• To understand the unique insider positioning of a researcher completing qualitative research
• To offer practical guidance and strategies for insider research
• To advance the understanding of research practices and ethics in the context of insider research
Background An embedded single case-study design was used to explore the experiences of men in rural New Zealand accessing mental health services. It is essential for researchers to acknowledge positionality in case study research and the lead author used reflexive practice to acknowledge his values and beliefs.
Aim To explore and demonstrate the reflexive process of the lead author’s position as an inside researcher.
Discussion Three groups were involved in the research: men with mental health challenges, their partners, and mental health clinicians. The article presents the initial research through memos and diarying in the context of current literature.
Conclusion Reflexivity is essential for ensuring the research process is complete and biases are identified. Positionality exists on a continuum and it is critical for researchers to be honest with themselves, the topic and the group being investigated, to show respect for the participants and the people they represent, as well as to be committed to revealing the truth.
Implications for practice Insider research has the potential to bridge the gap between academia and practice. It facilitates the transfer of research knowledge directly to practitioners, leading to more evidence-informed decision-making and practice.
Nurse Researcher. doi: 10.7748/nr.2024.e1909
Peer reviewThis article has been subject to external double-blind peer review and checked for plagiarism using automated software
Correspondence Conflict of interestNone declared
Ferris-Day PM, Hoare K, Minton C et al (2024) Reflections on being an insider researcher: a study exploring the experiences of men accessing rural mental health services. Nurse Researcher. doi: 10.7748/nr.2024.e1909
Open accessThis is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence (see https://creativecommons.org/licenses/by-nc/4.0/) which permits others to copy and redistribute in any medium or format, remix, transform and build on this work non-commercially, provided appropriate credit is given and any changes made indicated.
Published online: 30 May 2024
Mental health support may be accessible, yet whether it is helpful or what individuals require is determined by many variables, including the experience of the workforce (Jorm et al 2017). A review of mental health in New Zealand (Government Inquiry into Mental Health and Addiction 2018) found there was a lack of services nationally. It presented a range of suggestions, including the need to improve access and provide services that are meaningful and accessible. The review was followed by the introduction of a well-being plan (Ministry of Health 2021).
The study described in this article aimed to present the experiences of people accessing rural mental health services in a system recognised as problematic (Gluckman 2017, Potter et al 2018). The article presents the initial research data and analysis from an embedded single case study exploring men’s experiences of accessing mental health support in rural New Zealand. The case investigated three sub-units of analysis: men who have experienced mental health challenges and have sought mental health support; their non-professional supporters, such as partners; and professional mental health clinicians.
The lead researcher (PMF-D) was a mental health nurse in the study’s community and had previously provided clinical services to the region. He had a detailed familiarity with the field of study, but was mindful of maintaining the ‘critical gaze’ – balancing objectivity and subjectivity (Olmos-Vega et al 2022). He chose to use a case study methodology addressing people’s experiences, backgrounds and world perspectives as factors influencing the provision of mental health support.
However, personal circumstances resulted in his accessing local mental health services for a family member during his initial interviews with participants. This led to his experiencing the difficulties encountered by the study’s participants, with people not receiving the mental health care they needed or not meeting the criteria to be seen (Meier 2021).
This article shares PMF-D’s reflections on being an insider researcher when researching people’s experiences accessing mental health support in a rural community. It provides a lens to explore the positionality of researcher, nurse and mental health service user.
• It is crucial for insider researchers to manage potential conflicts of interest and maintain objectivity while also fostering positive relationships with the research stakeholders
• The insider perspective can offer valuable context, deepen understanding and facilitate nuanced analysis of research findings
• It is essential that insider researchers navigate the associated ethical considerations such as confidentiality and are cognisant of the power dynamics between them and the participants.
The assertion by Dodgson (2019) that it is crucial for researchers to openly declare their positionality in a study forms the basis for this article (Hesse-Biber 2007). Positionality describes someone’s worldview and position (Darwin Holmes 2020). It includes political and social content, as well as how the researcher’s background influences the research process and its findings.
Qualitative research originates from the ontological assumption that reality is not fixed and that someone’s existence encompasses their beliefs and how they use these to understand the world (Baldwin 2014, Polit and Tatano Beck 2021, Crabtree and Miller 2022). Researchers take a constructivist position and believe that people independently discover, construct and make sense of their world.
Constructivist truth is relative, context-driven and the result of perspective (Flick 2018, Franchin 2022, Martí 2022). This means that knowledge is not viewed as objective and universal; instead, it is seen as being constructed by people based on their unique experiences, perspectives and interactions with the world (O’Leary 2021).
Postpositivism asserts that people’s natural biases and experiences always influence the scientific exploration of fact. Mellor and Patterson (2004) echoed this position but implied that truth depends on the interests of those who may benefit from it: researchers have power and are not immune to the political and social milieux in which they conduct research (O’Leary 2021) – they are just as much a part of the conversation as the research itself. Their personal, epistemological and theoretical position can influence their research, its analysis and how they interpret data (Charmaz 2017); their epistemological and ontological positions can influence how they adapt a research process to ensure philosophical congruence between the research question and the methodology (Brydges and Batt 2023).
Reflexivity is central in producing knowledge and understanding the implications of being an insider researcher (Subramani 2019, Shaw et al 2020, English et al 2022). It is an awareness of your role in the research process and the way the object of your investigation influences this. It is a conscious attempt to make meaning that is focused on a broader understanding of social and political perspectives (Subramani 2019), and explores the impact of power differentials and the risk of assumed understanding.
Reflexivity must be considered within a broader understanding of the social, economic and political factors that can influence your research and its position (Barrett et al 2020). Personal experience, gender, race, ethnicity, social class, geographical location and history can influence your choice of research interests and topics, as well as your adoption of perspectives, motivation, conduct and results; they can shape your beliefs, values and preferences.
Finlay’s framework for reflexivity (Finlay 2002a, 2002b) suggests researchers should know their biases, assumptions and values, to identify and address issues related to power and privilege in their research. This enables them to consider their epistemological and ontological positioning, and to construct a lens to examine participants’ worldviews of truth as well as their own. The participant’s voice becomes explicit alongside their own voice, with both perspectives intertwining.
Engaging in a reflexive process couched in personal social and political positioning helps to mitigate potential biases and ensure rigour (Pitard 2017, Collins and McNulty 2020, Bukamal 2022, Lavorgna and Sugiura 2022). Reflective descriptions of a researcher’s history and experience might also serve as a lens for understanding the research question (Subramani 2019).
A central tenet of reflexivity is the need for ‘self-scrutiny’ (Hellawell 2006). To be reflexive is to consider and respond to your own emotions, motives and situations (Ide and Beddoe 2023). However, this is more than a self-indulgent reflection on your feelings – it involves asking questions of yourself to challenge your assumptions and scrutinise your influences and your sway over others. This enables you to acknowledge how you affect the research process and its outcomes (Green 2015, English et al 2022, Garrels et al 2022, Olmos-Vega et al 2022).
To be reflexive, you must be as transparent as possible about your emotions, social background, and philosophical and political assumptions (Hoare et al 2012). However, being open about personal experiences may put researchers in a vulnerable position (Tang et al 2020, Massoud 2022).
Makins (2020) discussed the personal conflict its author experienced when presented with moral judgements. His role as a researcher did not include being a therapist, nurse or counsellor, but such roles were always there. He was mindful of his social and political positionality, and conflict occurred when he took the moral stance not to defend services but to listen.
Researchers must also go beyond personal introspection and consider their epistemological position (Feucht et al 2017). Lakhanpaul et al (2019) emphasised that researchers engaging in reflexive practice must make sense of their current situation by using their expertise and position. Palaganas et al (2017) proposed that researchers need to be aware of the co-construction of meanings throughout the research process and that it is impossible to remain objective: participants influence researchers and researchers influence participants, with reflexivity a continuous and collaborative process between researchers and participants that affects each other’s worldview (Hoare et al 2012, Olmos-Vega et al 2022).
The positioning of ‘insideness’ and ‘outsideness’ is a central tenet of Relph (1976), who argued that insiders with a sense of place and belonging will feel ‘safe’ and familiar with what they know and can straddle a position between the two perspectives. But insider researchers who belong to the communities in which their research occurs must be upfront about their position and the biases they bring (Saidin 2016, Darwin Holmes 2020, Wilson et al 2022). The context of their research must be clear, with their position transparent, rigorous and trustworthy (Pitard 2017, Hordge-Freeman 2018, Spiers et al 2018).
An insider viewpoint has advantages: some participants may be more open to engaging in research and more honest in their reporting with an insider researcher (Hash and Kramer 2003). A researcher with a personal connection to a study site can better understand the culture of the population under investigation (Bukamal 2022, Massoud 2022), while an outsider may have little or no such knowledge (Fleming 2018).
However, this connection may be deep or superficial, depending on the researcher’s ‘closeness’ to the subject of the study (Fleming 2018). Knowing a service and how it works does not always equate to understanding it (Kennedy et al 2017, Natafgi et al 2022). But people can gain knowledge when confronting a situation from a previously obscured perspective, such as transitioning from a helper to someone needing help.
Insider researchers also often find it challenging to balance their professional roles and the expectations of being the researcher (Breen 2017). Dickson-Swift et al (2006) and Lavorgna and Sugiura (2022) commented on the blurring of the boundaries between the researcher and participants. Hoare et al (2012) suggested the blurring of roles depends on the researcher’s role and relationships in the social and cultural context of the area of enquiry. Researchers who have used mental health or disability services themselves must navigate professional and personal aspects of their roles, which can be complex and lead to uncertainty in identity (Gupta et al 2023).
This study used Finlay’s approach to reflexivity (Finlay 2002a, 2002b). Finlay stressed that researchers must be rigorous and evaluate how divergent elements of the research process influence data collection and subsequent analysis (Finlay 2002b). She also discussed the ethics and positionality of the researcher (Finlay 2002a).
Her approach to reflexivity emphasises the importance of self-awareness, critical reflection and transparency in identifying and addressing issues that may arise in the research process. Her framework has five steps:
1. Epistemological reflexivity: the researcher’s assumptions about knowledge and how it may influence their research.
2. Methodological reflexivity: the researcher’s approach to collecting and analysing data.
3. Ethical reflexivity: the researcher’s responsibilities to navigate ethical challenges.
4. Personal reflexivity: the researcher’s experiences and how they shape the research.
5. Positional reflexivity: the researcher’s social and political positionality and how it influences the research.
These five lenses of reflexivity formed the basis of the approach taken in the study when writing up reflexive practice.
Memo writing helps researchers to clarify ideas and make sense of data (Mohajan and Mohajan 2022), as well as understand their subjectivity (Lisi 2016). The reflexions in this article draw on field notes and memos PMF-D wrote when interviewing people who had experienced or supported men with mental health problems. He used diaries and field notes to document his thoughts and immediate impressions, and used ‘messy maps’ to make sense of these, note ideas and ascertain connections across each of Finlay’s five elements (Figure 1).
Messy maps are a way to document all aspects of the presenting situation and make sense of participants’ narratives alongside your own perspective (Nordtug 2022). They enable you to generate theory, describe systems and influences, and increase the awareness of marginalised voices (Andersson and Silver 2019).
Mapping complemented the reflexive process and was one of many processes created to gain a deeper understanding of the complexity of the phenomena being investigated. It was a helpful exercise in clarifying and articulating common themes that emerged from the participants’ stories, as well as identifying and clarifying the perspectives the researcher also had. An important element was ensuring that the reflexive approach had a structure, with thoughts and impressions focused back on each of the criteria established by Finlay (2002a, 2002b).
PMF-D entered the field as a researcher and a mental health nurse, understanding the mental health services and support available in the study region. He was upfront with participants about being a mental health nurse who lived in the region. This resulted in several participants asking him for his opinion of the local mental health services. Participants did not initially receive a view based on his personal access to and use of the local services, as he had not had that experience. He instead directed them to Government Inquiry into Mental Health and Addiction (2018), which highlighted general dissatisfaction with mental health services.
However, his role as a researcher was overlaid early in the study by his need to seek mental health support for a family member. His later experiences of the local services then paralleled those of many of the participants, especially regarding dismissal and minimising of concern.
Participant 1: ‘The police said that mental health services from the DHB will not get involved because it’s not a crisis; I said: “Okay, so it’s not crisis enough… does he have to kind of like be an ambulance at the bottom of the cliff sort of scenario?” And they said: “Yeah.”’
Participant 2: ‘It was a shambles. It was a complete shambles. And I wasn’t at the point of ringing 111, but that it was like: “Where are these people? You know, I need help, and I’m trying to ring the numbers I’ve been told, and there’s no one to talk to.”’
It was challenging for all the participants and PMF-D to access mental health support. A blurring of roles between service users and PMF-D became clear.
Being denied treatment, being put on waiting lists and poor communication were topics that resonated with participants. The participants had to find help independently, as professional services were scarce. They sought help from either their families or people they knew.
PMF-D could physically access the clinical services but could not use leverage to obtain mental health support. This resulted in a dissonance for him between what services should be provided and what was actually delivered and how.
Engaging in reflexive practice in the study enabled PMF-D to document his positionality and track its evolution. The reflexive approach of Finlay (2002a, 2002b) involved the researcher identifying the complexity of the participants’ stories alongside his own experiences. PMF-D’s vulnerability became a critical element of the approach using the framework of Finlay (2002a, 2002b).
Using Finlay’s framework in the study ensured that the researcher’s unique view and experiences of the world was central to the process, potentially influencing the research process and ultimately becoming part of the overall research landscape.
Deleuze and Guattari (1987) described a relationship between life’s rhythm and the beginnings of order from chaos. The chaos, in this instance, was the noise of uncertainty. The study’s participants universally had to search for people who could help – which aligned with the researcher’s experiences as well.
Acknowledging the context of research is vital. Denzin and Lincoln (2008) asserted that it is imperative for researchers to understand the context of their research, as considering the broader context in which the research takes place enhances the quality and significance of their work and ensures that their findings have a meaningful impact.
A strength of the study’s design was the researcher’s intimate knowledge of the social, cultural and organisational aspects of the region. It was also conducted in an environment in which people live and work, and the study’s participants were intertwined with the social environment in which they lived – people could tell their stories in the context of that environment. The study’s findings are therefore limited to that context and not meant to be generalised to other locations. However, further research in other geographical locales could use the study’s design. Participants could also be revisited over time to help address discourse related to changes resulting from revised mental health systems.
This article illustrates how researchers can apply reflexivity in their studies. It presents valuable insights for novice qualitative researchers who are seeking to define and establish their own positionality, and will help them to address their positionality.
Reflexion throughout the research process assists researchers in noticing their reactions to participants’ experiences; this helps them to acknowledge their biases and provides them with the opportunity to discuss potential weaknesses and strengths of the research. Yet rather than ‘just’ being aware of their positionality, researchers must be explicit about it in their research. Addressing positionality helps researchers to manage their positions in their research. An awareness of self is critical, reflecting where you sit along the continuum of insider/outsider; it is a requirement of tenable research that is credible, meaningful and explicit, and therefore considered in all reflexive approaches.
11 December 2024 / Vol 32 issue 4
Exploring the role and expertise of ward-based oncology clinicians
Aim The aim of this study was to involve ward-based band 6...
The biology of cancer
Cancer research is moving fast. Understanding of the biology...
An assessment of the value of music therapy for haemato-oncology patients
The aim of this service evaluation was to assess the value...
Assessing the benefits of social prescribing
Social prescribing provides GPs and other healthcare...
Making sense of cancer nursing research design
There is a bewildering array of research designs and...
