Using ethnography to improve intervention design

Purpose. The purpose of this research was to use a three-phase ethnographic approach to examine the range of factors that affect People's decisions about physical activity and diet. Design. We used open-ended data collection strategies, analyzed inductively, to inform the development of a family intervention. Setting. The study was conducted in a small low-income town in Colorado. Subjects. Families with young children were selected to include social, economic, and ethnic diversity. Twenty-nine of 31 invited families participated (94%). Measures. The measures consisted of 21 open-ended interviews in the first phase; 12 semistructured interviews in the second phase, and six home visits in the third phase. The Atlas.ti program(25) was used for data analysis. Results. Significant barriers to regular exercise and good dietary habits were grouped as social/structural (e.g., working parents, costs of exercise) and cultural (e.g., perception that fast food is normal). Behavioral facilitators include disease in the family and community opportunities for exercise. Results revealed family values and dynamics that other methods would have missed. Conclusions. These data suggest that families are embedded in a multicomponent "web" of factors that influence diet and physical activity. It is feasible and desirable to use ethnographic methods to discern the interactions of these factors that make each household unique. These results argue for dynamic intervention designs that operate from a broad contextual perspective.