces the risk of people changing or modifying their behaviours and can therefore reveal the true nature of behaviours and the phenomenon under study. The researcher can take part in the everyday life of the setting and experience the phenomenon in the same way as people in the setting. 4

H ow to conduct data collection

Systematically observing and recording observations are key elements of the field notes to be documented by a researcher. For the novice researcher, it can be overwhelming to figure out what to observe and how to document these observations. Spradley 8 outlined 9 observational dimensions to consider when undertaking participant observation; these are outlined in Table 15.1.

Table 15.1. Nine observational dimensions and their descriptions

DeWalt and DeWalt described 3 components of participant observation 2 , which are outlined here and are complementary to the 9 dimensions in Table 15.1.

Mapping the scene – mapping the physical and spatial layout and the social scene, including social interactions and where interactions take place in the space. 2

Counting – recording how many people are in the place in all the situations under observation. Categorise groups of people and record the counts; for example, how many people are facilitating an activity, how many children, how many women and how many attendees? How do the counts change throughout the observation? 2

Listening to conversations – attending to what is being said, by whom and when. Recording verbatim, as much as possible, the conversations that are taking place. The researcher may also casually facilitate some of these conversations, if appropriate. 2

It may be helpful to use Table 15.1 to create a data collection sheet with notes being recorded next to each of the dimensions. The unpublished data collection sheet in Figure 15.1 is from a study undertaken in surgical theatres to understand decision-making on antimicrobial prescribing. 9

Figure 15.1 Example of participant observation data collection sheet 9

Box 15.1 is an excerpt from field notes from Ayton’s PhD research 10 , which demonstrates how the 9 dimensions are recorded in narrative form. While this may seem lengthy, it provides a detailed description of the space, the people in the space and their activities. When the researcher re-reads the field notes, a strong and clear picture will be remembered about the community centre.

Box 15.1 Observation excerpt – community centre 10

The red and blue building of the community centre is modern; the space is open and light. When I enter the building the reception desk is in front and slightly to the left. The receptionist, Nicole, greets everyone who enters and she is always smiling. Cameron, a volunteer, is hovering at the entrance, eager to be helpful to those who enter. He has cerebral palsy; he wears a neck brace and walks with a limp. Despite it being a cold day, Cameron is wearing shorts and a T-shirt. He has a bushy beard and he is difficult to understand, communicating in grunts and energetic arm movements. He seems enthusiastic about his role as a volunteer and does not leave his post the whole day.

To the right are four large, comfortable blue chairs and a very big, comfortable, blue velvet, L-shaped couch. Cushions are scattered over the couch and chairs. There is a red circular carpet and a coffee table with the day’s newspapers on it. Next to the couch and against the wall, near the entrance to the computer room, is a bookshelf with some books including a Bible and a range of Christian books including self-help books and books about the Christian faith; none are specific to the Salvation Army. The bookcase also has a shelf of pamphlets about health services, upcoming courses and training opportunities, and a variety of health promotion materials such as booklets on depression and anxiety, and drug and alcohol assistance. On top of the bookshelf is a collection of board games. The atmosphere feels like one of a home, a comfortable place to hang out, a place that is open to everyone. The chairs all face each other so that no one would be sitting on the outer. When I walk to sit on the couch, I feel like I’m entering their circle.

On the other side of the computer training room, there is a table with Fair Trade tea and coffee. There is also a table with two large bowls of fruit. Notice boards are positioned on the main walls and these display newspaper articles about the centre, Salvation Army training college information, biographies of the officers-in-charge, a poster advertising the street soccer program coordinated by the Big Issue and a poster advertising a local drum school.

Advantages and d isadvantages of participant observation

Participant observation provides a holistic perspective of the research setting and people, and the opportunity for the researcher to experience the everyday life of the group or community. Participant observation provides a foundation for further enquiry as the researcher is embedded in the research context. Hence, the researcher learns the relevant research questions to ask and the potential cultural implications of the ‘how’ of the research. 4 However, there are many challenges, including navigating the ethical issues of consent and access to the research setting. The time and resources to undertake participation observation is often extensive and may not be easily covered in research budgets or timeframes. 4 Table 15.2 provides two examples of participant observation in qualitative research.

Table 15.2. Examples of participant observation from health and social care research

Participant observation is a hallmark of ethnography but can also be used in other qualitative research designs. The aim is to understand group culture and the phenomenon under study. Careful planning is required for participant observation, to ensure ethical considerations are addressed and processes are established for gaining access to the research setting and systems for collecting participant observation data.

Reeves S, Kuper A, Hodges BD. Qualitative research methodologies: ethnography. BMJ . 2008;7(337):a1020. doi:10.1136/bmj.a1020
DeWalt K, DeWalt B. Participant Observation: A Guide for Fieldworkers . Altamira Press; 2010.
Bernard R. Research Methods in Anthropology: Qualitative and Quantitative Approaches . AltaMira Press; 2006.
Guest G, Namey EE, Mitchell ML. Participant observation. Collecting Qualitative Data: A Field Manual for Applied Research . SAGE Publications; 2013.
Jorgensen DL. Principles, Approaches and Issues in Participant Observation . Taylor & Francis; 2020.
Copland F. Observation and fieldnotes. In: Phakiti A, De Costa P, Plonsky L et al., eds. The Palgrave Handbook of Applied Linguistics Research Methodology . Palgrave Macmillan; 2018.
Roulet TJ, Gill MJ, Stenger S et al.. Reconsidering the value of covert research: the role of ambiguous consent in participant observation. Org Res Methods . 2017;20(3):487-517. doi:10.1177/1094428117698745
Spradley J. Participant O bservation . Holt, Rinehart and Winston; 1980.
Peel TN, Watson E, Cairns K et al. Perioperative antimicrobial decision making: focused ethnography study in orthopedic and cardiothoracic surgeries in an Australian hospital. Infect Control Hosp Epidemiol . 2020;41(6):645-652. doi:10.1017/ice.2020.48
Ayton, D. ‘From places of despair to spaces of hope’ – the local church and health promotion in Victoria. Monash University Doctorate of Philosophy PhD 2013.
Ussher JM, Charter R, Parton C et al. Constructions and experiences of motherhood in the context of an early intervention for Aboriginal mothers and their children: mother and healthcare worker perspectives. BMC Public Health . 2016;16:620. doi:10.1186/s12889-016-3312-6
Reigada C, Arantzamendi M, Centeno C. Palliative care in its own discourse: a focused ethnography of professional messaging in palliative care. BMC Palliat Care . 2020;19(1):88. doi:10.1186/s12904-020-00582-5

Qualitative Research – a practical guide for health and social care researchers and practitioners Copyright © 2023 by Darshini Ayton is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

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Field Guide

Participant Observation Field Guide

What is an observation?

A way to gather data by watching people, events, or noting physical characteristics in their natural setting. Observations can be overt (subjects know they are being observed) or covert (do not know they are being watched).

Researcher becomes a participant in the culture or context being observed.
Requires researcher to be accepted as part of culture being observed in order for success

Direct Observation

Researcher strives to be as unobtrusive as possible so as not to bias the observations; more detached.
Technology can be useful (i.e video, audiorecording).

Indirect Observation

Results of an interaction, process or behavior are observed (for example, measuring the amount of plate waste left by students in a school cafeteria to determine whether a new food is acceptable to them).

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What Is Participant Observation Research?

Understanding an Important Qualitative Research Method

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The participant observation method, also known as ethnographic research , is when a sociologist actually becomes a part of the group they are studying in order to collect data and understand a social phenomenon or problem. During participant observation, the researcher works to play two separate roles at the same time: subjective participant and objective observer. Sometimes, though not always, the group is aware that the sociologist is studying them.

The goal of participant observation is to gain a deep understanding and familiarity with a certain group of individuals, their values, beliefs, and way of life. Often the group in focus is a subculture of a greater society, like a religious, occupational, or particular community group. To conduct participant observation, the researcher often lives within the group, becomes a part of it, and lives as a group member for an extended period of time, allowing them access to the intimate details and goings-on of the group and their community.

This research method was pioneered by anthropologists Bronislaw Malinowski and Franz Boas but was adopted as a primary research method by many sociologists affiliated with the Chicago School of Sociology in the early twentieth century . Today, participant observation, or ethnography, is a primary research method practiced by qualitative sociologists around the world.

Subjective Versus Objective Participation

Participant observation requires the researcher to be a subjective participant in the sense that they use knowledge gained through personal involvement with the research subjects to interact with and gain further access to the group. This component supplies a dimension of information that is lacking in survey data . Participant observation research also requires the researcher to aim to be an objective observer and record everything that he or she has seen, not letting feelings and emotions influence their observations and findings.

Yet, most researchers recognize that true objectivity is an ideal, not an actuality, given that the way in which we see the world and people in it is always shaped by our previous experiences and our positionality in the social structure relative to others. As such, a good participant observer will also maintain a critical self-reflexivity that allows her to recognize the way she herself might influence the field of research and the data she collects.

Strengths and Weaknesses

The strengths of participant observation include the depth of knowledge that it allows the researcher to obtain and the perspective of knowledge of social problems and phenomena generated from the level of the everyday lives of those experiencing them. Many consider this an egalitarian research method because it centers the experiences, perspectives, and knowledge of those studied. This type of research has been the source of some of the most striking and valuable studies in sociology.

Some drawbacks or weaknesses of this method are that it is very time-consuming, with researchers spending months or years living in the place of study. Because of this, participant observation can yield a vast amount of data that might be overwhelming to comb through and analyze. And, researchers must be careful to remain somewhat detached as observers, especially as time passes and they become an accepted part of the group, adopting its habits, ways of life, and perspectives. Questions about objectivity and ethics were raised about sociologist Alice Goffman's research methods because some interpreted passages from her book " On the Run " as an admission of involvement in a murder conspiracy.

Students wishing to conduct participant observation research should consult two excellent books on the subject: " Writing Ethnographic Fieldnotes " by Emerson et al., and " Analyzing Social Settings ", by Lofland and Lofland.

What Is Ethnography?
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Anthropology vs. Sociology: What's the Difference?
How to Understand Interpretive Sociology
Understanding Secondary Data and How to Use It in Research
Definition of Idiographic and Nomothetic
Defining Unobtrusive Measures in Sociology Experiments
An Introduction to Cultural Anthropology
Macro- and Microsociology
Biography of Patricia Hill Collins, Esteemed Sociologist
How to Conduct a Sociology Research Interview
A Biography of Erving Goffman
What Is Naturalistic Observation? Definition and Examples
Immersion Definition: Cultural, Language, and Virtual
Definition of Aggregate and Social Aggregate
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Participant Observation is

"A method of research in anthropology which involves extended immersion in a culture and participation in its day-to-day activities" (Calhoun, 2002).

This type of research methodology is used in circumstances where an individual wants to observe a group to which they do not belong without altering the behavior of the group because of their involvement. Because of this, before observations can be noted as being "natural," the observer must immerse themselves in the culture or group they are observing. The extent to which the observers' participation affects their results has been debated over time.

For more information on participant observation, review the resources below:

Where to Start

Below are listed a few tools and online guides that can help you start your Participant Observation research. These include free online resources and resources available only through ISU Library.

Participation Observation Field Guide [pdf] From Duke University, a thorough overview of participant observation.
Participant Observation by Danny L. Jorgensen Call Number: H62 .J625 1989 While providing an introduction to basic principles and strategies, this volume also explores the philosophy and methodology underlying the actual practice of participant observation. Taking a thoroughly practical approach to the methods of participant observation, Jorgensen illustrates these methods with both classic and current research studies.

Online Resources

Participant Observation definition From the Social Research Glossary, A thorough explanation, with links to the definitions of terms used and to other people's writings on the subject.
Participant Observation and Field Notes A guide to participant observation from the Ethnographic Action Research training handbook.
How to... Use Ethnographic Methods and Participant Observation From Emerald, a journal publisher, in their Research Zone for practicing authors.
Ethical Challenges in Participant Observation: A Reflection on Ethnographic Fieldwork An article by Jun Li from The Qualitative Report.
Participant observation--Wikipedia, the free encyclopedia Wikipedia can be a useful place to start your research- check the citations at the bottom of the article for more information.
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http://orcid.org/0000-0003-4892-909X Lisa L Woodson 1 ,
Adriana Garcia Saldivar 2 ,
http://orcid.org/0000-0001-8578-5510 Heidi E Brown 1 ,
http://orcid.org/0000-0001-8526-458X Priscilla A Magrath 3 ,
Nicolas Antunez de Mayolo 4 ,
http://orcid.org/0000-0001-6877-8490 Sydney Pettygrove 1 ,
http://orcid.org/0000-0001-7455-8531 Leslie V Farland 1 ,
http://orcid.org/0000-0001-7818-3394 Purnima Madhivanan 3 ,
http://orcid.org/0000-0002-3008-1695 Magaly M Blas 5
1 Department of Epidemiology and Biostatistics , The University of Arizona Mel and Enid Zuckerman College of Public Health , Tucson , Arizona , USA
2 Universidad Peruana Cayetano Heredia , Lima , Peru
3 Department of Health Promotion Sciences , The University of Arizona Mel and Enid Zuckerman College of Public Health , Tucson , Arizona , USA
4 School of Medicine , Universidad Peruana Cayetano Heredia , Lima , Peru
5 School of Public Health and Administration , Universidad Peruana Cayetano Heredia , Lima , Peru
Correspondence to Lisa L Woodson; lisalabita{at}arizona.edu

Due to COVID-19, schools were closed to mitigate disease spread. Past studies have shown that disruptions in education have unintended consequences for adolescents, including increasing their risk of school dropout, exploitation, gender-based violence, pregnancy and early unions. In Peru, the government closed schools from March 2020 to March 2022, declaring a national emergency that affected an estimated 8 million children. These closures may have unintended consequences, including increased adolescent pregnancy, particularly in Peru’s rural, largely indigenous regions. Loreto, located in the Peruvian Amazon, has one of the highest adolescent pregnancy rates in the country and poor maternal and child health outcomes. The underlying causes may not be fully understood as data are limited, especially as we transition out of the pandemic. This qualitative study investigated the downstream effects of COVID-19 on adolescent education and reproductive health in Loreto’s districts of Nauta and Parinari. In-depth interviews (n=41) were conducted with adolescents and community leaders. These were held in June 2022, 3 months after the reinstitution of in-person classes throughout Peru. Focus group discussions (FGDs) were also completed with community health workers and educators from the same study area in October 2022 to supplement our findings (3 FGDs, n=15). We observed that the economic, educational and health effects of the COVID-19 pandemic contributed to reduced contraceptive use, and increased school abandonment, early unions and adolescent pregnancy. The interplay between adolescent pregnancy and both early unions and school abandonment was bidirectional, with each acting as both a cause and consequence of the other.

Qualitative study
Global Health

Data availability statement

Data not available due to ethical restrictions. Qualitative data collected for this study are not publicly available as they contain potentially identifying information of the research participants. Due to the participants residing in small and remote communities in Nauta and Parinari, the research team ensured that the data presented were de-identified in a manner that preserves their confidentiality, including the use of generic participant labels for quotes used in the report.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/bmjgh-2023-012391

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WHAT IS ALREADY KNOWN ON THIS TOPIC

Disruptions to education have been shown to have adverse effects on adolescent girls. Longitudinal studies in Malawi and Kenya showed that COVID-19 led to lower school re-enrolment rates, higher dropout among older adolescent girls and increased pregnancy risk for girls aged 15–19 years. A systematic review across low-income and middle-income countries found varying increases in adolescent pregnancy during the pandemic due to factors like school closures, peer pressure and economic challenges. However, data from Brazil showed a decrease in unplanned adolescent pregnancy, likely due to social distancing measures.

WHAT THIS STUDY ADDS

We provide a better understanding of the effects of the COVID-19 pandemic on the education and reproductive health of adolescent indigenous girls in the Amazon basin of Peru. This study also highlights three key factors affecting adolescent pregnancy during COVID-19: economics, education and healthcare access.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

The pandemic may have long-lasting sexual and reproductive health consequences for adolescent girls whose education was severely disrupted. The knowledge gained from this research can be used to inform interventions and policies that may be implemented in this region to reduce the risk of adolescent pregnancy and school dropout, especially targeted towards indigenous youth.

Introduction

Adolescent pregnancy (AP) has adverse maternal and perinatal outcomes with increased risk of morbidity and mortality. 1 Globally, pregnancy and childbirth complications are the leading cause of death among girls 15–19 years of age. 2 3 To improve adolescent sexual and reproductive health (SRH) outcomes, increasing the educational attainment of girls is an effective strategy. 4 5 However, school closures to mitigate COVID-19 spread had unintentional consequences. It was estimated that 11–20 million children globally dropped out of school due to economic shocks of the pandemic, 6 7 a majority were secondary school-aged girls. 8 9 Dropout was more profound among girls in vulnerable and marginalised communities. 6 Girls who dropped out of school were at increased risk of exploitation, gender-based violence and child marriage. 10 Decreased female schooling is associated with low contraceptive use 11 and in turn, decreased contraceptive use has been shown to increase adolescent fertility. 12 13 Conversely, higher education levels deter AP, especially in low-income and middle-income countries. 14

A longitudinal study in Malawi of pre-COVID-19 and post-COVID-19 data found that extended school closures resulted in lower school re-enrolment rates and higher dropout rates, especially among older adolescent girls. 15 In Kenya, there were observed significant differences in secondary school-aged girls between the pre-COVID-19 and COVID-19 cohorts, with the latter group reporting a twofold to threefold higher risk of pregnancy and dropout. 16 A systematic review examining the effect of COVID-19 on adolescent health, education, and other social and economic factors in low-income and middle-income countries found that increased AP rates were influenced by school closures, peer pressure, lack of family planning and economic pressures. 17 Conversely, Latin America, particularly Brazil, experienced a decrease in unplanned adolescent pregnancies during the first year of the pandemic likely due to enforced social distancing measures. 18 These data, however, may not have fully captured the long-term risks of AP due to COVID-19 mitigation efforts, did not differentiate between high-risk groups and were not representative of all Latin American countries. 19

In Peru, there was a slight increase in AP in 2021, especially in the selva or jungle region, although it is unclear if this was a result of the pandemic as the study used live birth certificate data. 20 The study furthermore does not take into account Peru’s COVID-19 migration efforts put into effect on 12 March 2020. The government imposed some of the earliest and strictest lockdowns in the world and mandated school closures nationwide 21 affecting over 8 million children from pre-primary to secondary school. 22 23

Latin America and the Caribbean have the second-highest rate of AP in the world despite reductions made in the past two decades. 6 24 In Peru, the fertility rate among adolescents 15–19 years was 58.0 in 2020 and remains considerably high when compared with other middle-income countries. 24 Moreover, these rates are considerably higher among adolescent girls residing in rural areas, the selva (jungle) regions and within the lowest wealth quintiles of Peru. 25 Thus, it is not surprising that Loreto, located in the Amazonian basin of northeastern Peru with a predominately rural population and high rates of poverty, has one of the highest rates of AP in the country. 25 Loreto also has some of the country’s poorest maternal and child health outcomes. 26

Peru’s COVID-19 containment measures may have unintentionally affected adolescent girls in the Loreto region. However, available data are limited, making it challenging to fully understand the extent of these effects. The purpose of the study was to gain greater insight into the downstream effects of the COVID-19 pandemic on the educational and reproductive health outcomes of adolescents within the Amazon basin—specifically focusing on school dropout and AP.

Study sites

The study sites were located in Nauta and Parinari districts of Loreto, Peru along 210 km of the Marañón River, a major tributary of the upper Amazon River. We conducted research in 11 communities. The study sites ranged in size from 120 to over 400 people and were largely designated by the Peruvian government as indigenous population centres or communities. Most were only accessible by boat.

Less than 15 000 people reside in the rural communities of Nauta and Parinari of our study area, a majority identifying as either Catholic or Evangelical and indigenously as Kukama. 27–29 The predominant language spoken is Spanish. The main livelihood activities are fishing and farming; communities closer to the capital city of Iquitos also make and sell handicrafts.

Communities had limited access to health centres along the Marañón River depending on location and population density. In Peru, primary health centres are divided into four types from lowest (I-1) to highest (I-4) service provision. The urban centre of Nauta, which has the only paved road to Iquitos, services a larger population with I-4 and I-3 health centres. The population centre of Parinari has the other I-3 health centre. In our study area, there are 11 I-1, 1 I-2, 2 I-3 and 1 I-4 health centres (see figure 1 ).

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Map of communities in the districts of Nauta and Parinari, Loreto, Peru embedded with community health workers (CHWs) through Mamás del Río service area. Primary health centres are divided into four types from the lowest (I-1) and highest (I-4). I-1 refers to health posts which usually include one nurse’s aide, nurse or nurse midwife. I-2 refers to a health post with a medical doctor which includes one of the personnel/services from an I-1 establishment and a general physician or surgeon. I-3 refers to a health centre and includes personnel/services from I-1 and I-2, a dentist, laboratory technician, pharmacy technician and a statistical technician. I-4 refers to a health centre with an inpatient facility and includes personnel/services from I-1 to I-3, a specialist physician and professional pharmacist.

Not all communities have a secondary school. There are 38 secondary schools in our study area including 10 located within and directly around the port city of Nauta. Secondary school consists of 5 years from grades 7 to 11, with students typically aged 13–18 years. 30

Study design

We conducted both in-depth interviews (IDIs) and focus group discussions (FGDs). For the IDIs, we collected data from adolescents defined as either a pregnant girl, non-pregnant girl, or boy, and community leaders. Inclusion criteria for adolescent IDIs were Spanish-speaking youth between the ages of 15 and 17 years who attended school full-time before March 2020. Pregnant adolescents included those who were primigravida or primiparous (having become pregnant after August 2020 or 6 months after the start of the pandemic). Non-pregnant adolescent girls were nulliparous. Adolescent boys had no paternity exclusion criteria. We included male participants to enhance our comprehension of peer and relationship dynamics, aiming for a more comprehensive understanding of the experience of the pandemic for adolescents. Community leaders were identified as those who hold a place or occupation of distinction in our study sites, including certified medical professionals, and indigenous or youth leaders. Participants were required to be Spanish speaking and either worked or resided in Nauta or Parinari.

FGDs were conducted with educators and community health workers (CHWs) who volunteered to participate in the study. Educators eligible for inclusion had to be Spanish speaking and had current or prior experience working as an educator, staff, or administrator in a local secondary school in Nauta or Parinari. CHWs were required to be Spanish speaking, residents of Nauta or Parinari, had previous experience as a CHW before the pandemic and be current active members of Mamás del Río, a project through Universidad Peruana Cayetano Heredia. Mamás del Río is a community-based health intervention project focused on improving maternal and neonatal health outcomes in rural Amazonian communities of Peru. 31–36 We sampled CHWs and educators in key access points along the Marañón River. The FGDs were held in larger population centres because of the availability of secure and private spaces. Gender-specific FGDs were held with the CHWs. However, owing to the small number of educators, we did not separate these participants by gender for the FGDs.

We used purposive sampling using the snowball principle to identify interview participants for the study. We first identified pregnant adolescent girls in Nauta and Parinari with the help of local obstetricians and CHWs. In study sites with identified pregnant adolescents, we first introduced our research to the indigenous community leader or apu when available. Once permitted to conduct the study in the community, we would interview the apu. Next, we would interview the pregnant adolescent and ask her to refer an adolescent boy and a never-pregnant adolescent girl for an interview. In circumstances where they could not make a referral, we relied on the CHW or local obstetrician for the recruitment of participants in the same community who met our inclusion criteria.

Guides for the IDIs and FGDs were developed to gain a contextual understanding of factors that directly and indirectly influenced adolescent educational attainment and reproductive health during the pandemic. Additionally, our semistructured interview guides included sensitive SRH topics, which participants may under-report because of confidentiality concerns and reluctance to disclose potentially embarrassing personal information. 37 To address this, SRH questions were phrased to capture the experiences of adolescents in their community rather than of the individual. This technique was adapted from Westgard et al . 38

The numbers of IDIs and FGDs were determined by thematic saturation, 39 conducted in Spanish, and lasted approximately 45–90 min. Demographic data were collected from each participant at the start of the interview or FGD. IDIs and FGDs were recorded using a voice recording device. If the participant declined to be recorded, notes were handwritten.

Study participants

Table 1 shows that the mean age of adolescent participants was 15.9 years. Over half (55.2%) self-identified as indigenous. 44.8% did not specify an ethnic identity despite living in a recognised indigenous population centre or community. All adolescent participants were enrolled in secondary school before the pandemic, of which 58.6% were currently enrolled and 27.6% had since graduated. Four adolescents (13.8%) permanently dropped out of school between March 2020 and March 2022.

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Demographic characteristics of study participants in the study sites of Nauta and Parinari by type, n=56

IDIs with community leaders included seven apus, four medical professionals and one youth leader. Not all apus were available in the study sites for an interview; however, none had declined our request to conduct the study. Only one study site did not have an apu. All male community leaders in this sample were apus. Female community leaders consisted of obstetricians, a medical technician and a youth leader. The mean age of community leaders was 44.5 years with two-thirds (66.7%) having completed secondary school or higher. Most community leaders were indigenous (75.0%).

The mean age of the FGD participants was 45.7 years with 33.3% having completed primary school and 53.3% having completed secondary school or higher. All CHW participants identified as indigenous while educators identified as non-indigenous.

Data collection

Field observations were conducted in June and October 2022. Field notes were compiled and organised by date. This included notes on adolescent interactions and SRH education. Brochures and other health materials provided by the local health clinics of the ‘Decidamos Ya! Reducir el Embarazo Adolescente en Loreto’ campaign were also collected and reviewed. 40 41 We used these data to triangulate the findings from IDIs and FGDs on how and in what context SRH information was provided to adolescents.

IDIs were conducted in June 2022, 3 months after the reinstitution of in-person classes throughout Peru. Empirically, to reach thematic saturation, we had aimed to complete 12 IDIs among each homogeneous group 42 ; however, we had difficulty recruiting adolescents for the study due to the sensitive nature of discussing SRH, the unfamiliarity of participating in qualitative studies and time constraints. In total, we completed 41 IDIs consisting of 11 pregnant adolescents, 9 never-pregnant adolescent girls, 9 adolescent boys and 12 community leaders in Nauta and Parinari. FGDs with educators and CHWs were conducted in October 2022 to supplement interview findings.

Data analysis

Notes and recordings were transcribed and uploaded to ATLAS.ti Windows (V.22.0.6.0). 43 Using a thematic approach, we derived patterns from our qualitative data. Themes with subthemes were identified through an iterative process using notes gathered from field observations, field debriefings and IDIs across participant groups. Codes were developed both inductively and deductively. Broader code categories included: social norms, SRH access, SRH outcomes, contraceptive use, confidence/aspiration, COVID-19 effects, education, mobility, social interactions and technology use. For this paper, we only present data that were expressively linked to youth’s COVID-19 experience. A more in-depth examination of social norms is referenced in a compendium paper. 44 No new codes emerged from the FGDs. Once the codebook was finalised in Excel, codes were uploaded to ATLAS.ti and used by the research team to code each interview and FGD. Six IDIs were selected to test intercoder reliability with a Krippendorff alpha-binary of 0.80 or greater across code groups. Identified discrepancies were reviewed and discussed between coders, then recoded through a consensus process.

The design, data collection and analysis phases of the research were informed by the interdisciplinary expertise and experiential backgrounds of our research team in the fields of public health, medicine, sociology, epidemiology and anthropology. See the online supplemental appendix for reflexivity statement.

Supplemental material

Effects of covid-19-related restrictions.

Adolescents clearly remembered the day when they received news of the emergency declaration by the Peruvian government of a country-wide shut down due to the COVID-19 pandemic. The initial 15-day lockdown was extended for 2 years, and community members were severely restricted in their movement outside their homes.

At the time of the pandemic, it was different… For example, you couldn’t go out to play, you couldn’t go out to have fun in the street, everything was controlled, sometimes security took care of us, and you couldn’t go out anywhere. (adolescent boy, IDI)

With consecutive lockdown periods under the state of emergency, adolescents grew more hopeless. They also described this period as sad, fearful, lonely and boring.

That’s how we went and until I think the month of June when there was an indefinite lockdown. There we lost hope of everything. (non-pregnant adolescent, IDI) I gained a lot of weight because, what were we doing? In the house, we made our breakfast, our lunch, our dinner. We ate and laid down… everything was boring. We didn’t go out, we just looked out the window. We closed it because we were afraid of getting infected. (non-pregnant adolescent, IDI)

Drinking and smoking also increased during this time as a coping mechanism.

Well, here was a time that… they were a lot into alcohol. Yes, alcohol, and they [adolescent boys] smoked a lot… Yes, they were like that for a while. (non-pregnant adolescent, IDI)

The COVID-19 pandemic had negatively affected communities along the Amazon basin. Due to a growing fear of contagion, rural communities along the Marañón River closed their ports and followed strict social distancing precautions starting in early 2020 as the rapid spread of disease, and a large number of deaths were reported from Iquitos. In addition, adolescents feared leaving their homes. Despite these mitigation efforts, ‘in the end, we all ended up getting the disease’ (pregnant adolescent, IDI). Some shared personal experiences of deaths in their families; others recalled hearing about people dying of COVID-19 at the health posts. Yet, these restrictions may have been hard to enforce in rural areas, and over time, communities eased their COVID-19 restrictions as it became economically unviable to continue strict isolation measures.

Households reported a loss of income during the pandemic. Fishing, as the primary livelihood activity and part of the cultural identity of the Kukama people in this region, was affected by mobility restrictions along the Marañón River and port closures. The trade linkages were severely disrupted as fish and products could not be sold in the urban markets of Nauta and Iquitos, and family businesses were unable to get supplies.

It was pure state law. The other communities too, are a bit difficult to enter another community. In other words, they locked us up. (male community leader, IDI) There has been a port blockade here, right? No exit or entry, right? But that led to chaos. There was no rice, there was no chicken, there wasn’t much. (male community leader, IDI)

Households experienced financial hardships which were further exacerbated by increased food prices during COVID-19. Households faced food insecurity and resorted to negative coping strategies such as reduced food intake, selling non-essential household items, relocating, and/or subsistence fishing and farming.

Here are times, like they say, we don’t have the money. Sometimes, uhum (laughs) we eat little. Or sometimes my partner goes to look for work… on the farm; [what] he produces, he sells. Sometimes we have [money], we just buy it… sometimes you have little and you can’t buy so many things [like] what you want to eat sometimes… I know that a lot has gone up [in price]. What you could eat before… with little money and now it’s no longer possible. (pregnant adolescent, IDI)

Additionally, many fathers were forced to find work outside of the community leaving adolescents with less parental supervision. There was also a growing demand for adolescents to work in the chacras or farm/fields, family gardens or fish to supplement household food.

[We] sold everything. I didn’t know how; all the money had gone down the drain. We were left without money and so we went to the farm. (pregnant adolescent, IDI)

Other youth went ‘to look for work in the city’ (pregnant adolescent, IDI), which usually consisted of informal or labour-intensive employment such as construction. Adolescent girls hired as domestic workers reported unpaid and exploitative working conditions:

During the pandemic, I could not go out because, because I did not live with my mother. I lived with another lady, that is, she made us work a lot… What did I not do!? I didn’t rest. I [worked] mostly the fields, cultivated [all day] in the sun, sometimes washed clothes, and had no rest. (pregnant adolescent, IDI)

Young girls forced to work outside of their homes in larger urban areas due to economic insecurity during the pandemic were more vulnerable to early unions and AP; some girls had sexual relations with men in the home or extended family of their employer. However, from the accounts of the participants, it is unclear how these relationships were initiated.

Access to healthcare

Health centres, sporadically spread along the Marañón River, were not accessible as movement was severely restricted, and many facilities were closed during the pandemic. If open, they were understaffed and diverted their limited resources toward the COVID-19 response.

Additionally, health staff did not travel to the communities, and medicine was scarce, further disrupting regularly provided services, including contraceptive access, during this time.

Many continued to take care of themselves, and many did not because, as I say, they did not have as much access since the medicines did not arrive at the clinics. (female community leader, IDI) Yes, it has changed with the pandemic. The nurses are in charge of giving contraceptive methods but in the pandemic, they were not here [in the community], and there was no one to turn to. (adolescent boy, IDI)

Botiquines, or community medicine cabinets, were quickly depleted of their medical supplies and were not replenished, forcing participants to rely more heavily on CHWs and locally available medicinal plants or remedio vegetal for the treatment of COVID-19, other ailments and family planning. The use of medicinal plants was not uncommon to prevent unwanted pregnancies and may have had increased use during the pandemic as formal SRH services and modern contraceptives were severely limited.

I believe that there are, uh, enough plant medicines to take care of ourselves, as you say, ‘toronja’ [grapefruit] is one, for me, it is a very effective remedy. I took care of myself just like that… I cannot get pregnant. (female CHW, FGD)

Adolescent girls refrained from seeking reproductive healthcare beyond their community because of COVID-19-related restrictions. When intercommunity travel was permitted, girls were required to travel to the health post by boat chaperoned by a parent or older adult male relative. Unaccompanied travel was not permitted. This prompted concerns from girls about accessing confidential and private SRH services.

SRH information

Before the pandemic, adolescents accessed SRH education from visiting organisations or in school. Health clinics also provided SRH information to adolescents primarily during on-site appointments or health checks. When financed, the obstetrician from the health clinic visited neighbouring communities through campaigns to provide abstinence-based SRH education in schools (as noted in our field observations), at church or in other open community spaces. However, the subject matter varied depending on the instructor. Despite formal efforts to provide adolescents with SRH information, it was considered inefficient, inconsistent and at times, incorrect.

That is, they gave us talks but… we couldn’t prevent ourselves. In other words, even though they gave us instructions on how to take care of ourselves with the methods… most of my classmates have gone out… like this… that is, they are all moms. (pregnant adolescent, IDI) The teacher told them that they can also be infected [with HIV] when they use the same bathroom: ‘You have to wash the bathroom with bleach, do that… when you sneeze the virus spreads, just like COVID, you have to take care of yourself.’ (adolescent boy, IDI)

Regardless of how effective formal SRH education was perceived among adolescents, during the pandemic, it was largely absent or unavailable despite calls from Peru’s Ministry of Education to teach contraceptive methods to youth.

In the pandemic, in the first year they didn’t talk…, and now it [is said] that the Ministry of Education itself tells teachers to come and talk about contraceptive methods. (non-pregnant adolescent, IDI)

This can be attributed to lockdown measures that restricted adolescents from accessing education at the health posts. Also, virtual SRH education was considered less optimal and largely halted as schools and obstetricians lacked the resources to effectively teach the subject.

In the absence of formal SRH education during the pandemic, adolescents relied on informal networks for information and advice. For many, parents were identified as primary source of SRH information. However, the extent of information shared is unclear as one adolescent boy described it as ‘not enough’. The conversation between parents and daughters centred around ‘[taking] care not to get pregnant’, while conversations with sons had greater emphasis on ‘[taking] care of themselves’ (pregnant adolescent, IDI).

Thus, adolescents depended on friends for more explicit information on sexual intercourse and contraceptive methods, sharing what they learnt from personal experience, health posts, previous SRH workshops at school, parents, older siblings, partners or the internet. Due to increased access to technology during COVID-19, adolescents turned to this resource to obtain SRH information.

Prior to the pandemic, secondary schools located in the Marañón River employed teachers from urban areas who stayed for short periods with a schedule that allowed them to travel back and forth. The quality of teaching was considered low due to the poor recruitment of qualified teachers. Many also did not ethnically identify as indigenous. Not all communities had secondary schools and students had to travel by peke-peke or gasoline-powered wooden boats to attend in person. This presented challenges in terms of increased transportation costs and the dangers of traversing hazardous river conditions and inclement weather. In cases where students had to attend school in another community, they needed to rent accommodations in a dormitory, home or a designated hostel nearby, incurring additional educational costs.

During the pandemic, schools were closed, teachers did not travel and students were socially isolated in their homes. To meet the educational needs, teachers would make photocopies of the homework to be sent by boat to the communities each month. When available, the Peruvian government distributed tablets to promote virtual education. Households were required to pay for photocopy charges and to recharge mobile data plans for the tablets; however, many could not afford these additional costs as they were already experiencing economic hardships because of the pandemic. Furthermore, several communities in the Amazon basin do not have reliable access to electricity or internet via cellular towers. Government-issued tablets came with data plans from a single telecom company that were not uniformly available across communities. This rendered online education as an impractical option for many students. To help offset the educational costs during the pandemic, parents gathered small groups of students to share resources.

It was something…not as normal as it was before. You didn’t see your classmates anymore, it’s not like being at school with everyone together…it was something separate, we only met as a group [with] some of our classmates, that’s how it was. (adolescent boy, IDI)

Adolescents were less motivated to attend classes online. Some expressed frustration in adapting to this new format of learning and felt that it was less engaging, of lower quality, inconsistent and less productive. Virtual classes were offered less frequently and in shorter duration than in-person classes had been before the pandemic. Students, during this period, temporarily abandonado or abandoned virtual classes and stopped submitting homework; however, many did not consider this dropping out or leaving school permanently. In the end, students passed or graduated regardless of meeting academic proficiency or performance for their grade level by government order (Vice-Ministerial Resolution No. 193-2020-Minedu) 45 :

Yes, there were some changes as everything was virtual. All the students passed [their] grade, just like that, without knowing anything… that we have learned almost nothing. (adolescent boy, IDI)

Teachers recounted that when schools reopened for in-person classes in March 2022, many students could not be accounted for. It was assumed that these students dropped out.

I have students who have not been on my attendance list since March [2022] … and there are at least five in each classroom. We have not heard from them since March to this day [October 2022]. I don’t even know them either because they didn’t attend [school]. (male educator, FGD)

Adolescents were more likely to drop out in their final years of secondary school, usually reflecting changing life priorities related to work, relationships or having children.

I think now just to raise my child. Because I’m not thinking about going back to school… Everything is different – I mean that’s your reality, and besides that, the jobs that come don’t give you time for anything. (pregnant adolescent, IDI) Falling in love along the way, so after that, many do not finish secondary school. (male community leader, IDI)

During the pandemic, many adolescents were also pressured to discontinue their education due to the economic stress of the pandemic, choosing instead to support their families and, in some cases, work outside of their communities. Many did not re-enrol when schools reopened in their communities.

Interviewer: In the pandemic years, who has left school the most? Participant: The girls… Sometimes some young people, for work reasons, money…yes, mostly for that reason. (adolescent boy, IDI) [My friends/classmates] they didn’t want to go [to school] because maybe… well, it was boring, they worked, they saw the money and they didn’t want to study anymore. (pregnant adolescent, IDI)

Technology use

Communities along the Marañón River have limited access to the internet, and electricity was largely restricted to nightly use. However, our findings suggested that adolescents in this region used technology in a greater capacity than before the pandemic. Adolescents increasingly relied on technology to access virtual education through government-distributed tablets or personal cellphones, and as a means for social engagement when strict COVID-19 mitigation efforts limited individual movement and required youth to self-isolate. Adolescents also sought SRH information online because personal devices provided greater privacy. Yet, the use of technology for this purpose is not well supervised and community leaders were concerned about the growing technology use among adolescents and increased access to pornography.

They get into some programs, uh, let’s say that does a lot of harm to the child, to the adolescent… they use it [the internet] for bad things… and that is the issue for us; it is really worrying to see the child go crazy, right? (male community leader, IDI)

Early unions/AP

Many participants believed that the pandemic led to more unions and partnerships in their communities despite having limited social interactions during the pandemic.

No, the pandemic has made even more couples join together, and there have been even more couples here in the community because they did not go out, they did not go out to any town, and no town was allowed to enter… And that has meant that everyone… with that, the number of young people who have their partners within the community has increased. (male community leader, IDI)

Sexual and romantic relations were maintained in ‘secret’ (male community leader, IDI), using online platforms to connect and coordinate meetings in person despite strict lockdown restrictions.

Yes, sometimes when we go out there alone, we find ourselves, sometimes a chair, a bench, in a dark place as they say. (pregnant adolescent, IDI)

Many of the partnerships were observed between underage girls (<18 years) and older adult men 8–15 years their senior, with unions/cohabitation becoming obligatory upon pregnancy. The pandemic may have pushed more adolescent girls into relationships with older partners for economic stability and pressure to find a suitable partner. For example, the adult male partner of one pregnant adolescent was identified by his prominent position in the community and reported by the study participant and others as being ‘a good person’. The subsequent quote from a non-pregnant adolescent provided valuable insight into the dynamics of these relationships:

He is supporting me a lot, well, I tell you that from a very young age. Many girls always say: ‘I like older people’, right? (laughs) Because I think that an older person can help you, I say, or can guide you. (non-pregnant adolescent, IDI)

However, not all pregnancies result in a union. Some pregnant adolescents experienced abandonment during the pandemic.

During the pandemic, participants believed that there was an increase in APs in their communities. A pregnant adolescent shared that before the pandemic, many young girls played outside in the afternoons but afterward, she noticed most now have children. Others believed that AP was most common among girls aged 14–15 years but also included those as young as 12 years:

Well, in the pandemic it did affect a lot because people, students ah, about 15, 12 years old, 13, 14, 17, not much 17; more were 15 to 14 years old; there were quite a lot that they were gestating. (non-pregnant adolescent, IDI)

Causal diagram

Based on our research, we developed a causal diagram illustrating how COVID-19 affected education, health access and economics/household financial stability, and in turn, AP and school dropout (see figure 2 ). COVID-19 also inadvertently affected early unions and contraceptive use. The relationship between AP, school dropout/abandonment and early unions is bidirectional, indicating that AP is both a consequence and a cause.

Causal diagram of the effects of the COVID-19 pandemic on education and sexual and reproductive health of adolescents in the Amazon basin, Peru. Arrows indicate directionality, dashed lines indicate bidirectionality; red lines represent a negative relationship; black lines represent a positive relationship; outcomes are in grey boxes; the primary outcome of interest (adolescent pregnancy) is in the red diamond.

We observed that girls dropped out of school during the pandemic because they became pregnant or were forced to work due to economic insecurity. They migrated for work, often under exploitative conditions. They were vulnerable to advances made by adult men in the households they were employed and may have been subject to coercive sexual relations. Many returned to their communities pregnant; however, this would need further exploration as it was unclear from participant accounts how these relationships were formed. Likewise, girls may have also sought these relationships for greater economic stability.

Our research aimed to understand how adolescent SRH and education were affected during the COVID-19 pandemic. We were able to access remote indigenous communities in the Amazon basin of Peru and learn from vulnerable youth in this region. We found from our thematic analysis that the economic, educational and health effects of COVID-19 contributed to school dropout/abandonment, decreased contraceptive use, early unions and AP. However, the relationship between AP was not unidirectional between school dropout and early unions. In a longitudinal study in Peru, cohabitation and early unions were found to be intrinsically related to and often a result of pregnancy. 46

Economically during the pandemic, Peru experienced the greatest drop in gross domestic product among all Latin American countries, an estimated contraction of 11%. This decline can be attributed to the government’s COVID-19 mitigation efforts, and its effect on education, health and mobility. 47 Additionally, the pandemic pushed more families into poverty as unemployment increased. The informal job sector was particularly affected. 47 The financial repercussions of COVID-19 may have elevated the risk of AP, given that both low socioeconomic status and lack of employment opportunities in low-income and middle-income countries are associated with an increased likelihood of AP. 48

Likewise, the COVID-19 policies lacked cultural appropriateness and consideration for Peru’s indigenous people. The emergency declaration of compulsory social isolation by the Peruvian government gave little advance notice and left many indigenous groups without supplies and food. 49 When products were available locally, many households were priced out due to the high demand for these products when available. 49 The economic pressure of the pandemic not only pushed girls to drop out of school to seek employment outside of their communities, increasing their risk of AP, but changed nuclear family structures. Fathers, in particular, were forced to find work outside of the community resulting in a single-parent household, which may help drive AP. 46 50

COVID-19 mitigation efforts had further detrimental SRH consequences for adolescents. The pandemic made it difficult for youth to access SRH services. 51 This was affected by factors such as fear of COVID-19 contagion, access restrictions and cost. 17 52 Concerns around accessing confidential and private healthcare may have also reduced the utilisation of SRH services and contraceptives among adolescents. 52 Indigenous girls in our study sites were required to travel to the health post accompanied by a parent or adult man, potentially creating impediments to accessing these services. Such factors increased their susceptibility to AP as they face greater geographical, economic and cultural/linguistic barriers to accessing appropriate education and healthcare compared with their non-indigenous counterparts. 53

Education serves as a buffer against AP. 14 Favara et al found that in Peru, attendance and better school performance were associated with increased age of sexual initiation and a lower risk of early childbearing. 46 Conversely, girls with lower education levels were less likely to use contraceptives and were at a higher risk of pregnancy. 13 School retention is a key AP prevention strategy for secondary school-aged girls. 54 However, COVID-19 school closures affected how youth were able to access education. 17 Disadvantaged children in Peru (those whose parents did not complete secondary school) lost an average of 34% instructional time during the pandemic. 55 Ultimately, this may lead to wider educational inequalities and greater dropout, especially among poorer households like those in our study sites. 56 57

SRH information was largely absent during the pandemic and is unlikely to be compensated for in the future. 52 Even so, formal health education may have limited effectiveness in reducing AP among this population even before COVID-19 due to inconsistent programming and incomplete information. It has also been shown that SRH interventions based solely on school curricula have limited evidence of changing the sexual practices and behaviours of adolescents. 58 Apart from formal SRH education, adolescents also relied on parents, peers and the internet to acquire more knowledge. The reliability and accuracy of this information remain unclear and need further investigation as cultural taboos may restrict what is shared. 59 Notably, previous research in Peru’s central jungle region, as demonstrated in a case–control study, highlighted the protective effect of adolescent SRH communication with parents against AP. 60 While our study sample was of a different indigenous background, this finding underscores the significance of parent–adolescent communication and parent-sourced SRH education in AP prevention.

Furthermore, early unions between pregnant adolescent girls and older adult men were observed in our study and reportedly increased during the pandemic. Adolescent girls may be motivated to seek out relationships with older men for financial security or out of fear of not finding a suitable partner. 61 Studies have shown that adolescent girls were at higher risk of engaging in exploitative work during COVID-19 and were subject to unwanted sexual advances, 51 a known determinant of unintended pregnancies. 54 It is important to also consider the unequal gender power relationships between adolescent girls and their adult partners in the Amazon basin. Girls lacked agency to make decisions around their reproductive health. 62 The COVID-19 pandemic likely intensified these concerns. However, our data were limited as older male partners were not included as participants in our current research, restricting us from gaining deeper insight into this phenomenon within the specific cultural context of our study site.

Other limitations of our study included possible recall and social desirability bias. Participants may have had difficulty recalling events over the last 2 years since the national school closures in March 2020. To reduce this bias, we conducted IDIs with adolescents and community leaders within 3 months of school reopening in Peru.

We also recognise that social desirability may have influenced responses among adolescent participants when discussing SRH and education. In the demographic survey, only four adolescent study participants (13.8%) had declared that they had permanently dropped out of school during the pandemic; however, in interviews, we found that a larger number may have temporarily ‘abandoned’ school during this same period. Using other terminologies or descriptions in the demographic survey and interviews may help elicit this information better.

Due to the nature of how participants for the FGDs and IDIs were recruited, they may not have been representative of the population. CHWs who volunteered to be in our study could easily travel to the location of the FGDs; however, this inadvertently may have biased our sample as more isolated communities along the Marañón River may not have been represented. Likewise, educators for our FGD were only recruited from one secondary school in our study site, and medically trained community leaders did not identify as indigenous although they lived in these communities. Adolescents who agreed to participate in interviews may also be inherently different from those who declined. For future research, we would include adult male partners of adolescent girls, a group not originally part of the study design. It was only through IDIs and FGDs that we identified this knowledge gap.

Other effects of COVID-19 on adolescent health were not explicitly explored in our research. These include mental health, gender-based violence and poverty. However, we found that participants often alluded to these topics when relating their experiences of the pandemic in terms of their relationships, AP and school. These factors would need further investigation as they are important to uncovering the gaps in current knowledge of the pandemic’s effect on our study population.

Conclusions

As we transition out of the COVID-19 pandemic, we recommend concentrated efforts to counteract the effect COVID-19 had on adolescent girls in the Amazon who are the most vulnerable in Peru. This includes specific strategies aimed at reducing their risk of AP. The insight gained from our research, especially around how youth access and use information, health resources and technology, can help inform and develop post-pandemic interventions that aim to reduce the incidence of AP in these communities. Overall, our research underscores the growing importance of investing in tailored, comprehensive and consistent SRH education in indigenous communities that involves a broader network of formal and informal educators. Furthermore, we propose leveraging the increased use of technology by integrating it into SRH education. This approach must be paired with more accessible, adolescent-friendly, confidential and private SRH services. It is crucial to ensure that SRH services and education are culturally appropriate and readily accessible for indigenous populations, particularly during future pandemics, to effectively address their unique needs and geographical isolation.

Ethics statements

Patient consent for publication.

Not applicable.

Ethics approval

Ethical approval for the research was obtained from Universidad Peruana Cayetano Heredia as the IRB of record (SIDISI Code: 2071919) approved on 13 May 2022, and with amendments on 6 June 2022 and 3 October 2022. The University of Arizona served as the external IRB (STUDY00001109). Before data collection, we obtained written informed participant consent. For participants under the age of 18 years, we obtained both assent from minors and parental consent. Informed consent was obtained prior to community leader interviews and FGDs. Adolescent participants received a compensation of S/10 PEN (equivalent to US$2.50) per interview, whereas community leaders, CHWs and educators were given S/15 PEN (equivalent to US$3.75). For CHWs who incurred travel costs to attend the FGDs, we provided reimbursement for the cost of gasoline used (~S/20 PEN per gallon).

Acknowledgments

We would like to thank the Agentes Comuntarios de Salud of Mamás del Río, the community leaders, local health staff, teachers and adolescents of the communities of Nauta and Parinari for their contribution to our research. We would also like to acknowledge the support and guidance of Mamás del Río, Universidad Peruana Cayetano Heredia, Gerencia Regional de Salud de Loreto and the University of Arizona. Special thanks also go to Elizabeth Jacobs and Cory Mabel for their contributions.

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Supplementary materials

Supplementary data.

This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

Data supplement 1

PM and MMB are joint senior authors.

Handling editor Manasee Mishra

PM and MMB contributed equally.

Presented at The research was previously presented as a poster presentation at the Ninth Annual Stanford Global Health Research Convening at Stanford University, California on 25 January 2023.

Contributors LW, PM and MMB led the conception and design of the study with input from PAM, LVF, SP and HEB. LW, PM, HEB and MMB helped to secure funding for the research. LW, PM and MMB coordinated efforts for ethics approval through the University of Arizona and Universidad Peruana Cayetano Heredia. Study site logistics were coordinated with MMB, NAdM and AGS. LW and AGS conducted data collection, codebook development and analysis. LW and AGS interpreted the data with guidance from MMB. LW drafted the manuscript. PAM, MMB, HEB, PM, AGS and NAdM provided revisions to the manuscript. All authors reviewed the final manuscript for publication. LW, as the guarantor, accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

Funding This work was supported by the Fulbright-Fogarty and Global Health Equity Scholar’s Programme (grant #: D43TW010540). Additional funding was provided by the University of Arizona’s College of Public Health Dean’s Fund (grant #: N/A) and the Graduate and Professional Student Council Research and Project grant (grant #: N/A).

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Competing interests None declared.

Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

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COMMENTS

Chapter 13. Participant Observation
Introduction. Although there are many possible forms of data collection in the qualitative researcher's toolkit, the two predominant forms are interviewing and observing. This chapter and the following chapter explore observational data collection. While most observers also include interviewing, many interviewers do not also include observation.
What Is Participant Observation?
Participant observation is a type of observational study. Like most observational studies, these are primarily qualitative in nature, used to conduct both explanatory research and exploratory research. Participant observation is also often used in conjunction with other types of research, like interviews and surveys.
Observations in Qualitative Inquiry: When What You See Is Not What You
Observation in qualitative research "is one of the oldest and most fundamental research methods approaches. This approach involves collecting data using one's senses, especially looking and listening in a systematic and meaningful way" (McKechnie, 2008, p. 573).Similarly, Adler and Adler (1994) characterized observations as the "fundamental base of all research methods" in the social ...
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This paper explores the validity of qualitative observational research methods, specifically participant observation. Through an exploration of the relevant literature and a critical review of a ...
Participant Observation as a Data Collection Method
Abstract. Observation, particularly participant observation, has been used in a variety of disciplines as a tool for collecting data about people, processes, and cultures in qualitative research ...
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Participant observation is in some ways both the most natural and the most challenging ... forms of commercial, public policy, and nonprofit research. Anthropology and sociol - ogy, in particular, have relied on participant observation for many of their seminal ... participant observation is inherently a qualitative and interactive
How to use and assess qualitative research methods
Qualitative observations can be either participant or non-participant in nature. In participant observations, the observer is part of the observed setting, for example a nurse working in an intensive care unit . In non-participant observations, the observer is "on the outside looking in", i.e. present in but not part of the situation ...
Chapter 15: Participant observation
What is participant observation? Participant observation is the hallmark data-collection method in ethnography (see Chapter 9). 1, 2 A major feature of this method is that the researcher is embedded in the context of the research to conduct fieldwork, and takes part in the daily life of the group. As an observer, the researcher studies the activities, events, rituals and interactions of the ...
Participant Observation
Qualitative Research Guide: Participant Observation. Online and collection-based resources to aid in conducting, finding, using, synthesizing, and teaching qualitative research in the health sciences. ... "Participant observation is the central research method of ethnography.
Qualitative Research: Participant Observation
Participant observation forms part of the phenomenological approach. This approach is about studying the personal experience and gathering data from the perspective of the researched individual (s). In the context of epistemology, phenomenological research is founded on personal knowledge and is thus considered subjective (Lester 1999, p. 2).
Planning Qualitative Research: Design and Decision Making for New
Qualitative research draws from interpretivist and constructivist paradigms, ... Much like case studies, data collection may include a variety of types of sources such as participant observation, interviews, documents, artifacts, and immersion in the cultural setting as an insider. Given that a researcher is likely to be studying a culture ...
What Is Qualitative Observation?
Qualitative observation is a research method where the characteristics or qualities of a phenomenon are described without using any quantitative measurements or data. Rather, the observation is based on the observer's subjective interpretation of what they see, hear, smell, taste, or feel. ... Participant observation is a research method ...
Qualitative research method-interviewing and observation
Observation. Observation is a type of qualitative research method which not only included participant's observation, but also covered ethnography and research work in the field. In the observational research design, multiple study sites are involved. Observational data can be integrated as auxiliary or confirmatory research.
Series: Practical guidance to qualitative research. Part 3: Sampling
Participant observation is a method of data collection through the participation in and observation of a group or individuals over an extended period of time . ... The qualitative research interview seeks to describe the meanings of central themes in the life world of the participants.
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[Qualitative research is] research using methods such as participant observation or case studies which result in a narrative, descriptive account of a setting or practice. Sociologists using these methods typically reject positivism and adopt a form of interpretive sociology. (Parkinson & Drislane, 2011)
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Page 4 of 4 The SAGE Encyclopedia of Qualitative Research Methods: Participant Observation or personal life, taking on a small task that benefits the group to be observed, and staying in the field long enough for habituation to occur. Finally, it is well known that the presence of an observer will change to at least some extent the context ...
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Qualitative research methods. Each of the research approaches involve using one or more data collection methods.These are some of the most common qualitative methods: Observations: recording what you have seen, heard, or encountered in detailed field notes. Interviews: personally asking people questions in one-on-one conversations. Focus groups: asking questions and generating discussion among ...
Observation
A way to gather data by watching people, events, or noting physical characteristics in their natural setting. Observations can be overt (subjects know they are being observed) or covert (do not know they are being watched). Participant Observation. Researcher becomes a participant in the culture or context being observed.
Participant Observation -- Definition
This research method was pioneered by anthropologists Bronislaw Malinowski and Franz Boas but was adopted as a primary research method by many sociologists affiliated with the Chicago School of Sociology in the early twentieth century.Today, participant observation, or ethnography, is a primary research method practiced by qualitative sociologists around the world.
Participant Observation
Participant Observation is. "A method of research in anthropology which involves extended immersion in a culture and participation in its day-to-day activities" (Calhoun, 2002). This type of research methodology is used in circumstances where an individual wants to observe a group to which they do not belong without altering the behavior of the ...
Ethics in Qualitative Research: A View of the Participants' and
For example, ethical unsoundness or physical and emotional risks to the researcher can arise in qualitative research if the researcher (a) faces aggression from the participant, (b) undertakes fieldwork at premises unfamiliar to the researcher, or (c) divulges too much personal information during the process of the research (Dickson-Swift ...
Qualitative Study
Qualitative research is a type of research that explores and provides deeper insights into real-world problems.[1] ... and participant observation to not only help generate hypotheses which can be more rigorously tested with quantitative research but also to help researchers delve deeper into the quantitative research numbers, understand what ...
Playful Strategies to Engage STEM Students in Qualitative Research
How many students can say they had a dance party in their research methods class? For faculty that would like to do a more in-depth examination of observation and participant observation, we recommend a homework assignment outlined by John Omohundro (2008, pp. 81-82), which inspired this in-class activity. In this assignment, students observe ...
Managing Unexpected Events in Participant Observation
In business management, participant observation is a qualitative research method where you immerse yourself in a group to observe interactions and behaviors. However, unexpected situations can arise.
A qualitative study of the barriers to commissioning social and
The interviews were conducted by a research assistant trained in qualitative data collection techniques and analysis. ... One participant referred to the evidence of STH for severe and enduring mental illness and that whilst there was evidence to support its use, it was not widely publicised. ... An interesting observation that emerged from the ...
Victimisation in the life of persons with severe mental illness in
Design. This was a pluralistic qualitative sub-study to explore victimisation among patients with severe mental illness. The sub-study was an offshoot of a bigger project comprising two studies: (i) the Main Study which investigated the epidemiology of HIV infection and risky sexual behaviour among patients with severe mental illness (SMI) and (ii) the Clinical Trials Preparedness study which ...
Qualitative Research Part II: Participants, Analysis, and Quality
This is the second of a two-part series on qualitative research. Part 1 in the December 2011 issue of Journal of Graduate Medical Education provided an introduction to the topic and compared characteristics of quantitative and qualitative research, identified common data collection approaches, and briefly described data analysis and quality assessment techniques.
Use of the International IFOMPT Cervical Framework to inform clinical
Trustworthiness of findings. The research study was conducted according to an a priori protocol and additional steps were taken to establish trustworthiness of findings [].Field notes supported deep familiarization with data and served as a means of data source triangulation during analysis [].One researcher coded transcripts and a second researcher challenged codes, with codes and themes ...
The downstream effects of COVID-19 on adolescent girls in the Peruvian
Due to COVID-19, schools were closed to mitigate disease spread. Past studies have shown that disruptions in education have unintended consequences for adolescents, including increasing their risk of school dropout, exploitation, gender-based violence, pregnancy and early unions. In Peru, the government closed schools from March 2020 to March 2022, declaring a national emergency that affected ...

Chapter 13. Participant Observation

What is Participant Observation?

Observation and Qualitative Traditions

Entry Access and Issues

Reflexivity in Fieldwork

The Data of Observational Work: Fieldnotes

Ethics of Fieldwork

Summary Checklist for Successful Participant Observation

Further Readings

Chapter 15: Participant observation

Learning outcomes

What is participant observation?

How to undertake participant observation

H ow to conduct data collection

Table 15.1. Nine observational dimensions and their descriptions

Box 15.1 Observation excerpt – community centre 10

Advantages and d isadvantages of participant observation

Table 15.2. Examples of participant observation from health and social care research

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Qualitative Research: Observation

Field Guide

What is an observation?

Suggested Readings and Film

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What Is Participant Observation Research?

Subjective Versus Objective Participation

Strengths and Weaknesses

Research Methodologies Guide

Participant Observation

Where to Start

Online Resources

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Data availability statement

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WHAT IS ALREADY KNOWN ON THIS TOPIC

WHAT THIS STUDY ADDS

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

Introduction

Study sites

Study design

Study participants

Data collection

Data analysis

Supplemental material

Access to healthcare

SRH information

Technology use

Early unions/AP

Causal diagram

Conclusions

Ethics statements

Ethics approval

Acknowledgments

Supplementary materials

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