Abstract
How do we explore the meaningfulness of others’ experiences? What means do we have to access their experiencing of the world? How do we express our understandings of others’ experiences of body and place without reducing them to objectification? In this methodological paper, we reflect on how we can gain valuable insights into the lived experiences of others through research activities that are conducted ‘alongside’ participants. Phenomenological concepts of intentionality and embodiment are considered as we draw on an empirical example of exploring the experiences of hospitalized patients with neurological diseases through observations and interviews. The aim is to unfold alongside as an epistemological stance to explore the meaning of another’s lifeworld. We strive to show that personal presence and engagement within this approach contains relational, existential, and aesthetic dimensions worth considering.
Giving consideration to the experiences of patients is paramount to contemporary healthcare practice. In particular, knowing how an ailment shapes an experience of illness or how providing a medical intervention affords an experience of care may support shared understanding and consequential conversations between patients and their healthcare providers (Toombs, 1987). For those interested in advancing this kind of knowledge, multiple questions may be asked: What methodological considerations ought to guide patient engagement to elicit their experiences? How do we balance varied and, at times, competing patient perspectives? And, how do we gain access to the meaning that arises in a patient’s experiencing of their world? This last question is the focus of this paper, recognizing that people may have difficulty articulating their thoughts, feelings, or perspectives as a consequence of issues associated with age, illness, mental health, and/or other difficulties. As well, we should acknowledge that what individuals say about their experiences may miscue or skirt over meanings that are formative of their lived experiences. There always remains a difference between the lived and the understood (Merleau-Ponty, 1947/1964, p. 81). And yet, if we do not aspire to learn about patients’ experiencing of their worlds – their lifeworlds – then we ought to question how we actually care for them (Piemonte & Ramsey, 2018, p. 220).
When it comes to exploring how individuals experience their world, interviewing and observation are well-known and often applied methods. Application of these methods requires assessment and consideration of a whole series of questions to follow the methodological prescriptions (Jones et al., 2008). However, researchers do not always acknowledge that participants’ experiences consist of more than their verbalized opinions, views, or perspectives. In addition, prescriptive approaches to interview and observation have their limits; and, more or less semi-structured interviews and/or observations are at risk of yielding mostly superficial findings, fragmentations of understanding, and scarcity of meaning (Missel et al., 2015).
Researchers may turn towards phenomenology to explore experiences in their meaningfulness. However, there are a wide variety of understandings of phenomenological inquiry within and beyond philosophy (Bernasconi, 2000). While human science phenomenology methodologists may vary in how they too understand the project of phenomenology, even those that differ in their methodological commitments describe that research methods, such as interview and observation, should be employed commensurate to the phenomena being studied and in such a way that they reflect the methodological significance of phenomenology (Bevan, 2014; Moustakas, 1994, p. 104; van Manen, 2023, p. 8). However, interview and observation are rather unfortunate concepts if they are merely taken as instrumental approaches to ‘collect data’, wherein researchers and participants are isolated, set apart, or otherwise detached from one another. We, therefore, use the term ‘alongside’ to draw attention to intersubjective methodological considerations for these human science methods.
Alongside is the contraction of the prepositional phrase expressing “close by the side of a person or thing; side by side; together with; at the same time as; in coexistence with” (Oxford English Dictionary, 2023). It draws attention to the propinquity in which researchers and participants may be together in space, time, relation, materiality, and other existential aspects. And yet, almost paradoxically, it is in proximity to another that we encounter another as an Other (Levinas, 1961/1991, p. 103). Although we may diminish the distance of our individual subjective understanding of the world to a condition of intersubjective understanding, there remains difference. Said differently, when the health researcher is alongside a research participant, there exists the possibility for an intersubjective coexistence and understanding presence for both of them that transcends yet also never quite achieves wholly understanding the other’s being-in-their-world.
Part of the import of alongside for qualitative health research is that the researcher may attend to a participant’s bodily engagement in their world. However, from Husserl (1913/1989, p. 239–240), Stein (1917/1989, p. 75–84), and others, we need to be cognizant that drawing inferences from observing another’s bodily engagement in the world risks imposing our own subjective understanding on their experiencing of the world. Here, ‘subjectivity’ should not be taken synonymously with personal prejudice, emotional bias, or otherwise as antithetical to ‘objectivity’. Rather, subjectivity should be understood as rooted in our “ordinary consciousness” wherein the ‘self’ is uniquely embodied in the world (Durt, 2020, p. 69). Following, we may understand phenomenological description and interpretation of another’s experiencing of the world as necessarily cautious, tentative, and, at times, speculative (van Manen, 2017a). This reflects, in part, the ethics of qualitative research: the responsibility to seek understanding regarding others’ experiencing of the world yet refrain from reducing their lived experiences to our own subjective (and at times objectifying) gaze (van Manen, 2021, p. 74). Here, we understand ethics as an existential phenomenon: “more primordial than what drives most contemporary forms of bio-ethics” (p. 4). Ethics arise when we confront someone ‘other’ to ourselves as we recognize them as having their own unique perspectives, lived experiences, bodily existence, and so forth. Notions of morality – what is ‘good’ or ‘bad’ – arrive late to this intersubjective engagement.
We recognize that for many qualitative research traditions, the notion of ‘collecting data’ in the field is not new. Researchers have written about ‘how to’ conduct go-along interviews, walk-a-longs, or walking interviews in the health sciences, anthropology, and sociology literature (Anderson, 2004; Carpiano, 2009; Flick et al., 2019; Jensen et al., 2016; King & Woodroffe, 2019; Kusenbach, 2003; Maben et al., 2016; Stiegler, 2020). It has been proposed that these approaches capture the natural relationship between person and place in a participatory manner (Cummins et al., 2007). For example, the research may involve a participant-guided tour of the places where participants spend their lives. Largely, however, these approaches have been treated generally and reflected upon instrumentally, as mobile means to ‘gather data’ that might otherwise be overlooked by using traditional interview formats (Garcia et al., 2012). As well, limited critical attention has been given to experiential aspects of these activities (Jones et al., 2008).
In the phenomenological human science literature, various methodologists have emphasized and/or elaborated the value of observation (Churchill, 2021, p. 36; Dahlberg et al., 2008, p. 205; Vagle, 2018, p. 85; van Manen, 2023, p. 402). In many ways, their work is parallel to those in phenomenological anthropology, whereby ethnographic inquiry (including various forms of participant observation) has been influenced by phenomenological philosophy (see, for example, Katz and Csordas, 2003; Jackson, 2015; Ram & Houston, 2015; Desjarlais & Throop, 2011). While we acknowledge this work, it is important to note that, for the most part, those in phenomenological anthropology have provided limited guidance on methodological considerations for observation in phenomenological research (Klinke & Fernandez, 2023).
We would be amiss, however, to not point to the oeuvre of Karin Dahlberg and her colleagues regarding participant observation in phenomenological research (see, for example, Dahlberg, 2006; Dahlberg et al., 2008). While recognizing the value of observation, Dahlberg (2006) highlights that observed behaviour is open to a broader range of interpretations than what may be drawn from a text. Observation, therefore, benefits from dialogue situated in a reflective stance oriented to the phenomena of interest. This is nicely exampled in a study exploring pre-hospital emergency care where observations of ambulance workers were informed by concurrent interviewing (Wireklint Sundström & Dahlberg, 2011). And we recognize there are, of course, other empirical examples of phenomenological research showing the use of observation and interview. For example, some phenomenological Qualitative Health Research publications drawn, in part, from observation include Lemermeyer (2021), Thoresen and Öhlén (2015), and van Manen (2017b).
Our aim in this paper is not to lay claim to the interplay of observation and interview in phenomenological research but rather to develop and advance methodological discussions on observation-related aspects in phenomenological research. Specifically, we explore considerations for how alongside interviewing may enhance understanding of the body, space, time, relations, materiality, and other existential aspects in health-related settings. To achieve this aim, we draw on an empirical study called ‘Hospitality’, whereby we investigated the experiences of the hospital environment of patients with neurological diseases (Beck et al., 2021). As health researchers, we endeavoured to ‘walk’ alongside our patient participants, drawing observations and conducting interviews, by way of a serendipitous intuition, as they moved beyond their rooms, recognizing that these patients ‘walk’ in a manifold of different ways (e.g., without assistance, using walkers, wheelchairs, or other means). In this context, we approached patients’ experiencing of their world as they shared their life experiences of being a patient on a neurological unit in action and talk. Engaging in conversational interviews in this manner generated new insights into embodied lived experiences, thus building on the phenomenology inquiry addressing the ‘things themselves’ (Willis, 2001).
‘Walking’ Through ‘the World’ of Healthcare: An Empirical Example
The aims of our ‘Hospitality’ study were twofold: (1) to offer a vivid portrayal of patients’ experiences of the hospital environment and (2) to facilitate dialogue about healthcare aesthetics that support patients in their hospitalization. In a philosophical–phenomenological optic, aesthetics can be understood in a much broader sense than as one related to the practice, interpretation, or theory of art. Aesthetics is a fundamental condition of human existence and includes the relationship between the senses, the surroundings, and the attunement of humans (Løgstrup, 1983). Attunement to our surroundings impacts our minds through our senses and, in this way, nourishes experiences that we may evaluate as positive or negative. Aesthetic impressions are interwoven: for example, tone of voice is so enmeshed with speaking such that it cannot be separated from the words that are spoken. Following, we can say that attunement to our surroundings, which we as humans are always a part of, shapes our lived experiences and reflective understanding of a given situation.
The ‘Hospitality’ study explored aesthetic aspects of the lived experiences of hospitalized patients with neurological diseases. Neurological diseases included conditions such as brain injury, dementia, cognitive decline, and so forth. The empirical material was collected through observation and interview oriented from an epistemological stance of researchers being positioned alongside participants. This meant that observations and interviews for this study were interwoven: conducted by walking slowly and patiently, pausing and listening carefully, alongside the patients. Because we were oriented towards investigating aesthetic aspects of patients’ experiences in the hospital environment, we recognized that researchers benefited from accompanying patients to those hospital places where aesthetics made an impact on their descriptions of their experiences.
There was an ‘experimental’ character to ‘data collection’ in that observations and interviews were shaped by where and how participants moved about the neurology unit. The following questions were routinely asked: Show me a place in this unit that has made an impression on you? Is there a certain place you would like to show me here?
Participants were encouraged to comment on whatever came to mind while moving through the hospital unit; they might look at something, hear or smell something, in which the experience was sharable, and were encouraged to elaborate on their immediate thoughts. A small recorder, the size of a pen, placed in the patient’s shirt, not inhibiting their movement, was utilized. In this way, participants were free to decide where to ‘go’ and what to ‘see’ as we watched and recorded our engagement together.
Reflecting on the epistemological stance of researchers being positioned alongside participants, we suggest four substantive aspects for consideration: intersubjective embodied experiences; shared experiencing of space; meaningfulness of space as place; and experiencing embodied existence. We engaged these aspects within a process of recovering structures of meanings that were embodied and dramatized in human experience represented in the material drawn from the alongside observations and interviews. In other words, we themed the key aspects of being alongside from a wholistic, selective, and detailed reading of the research material guided by the work of van Manen (2023, p. 407). Below we expand on these thematic aspects with the assistance of concrete examples. These examples have been fictionalized in the sense that pseudonyms are used in place of names with identifying features removed, yet retaining ‘truth value’ as they resonate with the experiences of the researchers who conducted this study.
The study was approved by our institution’s research ethic committee (approval no. REG-081-2018). All participants provided written informed consent before enrolment in the study.
Intersubjective Embodied Experiences
What happens when a researcher walks alongside a research participant? Is it simply an opportunity to talk in an informal and relaxed manner? Does the conversation become more capricious as the context is wayward? While these last two questions can often be answered affirmatively, the first is more complex. Consider the following encounter: Walking alongside John, who had a recent stroke, I cannot help but notice how my own gait slows as I share in his rhythm: step-shuffle, step-shuffle, step-shuffle. I see John look up to the bench ahead as he firmly grips the walker. His knuckles whiten and arm muscles tense. We cannot talk while he is walking. His attention is solely focused on getting there. As we near the bench, I slow down, expecting that we will pause to sit. He turns to me with a grin, “Oh we’re not stopping yet.”
As we walk alongside another person, in a taken-for-granted way, our body may adopt the movements of our companion. It is as if our body synchronizes a shared pace, rhythm, or other corporeal aspect through an intuitive grasping of the other’s way of being-in-the-world. Merleau-Ponty (1945/2012) talks about the phenomenon of bodily intentionality: we experience the world through our bodies before we even reflect on it (p. 139). As our own gait changes to an imitative ‘step-shuffle, step-shuffle, step-shuffle’, we are afforded an intersubjective sense of an effortful hemiplegic walking whereby a spastic limb is pulled along. While we may not suffer the same primal experience, the actual ‘pain’ as the patient whose leg has been paralyzed by a stroke, we may gain an empathic sensation of the ‘awkwardness’ that such a condition poses for the patient.
Drawing on the work of Merleau-Ponty, David Seamon (2023) reminds us how qualities of the world may directly resonate with the lived body to convey meanings and ambiences through a tacit, unself-conscious repertoire of seamlessly interconnected intentional gestures and movements (p. 20). Later, he emphasizes that the world as experienced in our natural attitude, meaning our usual unreflective way of being in the world, is “unself-consciously grounded” (p. 34). And yet, we need to acknowledge that this awareness of our world, through our body, is not the same as the world as lived through the body of another. While we may interpret the pace of another walking as measured and arduous, to the afflicted person the resulting experience may be one of caution and unsteadiness. In other words, our bodily perception of another’s existence is only approximate as perception is virtually and partially intertwined with our own subjectivity and lacks aspects of their bodily being-in-the-world (Merleau-Ponty, 1945/2012, p. 374). Following, as researchers, we need to acknowledge how our alongside observations necessitate ‘talk’ to clarify understandings (Dahlberg, 2006). This is assuaged by an acknowledgment that accounts of pre-reflective experiences are not necessarily easy to express. Experiential accounts of lived experience undergo transformations in the process of verbalization.
Returning to the hospital, on occasion our bodies moving about, alongside each other, would be reflected in a window, a glass surface, or a glossy wall. In these reflective surfaces, we were ‘just’ two objective bodies walking around. In this way, we became aware of our individual presence in the hospital setting, in an act of self yet also other observation. We were two images, sometimes overlapping, sometimes touching, and sometimes moving independently in the space of the hospital hallways. Other times, it was not clear who was who in the shadow play of the figures on the walls. It was in moments like these when the psychological reality of being a hospital patient slid into a phenomenological wonder of what was real and what might have been. These moments were elusive and difficult to describe, especially for those with neurological illnesses. Yet, through the intersubjective activity of ‘walking’ alongside participants, bodily aspects of their hospital experience were vividly brought to presence. Thus, the bodily interaction with the world during the alongside observational interviews became a horizon achieved while being in motion, where things or situations that patients were involved in became meaningful to discover or disclose together. At the same time, we realized the inadequacy of the terms observation and interview, if they are understood to mark a division between self and other. The speculum of the glossy hospital walls showed that walking and talking along is also a walking and talking between. It is in the space between the two figures, the researcher and the participant, where this space suddenly becomes pregnant with an atmosphere of care and attentive togetherness.
Shared Experiencing of Space
What can alongside observational interviewing tell us about the ‘world’ of the hospital, the aesthetics of the space? We may begin by reflecting that in being alongside another, the researcher is presented with the world of the participant in a lucid aesthetic way. Experiencing common sensual sources such as lighting, sounds, and odours offers a common ground for reflection, recognizing that the subjective aspects of such experiences may be variably felt. For example, the bright lights of a hospital corridor may be glaring to the patient with glaucoma. Just as the noisy nursing station may be relatively mute to someone who is hearing impaired. And yet, despite the possibility for intersubjective differences in understanding, researchers being able to share in the experiencing of the space of patients offers the possibility of understanding. Sitting next to Bo at the exit of the unit, we have placed ourselves at his ‘usual’ spot. Bo shares how he likes to sit here, to be close to the staff and to have an overview of the hallway, should anyone come looking for him. However, the constant ‘beeping’ from the monitoring alarms as well as commotion from people walking in and out of the unit make it difficult to have a conversation without interruptions. Bo offers, “If you want, I can show you another place. It’s just a short distance from here.” We walk outside to a bench bordering the parking lot. “Here, I sit in peace when the ‘beeping’ gets too much,” Bo tells me. He pounds on the bench, meaning that I should sit too. He points to an old tree on the horizon and says, “Look, there is my favourite spot. It is not much, but it is worth the walk, don’t you think?” After sitting for another couple of minutes, not talking, just sitting, we nod silently to each other. Bo smiles and whispers, “There you have it … quietness.”
Now, Bo might have said, “There you have it … togetherness.” After all, Bo usually sits near the hallway from where he would be able to see “should anyone come looking for him.” Such words reveal not only that aesthetic experiences can be shared but also that meaningfulness may arise in the sharing of such experiences. We can all recognize textures of a space that over time become recognizable, familiar, or habitual. Just as we know that we may desire different aspects at different times in our lives. At times, it may feel good to be among the activity of people, and other times, we may yearn for peace, solitude, and stillness. We may recognize the aesthetic qualities of a space that afford such opportunities, and also those that may threaten us as spaces are juxtaposed as examples.
The German scholar Frederik Buytendijk referred to phenomenology as the “science of examples” (van Manen, 2023, p. 164). Examples may be understood as “rhetorical and aesthetic devices for evoking phenomenological understandings or phenomenological knowledge that cannot necessarily be expressed, explained, or explicated in a straightforward descriptive or prosaic manner” (van Manen & van Manen, 2021, p. 14). Being alongside participants provided us with unique opportunities to explore examples of hospital spaces: waiting spaces (hallway chairs), shared spaces (meal rooms), visiting spaces (entrance seating areas), and so forth. Engaging in observation and interview in these different spaces offered an understanding of the experience of hospitalization that transcended illness itself.
Dahlberg (2006) writes on the “surplus of meaning” from which observation draws: “there are many more intentional objects than the phenomenon” (p. 4). In plainer language, we may say that observations yield multiple phenomena. And we may expand: in observation, we encounter a surplus of meaning deriving from the sensual aspects of experience (noise, light, smells, touch, and so forth); the unique manner an individual is embodied in the world; the particular aims, motivations, preoccupations, and other aspects of the inner psychological life of the person; the inimitable individual’s life history; and so forth. And this surplus of meaning also portends that observation may disclose a manifold of different expressions of experience which may or may not relate to the phenomena of study (Dahlberg, 2006). This is both the challenge and opportunity for methods of observation and interview that resist structure, explication, or constraint.
So, in health settings we may appreciate lived meanings of everyday objects and environmental aspects (doors, windows, and other openings; shared and private patient areas; etc.) in both their intuitive and reflective character when we take time to observe and converse about them. Following, we can regard engaging in observations and interviews alongside participants as a practical way of taking up an attitude of immediate seeing and practicing awareness of the hospital world as it is experienced rather than as conceptualized or theorized (see van Manen & van Manen, 2021). In this sense, being alongside is a powerful methodological device as well as an aesthetic source to share in experiences of space.
The Meaningfulness of Space as Place
We all have our places in the world: routine places, safe places, special places, intimate places, private places, and so forth. Such places are composed of objects as much as the people, sounds, smells, and happenings that occur within them. The hospital is, in some ways, no different: a collection of spaces that may take on meaning as places. And yet, we may acknowledge that patients are rarely afforded choices when it comes to creating hospital spaces. Instead, they must find places within the hospital that fit their situatedness (van Manen, 2012). How is such meaningfulness disclosed in a research interview? Is it a matter of words and gestures? Or can observation or interview itself show the meaning of a place in its concrete vividness? Consider the following: Eric is physically disabled and has aphasia as a consequence of a brain hemorrhage. I meet him initially in his room. He is smartly dressed in formal attire. Following introductions, we walk slowly into the hallway. He nods politely to people passing by, concentrating on one step at a time. Pausing. Walking. Pausing. Walking. Each cluster of steps is deliberate. Pausing. Walking. Pausing. Walking. “Where do you want to go, Eric?” Pausing. Walking. He stops. Eric seems like he wants to say something, but remains silent. “Maybe you can show me a place that has made an impression on you while being here?” Eric’s facial expression changes. He walks slowly, but resolutely, to a door in the hallway and pulls it forcefully open to reveal a shared room. One person lies in a bed, watching TV, with the volume turned too loud. Across the room, another is visible sitting at the toilet, looking somewhat diffident. Eric studders, “THAT … has made … an impression on me.” He closes the door. Moving on towards a couple of chairs in the hallway, Eric sits down and after gathering strength, he carefully says, “There is no privacy in here … We can’t even shit on our own.”
While walking and talking alongside a research participant to understand their hospital life can be a psychological activity, walking and talking beside a participant to try to understand the transcendent nature of certain hospital experiences is a phenomenological task. When Eric is asked to show some of the places that are meaningful to him, he abruptly pulls open the door of a common room. This rough gesture is unusual for Eric who usually is respectful and considerate to the people around him. But in this gesture, we can detect the difference between meaning and meaningfulness. The meaning of the common room is the function of the room. But the room also is meaningful to Eric – meaningful in a negative sense. Eric reveals the negative meaningfulness of the common room by exposing how it is misused. This is not a room that invites a meaningful sharing of this place by the patients. We also note how the pauses in Eric’s aphasia-affected commentary speak more powerfully than his words.
As healthcare providers, we are not always aware or at least considerate of how hospital spaces afford experiences of privacy, dignity, and worth. Bathroom areas tend to be designed functionally, to accommodate walkers, wheelchairs, or mobility aids to mitigate risks of falls and lend themselves to cleaning should accidents occur. Even when bathroom doors are present, they may be propped open, to ensure patients remain under the nursing staff’s attentive eyes. While we may recognize that patients variably experience such aesthetics, we should acknowledge that such experiences may be deeply meaningful to patients’ sense of person. The study of meaningful experiences can either or both be psychologically or phenomenologically framed. Psychological research tends to focus on the personal and social psychological dimensions of the hospital patient; phenomenological research tends to explore phenomena and events that transcend personal empirical psychic concerns.
Pragmatically and existentially, walking alongside a research participant, we may recognize how conversations may move in the direction of where a participant chooses to go: subjects and objects for the talk that may be passed over in a traditional interview. When a participant’s movement and perspectives guide the conversation, even for a participant who may ‘only’ be able to provide short sentences or a few words, the combination of their bodily expressions and the location where they walk and talk provide ‘rich’ understanding.
Descriptions of lived experiences are often difficult to express and verbalize because they are typically tacit, preconscious events (Seamon, 2023, p. 90). When participants were asked to describe their experiences in the ‘Hospitality’ study, they would often hesitate and apologize for not being able to put the right words together. For example, often they would say, “I don’t know how to express it or if I will say anything useful, but I would really like to go for a walk with you.” Merleau-Ponty (1945/2012, p. 422) describes lived experiences as pre-reflexive cogito, which means that people are connected to the world before any thought. Drawing on Merleau-Ponty, David Seamon (2018) describes the body in its “pre-reflective perceptual presence as an integral constitute of place and place experience” (Seamon, 2018, p. 15). Elsewhere, Seamon (2023) elaborates how this means that we are “enmeshed and entwined in our world, which, simultaneously, is enmeshed and entwined in us” (p. 89). And so, with a nod to Merleau-Ponty and Seamon, we may describe alongside observational interviewing as an approach to gaining access to the world of an immediate taken-for-grantedness that discloses the meaningfulness of a space as a place.
Experiencing Embodied Existence
How does a place afford a subjective sense of one’s body? What aspects of aesthetics and design condition experiences of disease and also health in a hospital environment? Anne wants to brush her hair before the interview. She doesn’t want to look ‘slubby’ while wandering around the hospital. Queuing for coffee, Anne touches her hair and looks around. “You know the feeling of being naked, right? That is what it is like being here. I don’t have my earrings. They were afraid they might be stolen.” Anne touches her ears. “I always wore them,” she says. Getting coffee, we walk down the hallway. Anne continues “I really miss my earrings. They are a part of me and in here I lack something that reminds me of me.” She stops, nips a plant by the window, and continues, “I guess you can think of hospitalization as a wound. Something that hurts and takes time to heal and, in that process, you need something to feel like yourself.”
Although we may recognize the logic of patients not bringing valuables into a hospital environment, we may also recognize how without these ‘everyday things’ it can be hard to feel quite ‘right’. Our bodies, after all, are not just the bodies we are born with. We compose our bodies through our clothing and dress, personal items, and so forth. In comparison, we recognize that aesthetics are not just expressed in the physical design of a hospital environment; they are also founded in the rules, routines, and other activities that compose a place. All of these ‘things’ affect the experience of the body in place.
We may understand alongside observations and interviews are not just a special way of relating to persons but rather a way of understanding their life situations. For example, one participant walked to the basement of the hospital to show a place that made an impression on him. While walking through the basement, looking at empty beds lined up, side by side, ready for cleaning, he said, “Well, in a way, we all have the same endpoint.” His comment opened a conversational space to talk about living with uncertainty and the eventuality of death. A significant point here is that the world of the healthcare system is not ‘just’ what health professionals think but rather what the patients ‘live’ through. Thus, moving to places with unconscious yet purposeful thought allows investigating lived experiences; being in motion provides insightfulness into pre-reflective aspects that illuminate the meaning of ‘what it is like’ to be a person in the world of the hospital. These conversations may open understandings of space, time, and other existential aspects of the world as the patients ‘live’ (through) it. Giving a ‘direct description’ of experience is not just narratively reporting, copying, or telling a story but is a showing of how life may take place ‘in space’ in the hospital (Bollnow, 1963/2011, p. 240).
The epistemological stance of researchers being positioned alongside participants offers a powerful possibility to witness how an individual’s life takes place in a hospital space, from their morning routines right through to their afternoons, evenings, and nights. The interviewer may be afforded an understanding of not just their body in physical motion but also of temporal aspects of their hospital experience. And more broadly, being in motion while describing what it is to be a person in the hospital offers an understanding of a bodily perception that composes a patient’s experiences of diagnoses, prognoses, and so forth. We may, therefore, say that alongside observational interviewing is a way of explicating how the world of healthcare settings touches us as humans, as patients, when being in contact with the healthcare system, voicing the world of lived life in spaces and places in a healthcare setting.
The work of Otto Friedrich Bollnow (1963/2011), one of the founding fathers of aesthetics and the phenomenology of atmospheres, showed the importance of (human) life taking place ‘in space’ and how humans are never subjects deprived of space (p. 19). Humans always find themselves in some lived and experienced relationship with space, a relationship that determines it and gives it an imprint. This means that we must give up the idea that we exist ‘in’ space, thus always experiencing space in a ‘certain way’ animated by experiences suggested by the space itself. Instead, Bollnow (1963/2011) suggested that ‘being in’ spaces and places as a human is intertwined with (more or less intense) emotionality and existential aspects that provide valuable insights into what it is like to be a human (p. 22.). Thus, acknowledging the role of space and place to ill people alongside observational interviewing addresses the fluid interdependence of sensed life and lived experiences in the healthcare environment, illuminating insight on how life takes place in spaces and places of contemporary healthcare settings.
Discussion
In our ‘Hospitality’ study, being alongside participants supported a way of letting moments ‘breathe’ while walking and talking. Theoretically, this was possible as being alongside wove together observation and interview to explore in situ examples of lifeworld existentials: lived relation, body, space, time, and materiality. As described by van Manen (2023), we all experience our lifeworld through these existentials (p. 408). The value of using existentials as heuristics to explore meaningful aspects of our lifeworld is not new within phenomenological research but was benefited from a methodological focus on being alongside research participants in our study.
Phenomenology may be understood as a project that is “concerned with questions of access and particularly questions of gaining access to what is largely inaccessible, that retreats as we approach it, is almost always struggling with language” (Bernasconi, 2020, p. 3). In this paper, we aimed to show this struggle through writerly reflection on meaningful moments disclosed through what we have described as being alongside. In reflecting on observation methodologically, Dahlberg (2006) writes, “it is the researcher who words the experience” (p. 4). This not only points to how, as researchers, we put the existential meaning of phenomena into words but also that there exists the possibility of bringing to language aspects of an experience that are detached, inconsistent, or otherwise lack understanding of an experience as lived through.
More could clearly be said and written on the topic of this paper recognizing that different phenomena pose their own challenges and opportunities for weaving together observation and interview. Following, it could also be said that phenomenological researchers should focus not on methodological ‘rules’ so much as ‘considerations’. As Dahlberg (2006) writes, “our focus as researchers must be on how we choose our viewpoints, outlooks, distances and perspectives when we try to understand something, and how we make phenomena and their meanings explicit” (p. 3). If we understand the notion of lived experience as announcing the intent to explore directly the originary and pre-reflective dimensions of human experience, then an alongside focus orients to the living moment of the ‘now’ as lived experience comes to be constituted in observed actions and shared words (van Manen, 2023, p. 120).
The use of observation in human science research has been articulated as involving environmental perception, spatial practices, biographies, social architecture, and social realms (Kusenbach, 2003). To this way of articulating observation, we add a new aesthetic area where perceptual impressions (sensing the world of the healthcare environment) are addressed by moving right through it. We argue that, whether considering movement by the participant and/or the researcher, mobility takes research out of fixed (safe, controlled) environments and introduces a range of new significant possibilities to draw on illuminating existential and aesthetical aspects of life. Pairing observation and interview in these contexts may enrich experiential understandings.
Considering the broader qualitative literature, researchers have described forms of interviewing in real-life situations as effective ways of balancing the power dynamic inherent in the research and thus encouraging a more collaborative approach to shed light on ill peoples’ lived experiences (Anderson, 2004; Carpiano, 2009). Our experience is commensurate with this literature in that participants tended to talk more ‘freely’ when we walked together compared to traditional approaches like semi-structured interviews and observations (Beck et al., 2018, 2019). Said differently, when walking, the participants were in a more ‘natural’ situatedness (e.g., enacting their day-to-day routines) affording a dialogue-based approach, in keeping with the work of others (such as Wireklint Sundström & Dahlberg, 2011).
Engaging in alongside observations and interviews poses ethical challenges. As researchers, we needed to make moral judgements – what is ‘good’ or ‘bad’ – whether alongside observations and interviews are appropriate at the time, in the hospital environment with other severely ill patients, and how to handle unexpected situations. In line with van Manen (2014), we believe that being alongside should be imbued with ethical decisions, not only dealing with what is ‘good’ or ‘bad’ decisions resulting from our actions but also founded in our relationships with others in the context of the healthcare settings we wish to investigate. In this sense, alongside observational interviews hold several ethical–moral questions concerning how we should address this walk and talk with people to openly encounter their differences and accommodate their vulnerability that might occur when walking around in the hospital practice.
Finally, we acknowledge the practical issues of alongside observational interviewing in clinical hospital settings that are intertwined risks of being interrupted while ‘walking and talking’ (e.g., other patients, visitors asking for help, and staff wanting to examine or give medication) combined with background noise from the clinical surroundings. Many of these more pragmatic issues also arise in traditional observation and interview settings, for example, when thinking about the location in clinical settings where an interview can take place (King & Woodroffe, 2019). On the one hand, we addressed such concerns by considering when to engage in observation and interviews, taking breaks, walking patiently, adjusting ‘in the moment’, and waiting for the potential ‘right time’ for the participants to take a walk. On the other hand, we considered these interruptions as a well-suited way to explore the world of the patient, as it paved the way to sensitive aspects of the subtleties and depths of the contexts research participants are part of. Hence, this approach that incorporated the context, accepting the interruptions as they were, became an opportunity to give voice to human experience, as well as providing the opportunity to vividly portray the world of the hospital to people participating in it.
With this paper, we strove to show how being alongside research participants contains relational, existential, and aesthetic dimensions worth investigating. We suggest researchers ‘walk the talk’ and let people’s lived experiences breathe through motion within the present healthcare settings, to glorify that when people move, great thoughts about life arise.
Footnotes
Acknowledgments
We are grateful to the patients who were willing to participate in this study, walking around in a hospital setting while sharing meaningful moments, as well as thoughts of being a person admitted to the hospital setting. In addition, we would like to thank the Management of the Department of Neurology, Zealand University Hospital, Region Zealand, for their full support to this study. We would also like to acknowledge our phenomenological colleagues, participating in the ‘International Human Research Conference’ in New York 2022, for sharing interesting reflections and questions on this methodological approach, which paved the way for further motivation of writing this paper.
Ethics Statement
Declaration of Conflicting Interests
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Michael van Manen is a Deputy Editor of Qualitative Health Research. He was not involved in any part of the peer review process and the manuscript was subject to the same standard of peer-review as others submitted to the journal. This includes the input of two or more independent peer-reviewers who were blinded to the author’s editorial association with Qualitative Health Research.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study received financial support from Department of Neurology, Zealand University, Region Zealand, and Counsel of Innovation, Zealand University Hospital, Region Zealand, Denmark.
Correction (August 2024):
The Conflict of Interest statement has been updated in the article since its original publication.
