ABSTRACT
Biopharmaceutical development plays a critical role in global health, focusing on the discovery, development, and production of innovative drugs and therapies. This contribution is multifaceted, encompassing disease prevention, treatment provision, global access to medicines, fostering innovation, and supporting economic growth. However, there is a growing recognition of the need to consider cultural norms in healthcare, as they are significantly influence health outcomes. Cultural norms shape beliefs, behaviors, and healthcare-seeking patterns, and understanding them is essential for developing scientifically effective and culturally appropriate drugs and treatments. Additional, as drug development expands into diverse locations, considering cultural nuances becomes crucial. Ethnographic research can provide valuable insights into cultural norms, beliefs and behaviors that impact diagnosis, treatment, and patient outcomes. Incorporating ethnographic research into the drug development process allows for tailored interventions that address individual’s’ diverse needs and preferences.
1. Introduction
Biopharmaceutical development plays a crucial role in global health by focusing on discovering, developing, and producing innovative drugs and therapies to prevent, treat, and cure diseases. Through extensive research, clinical trials, and regulatory approvals, biopharmaceutical companies ensure the safety and efficacy of their pharmaceutical products. This contribution to global health is multifaceted. First, it aids in disease prevention and control by developing vaccines and preventive medications, effectively reducing the burden of infectious diseases worldwide. Additionally, biopharmaceutical products provide vital treatments for various health conditions, addressing unmet medical needs and improving patient outcomes and quality of life. These companies also strive to promote global access to medicines, employing measures such as affordable pricing, licensing agreements, partnerships with governments and non-profit organizations, and drug donation programs. Biopharmaceutical development fosters innovation by pushing scientific boundaries, leading to the discovery of novel therapeutic approaches, precision medicines, and breakthrough treatments that have the potential to transform healthcare and address global health challenges.
Furthermore, it contributes to economic growth, job creation, and research and development investments, supporting healthcare infrastructure development, fostering collaborations, and enhancing scientific capabilities globally. While biopharmaceutical development alone cannot solve all global health challenges, it is a critical component within the larger global health ecosystem. By intersecting with public health initiatives, healthcare delivery systems, policy frameworks, and global health organizations, biopharmaceutical development collectively works towards improving health outcomes and promoting well-being on a global scale.
Nevertheless, even as a contributor to global health, the industry focus has traditionally been on scientific and clinical research, with an emphasis on rigorous testing and efficacy evaluations. However, there has been a growing recognition of the need to consider the broader social and cultural factors that influence healthcare outcomes in recent years. Cultural norms play a significant role in shaping individuals’ health beliefs, behaviors, and healthcare-seeking patterns. These norms encompass various factors, including religious beliefs, social values, and traditional practices. For example, in some cultures, seeking medical treatment may be influenced by spiritual or religious beliefs, and traditional healing methods may be preferred over conventional medicine. Understanding and addressing these cultural norms is essential for biopharmaceutical companies to develop drugs and treatment approaches that are scientifically effective, culturally appropriate, and acceptable to patients. Biopharmaceutical companies can better cater to individuals’ diverse needs and preferences and improve health outcomes by incorporating cultural sensitivity into the drug development process.[1]
Furthermore, as drug development expands into diverse locations, it becomes crucial to consider the cultural, social, and demographic variations in those regions. Different populations may have distinct healthcare needs, access to resources, and cultural beliefs that can influence their response to treatments. Conducting ethnographic research in these diverse locations can provide valuable insights into the cultural norms, beliefs, and behaviors that may impact diagnosis, treatment, and patient outcomes. Therefore, as drug development moves into new locations, understanding the cultural nuances and tailoring interventions accordingly becomes even more critical for successful and effective drug development.
1.1. The Importance of Cultural Norms in Healthcare
Understanding cultural norms in healthcare, including stigma, cultural practices, religious beliefs, and other factors, is of utmost importance for several reasons. First, it enables the delivery of patient-centered care that aligns with individuals’ cultural values and preferences. This approach improves patient satisfaction, trust, and engagement in their healthcare journey. Additionally, cultural norms can contribute to health disparities, making it essential to identify and address barriers to care in specific cultural contexts to promote health equity and reduce disparities. Understanding and addressing the stigma associated with certain diseases or health conditions is crucial, as stigma can hinder timely diagnosis and treatment.[2] By creating supportive environments, healthcare providers can encourage individuals to seek care and reduce the negative impact of stigma on their health.
Moreover, cultural norms influence treatment adherence, and by understanding and accommodating patients’ cultural beliefs, healthcare providers can improve adherence and overall health outcomes. Cultural norms also influence effective communication, and understanding these norms enables clear and accurate information exchange, shared decision-making, and informed consent. Understanding cultural norms is vital for designing culturally appropriate health promotion strategies and preventive interventions and facilitating behavior change within specific contexts. Ethically, respecting cultural values and practices is essential in healthcare delivery, promoting patient autonomy, dignity, and well-being.[3] Understanding cultural norms in healthcare is crucial for patient-centered care, reducing health disparities, promoting treatment adherence, effective communication, health promotion, and ethical healthcare delivery. It fosters improved health outcomes and increased patient satisfaction by acknowledging and respecting patients’ cultural identities.
Furthermore, biopharmaceutical companies often focus on evaluating the prevalence and incidence of a specific disease or condition when advancing a new product or indication and not necessarily the cultural phenomena that might be associated with a population. However, while these epidemiological factors are important in understanding the scope and impact of a health issue, they may not capture the complete picture of cultural factors that can significantly influence the success and effectiveness of a product in different populations.
Considering cultural factors is essential for several reasons. First, cultural factors such as beliefs, values, and practices can impact the acceptance and adoption of new treatments. Different cultures may have varying preferences for treatment modalities, traditional remedies, or religious/spiritual considerations that can influence treatment decisions.[4] Failing to consider these factors may result in low acceptance or adherence to the product in specific populations. Moreover, cultural norms and beliefs shape individuals’ understanding of health, illness causation, and treatment efficacy. Cultural factors influence how people perceive and interpret symptoms, their trust in modern medicine, and their willingness to seek professional healthcare. Failure to address these cultural beliefs can hinder a new product’s successful introduction and uptake.
Additionally, cultural factors influence healthcare-seeking behaviors, including patterns of help-seeking, utilization of healthcare services, and interaction with healthcare providers. Understanding these behaviors is crucial for effective product development and implementation. Neglecting cultural factors may result in ineffective marketing strategies, limited accessibility, and low product utilization.
Cultural factors also encompass language diversity, communication styles, and health literacy levels. Not considering these factors may lead to communication barriers, misunderstandings, and inadequate information dissemination.[5] This can hinder the effective promotion, understanding, and use of a new product within specific cultural communities. Furthermore, cultural factors contribute to stigma and discrimination associated with certain diseases or health conditions. Ignoring these cultural dynamics can undermine the success of a product by perpetuating stigma, hindering diagnosis, and reducing treatment-seeking behaviors.
Biopharmaceutical companies can comprehensively understand the target population by considering cultural factors alongside epidemiological data. This understanding helps tailor product development, marketing strategies, educational materials, and healthcare delivery to specific cultural contexts, enhancing the likelihood of successful adoption and positive health outcomes. Incorporating ethnographic research and cultural competence into product development can help bridge the gap between epidemiological data and cultural realities, resulting in more effective and culturally appropriate healthcare interventions. By understanding and addressing cultural factors, biopharmaceutical companies can optimize the impact of their products and ensure they meet the diverse needs of global populations.
This paper’s central thesis is that incorporating ethnographic research in biopharmaceutical development is crucial. This approach is necessary for understanding and addressing the impact of cultural norms on diagnosis and treatment. By integrating ethnographic research methods, biopharmaceutical companies can gain insights into cultural beliefs, practices, and stigma surrounding health and healthcare, leading to more effective and culturally sensitive interventions.
2. Understanding Ethnographic Research
Ethnographic research is a multifaceted and immersive method used to study and depict the culture of a particular group or community. It aims to understand individuals’ experiences, beliefs, behaviors, and social practices within their cultural context. By adopting a qualitative approach, ethnography delves into the complexities and nuances of human existence, emphasizing the importance of cultural perspectives. Fundamental principles underpinning ethnographic research involve immersing oneself in the field, maintaining a participant-observer role, and embracing a holistic perspective. [6] Immersion requires investing significant time within the community or setting being studied to gain a profound understanding of its intricacies. As a participant-observer, the researcher actively engages with community members, participating in their activities and observing their daily lives. However, it is crucial to balance involvement and detachment to maintain objectivity and avoid bias. Researchers must maintain a critical distance and self-reflect throughout the research process.[7]
A holistic perspective is essential in ethnographic research, recognizing that individual behaviors are influenced by various interconnected factors, such as social, economic, political, and cultural influences. By examining the broader context within which culture operates, researchers acknowledge the interplay of these factors in shaping social phenomena. Ethnographic research also emphasizes inductive reasoning and an iterative approach.[8] Researchers derive theories and concepts directly from their data, allowing specific observations and patterns identified during fieldwork to guide the research process. This bottom-up approach promotes the emergence of new insights and understandings rather than starting with preconceived hypotheses.
Reflexivity and cultural sensitivity are fundamental to ethnographic research. Reflexivity involves constant self-awareness and critical reflection on the researcher’s biases, assumptions, and subjectivity.[9] By acknowledging their influence on the research process and results, researchers enhance the validity and reliability of their findings. Cultural sensitivity involves respecting and understanding the studied community’s cultural norms, values, and beliefs, ensuring ethical research practices.[10] By adhering to these key principles, ethnographic research provides a comprehensive and nuanced understanding of different cultures and societies. It offers valuable insights into the complexities of human behavior and social dynamics, enabling researchers to create a holistic cultural portrait that incorporates the perspectives of both participants and researchers.
While ethnography has strengths in providing in-depth insights into cultural phenomena, it also presents challenges. The method requires a solid grounding in cultural anthropology and demands extensive time commitment, making it less suitable for projects with strict deadlines. Researchers must remain vigilant about becoming too immersed in the group or being influenced by ethnocentrism, ensuring they maintain objectivity and rigor in their observations.
2.1. The Applicability of Ethnographic Research in Healthcare and Drug Development
Ethnographic research holds great applicability in healthcare and drug development because it provides a unique perspective that complements traditional quantitative approaches.[11] This type of research allows for an in-depth understanding of the social, cultural, and contextual factors that influence health behaviors, treatment adherence, and the effectiveness of healthcare interventions. By immersing researchers in the everyday lives of individuals and communities, ethnography uncovers rich insights into the complexities of healthcare experiences.
One key advantage of ethnographic research in healthcare is its ability to capture patients’ subjective experiences and perspectives.[12] Unlike traditional quantitative methods that often focus on objective measures and outcomes, ethnography delves into the lived experiences, emotions, and meanings associated with health and illness. This understanding can inform the development of patient-centered care approaches and interventions that better meet the needs and preferences of individuals.[13]
Ethnographic research also sheds light on the social and cultural determinants of health. It examines how cultural beliefs, social networks, community dynamics, and socioeconomic factors influence health-related behaviors and decision-making processes.[14] By uncovering these influences, ethnography provides insights that can inform the design and implementation of culturally appropriate healthcare interventions. It helps identify barriers and facilitators to healthcare access, treatment adherence, and health promotion strategies.
Moreover, ethnographic research is highly relevant in the field of drug development. It contributes to understanding the broader social and cultural contexts in which drugs are used.[15] By studying how individuals perceive and interpret medications, their beliefs and expectations about effectiveness, and the social dynamics surrounding medication use, ethnography helps develop drugs that are not only effective but also acceptable and accessible to the target populations.
Additionally, ethnographic research promotes patient engagement and empowerment by involving patients as active participants in the research process. This participatory approach recognizes patients’ expertise and gives them a voice in shaping healthcare practices and policies. It fosters a sense of ownership and trust, leading to better collaboration between healthcare providers, researchers, and patients.[16]
Despite its advantages, integrating ethnographic research into healthcare and drug development presents challenges. Ethnographic evidence often does not align with the dominant paradigms of evidence-based medicine and may be perceived as less rigorous due to its qualitative nature. However, there is a growing recognition of the limitations of solely relying on quantitative data and an appreciation for the complementary role of ethnography in providing a more comprehensive understanding of health issues.
Ethnographic research brings valuable insights into healthcare and drug development by uncovering subjective experiences, social determinants, and cultural contexts that shape health behaviors and outcomes. Complementing quantitative approaches enhances our understanding of healthcare practices and patient perspectives, leading to more patient-centered and culturally appropriate interventions. Integrating ethnographic research into healthcare and drug development promotes patient engagement, empowerment, and the pursuit of equitable and effective healthcare for diverse populations.
3. Cultural Norms and Their Influence on Diagnosis and Treatment
The significance of cultural norms in healthcare decision-making is multifaceted. Cultural norms play a pivotal role in shaping individuals’ access to healthcare services, either facilitating or hindering their ability to seek and utilize care. For instance, in low- and middle-income countries, cultural norms and beliefs can significantly influence women’s willingness to access cervical cancer prevention services, perpetuating barriers in diagnosis and treatment.[17] These norms intersect with individual factors such as age, marital status, socioeconomic status, and religious beliefs, emphasizing the interplay between individual and cultural influences on healthcare access.[18]
Incorporating cultural norms into healthcare decision-making is crucial for delivering patient-centered care that aligns with patients’ values and expectations.[19] By recognizing and respecting cultural norms, healthcare professionals can provide culturally sensitive care, improving patient satisfaction, engagement, and adherence to treatment plans. Furthermore, cultural norms profoundly impact health outcomes, including adherence to treatment and engagement in preventive services. Awareness of cultural stigmas and barriers can help healthcare systems design comprehensive programs that address these issues, enhance awareness and knowledge, overcome stigma, and promote the utilization of preventive services.
Effective communication in healthcare relies on understanding and addressing cultural norms. Cultural norms shape individuals’ perceptions, attitudes, and behaviors toward healthcare services.[20] Healthcare professionals must know these nuances to establish effective patient communication and trust. By accommodating cultural norms, healthcare professionals can navigate potential communication barriers, promote shared decision-making, and deliver patient-centered care. Moreover, recognizing and addressing cultural norms contribute to developing cultural competency among healthcare professionals, fostering trust and rapport with patients, and facilitating effective cross-cultural interactions.[21]
Considering cultural norms also helps identify and mitigate healthcare disparities, working towards health equity.[22] Different cultural groups may face unique challenges and barriers to healthcare access. By recognizing and addressing these disparities, healthcare systems can strive for equitable healthcare delivery. Culturally appropriate interventions, designed with community involvement, can empower marginalized populations, foster a sense of ownership, and improve healthcare access and outcomes.
The significance of cultural norms in healthcare decision-making is vital. Cultural norms influence access to healthcare, patient-centered care, health outcomes, and effective communication. By integrating cultural norms into decision-making processes, healthcare systems can improve healthcare quality, enhance patient satisfaction, foster cultural competency among healthcare professionals, and work towards achieving health equity for individuals of diverse cultural backgrounds. Moreover, understanding how cultural norms shape perceptions of health and disease is vital for biomedical researchers to develop effective, culturally sensitive, and equitable interventions. It allows researchers to design interventions and communicate with patients in a way that respects their cultural backgrounds, improves health outcomes, and addresses health disparities among diverse populations.
3.1. How Cultural Norms Shape Perceptions of Health and Disease
Cultural norms play a significant role in shaping perceptions of health and disease within a community or society. These norms are a set of shared beliefs, values, behaviors, and practices passed down from generation to generation, influencing how individuals understand and interpret health-related concepts.[23] Understanding how cultural norms shape perceptions of health and disease is crucial for healthcare providers and public health practitioners as it enables them to design culturally sensitive interventions, tailor health education materials, and ensure that healthcare services align with their communities’ cultural values, beliefs, and practices.
One way in which cultural norms shape perceptions of health and disease is through the definition of health itself.[24] Different cultures may have varied definitions of what it means to be healthy. Some cultures prioritize harmony and balance within the body and environment as indicators of good health, while others may focus on the absence of specific symptoms or diseases.[25] These cultural norms influence individuals’ perceptions of what constitutes a healthy state and guide their health decision-making. Moreover, cultural norms provide frameworks for explaining the causes and origins of illness and disease. These explanations can be rooted in spiritual, supernatural, or naturalistic beliefs.[26] Cultural norms attribute disease to factors such as spiritual imbalance, environmental factors, personal behaviors, or punishment from a higher power. These explanations shape how individuals understand the reasons behind illness and influence their perceptions of illness causation. Cultural norms also impact individuals’ choices regarding seeking healthcare and adhering to treatments, as the perceived causes of illness influence the appropriate responses and interventions according to cultural beliefs.
Cultural norms also influence the types of treatments and healing practices that are considered effective and acceptable within a particular culture. Traditional healing methods, such as herbal remedies, spiritual rituals, or alternative therapies, may be valued and preferred over Western medical interventions in some cultural contexts. Cultural norms guide individuals in their decisions about seeking healthcare, determining which providers to consult and choosing between traditional and biomedical approaches. These norms shape individuals’ perceptions of effective and appropriate management of their health conditions.
Cultural norms also influence stigma and taboos surrounding certain health conditions. Stigma arises from cultural beliefs and attitudes surrounding specific illnesses or conditions, leading to discrimination, social exclusion, and negative stereotypes.[27] Cultural norms may stigmatize mental health issues, sexually transmitted infections, or diseases associated with certain lifestyles or behaviors, which can significantly impact individuals’ perceptions of their own health and their willingness to seek help, disclose their condition, or adhere to treatment regimens. Cultural norms play a pivotal role in shaping societal attitudes toward health conditions and can either perpetuate or challenge the stigmatization and discrimination associated with certain diseases.
Furthermore, cultural norms dictate help-seeking behaviors by shaping individuals’ perceptions of when, where, and from whom to seek healthcare.[28] Cultural norms determine who is considered a legitimate healthcare provider, which can include traditional healers, religious leaders, community elders, or biomedical professionals. These norms also determine acceptable ways of discussing and addressing health concerns within the community. They may influence individuals’ comfort levels in seeking help and expressing their health-related needs. Cultural norms can act as barriers or facilitators to accessing appropriate healthcare services, depending on the level of alignment between individuals’ health-seeking behaviors and the prevailing cultural norms.
Cultural norms have a profound impact on perceptions of health and disease. They shape individuals’ definitions of health, explanations of illness, treatment preferences, and help-seeking behaviors. Understanding and recognizing how cultural norms shape these perceptions is crucial for healthcare providers and public health practitioners to deliver effective and culturally sensitive care. By aligning healthcare services with cultural values, beliefs, and practices, healthcare providers can enhance trust, improve health outcomes, and ensure that healthcare interventions resonate with their communities.
3.2. Cultural Factors Affecting Help-Seeking Behaviors, Diagnosis Delay, and Treatment Adherence
Cultural factors significantly impact help-seeking behaviors, diagnosis delay, treatment adherence, and even drug development within a society or community. These factors encompass a wide range of beliefs, values, practices, and norms that shape individuals’ perceptions and behaviors related to healthcare. Understanding their influence is crucial not only for providing effective healthcare but also for drug development processes to address cultural barriers and promote equitable access to healthcare innovations.
Help-seeking behaviors are deeply influenced by cultural norms. Some cultures associate seeking healthcare with weakness or loss of autonomy, resulting in delayed help-seeking until conditions worsen. The stigma associated with certain health conditions can also affect help-seeking behaviors. For example, tuberculosis (TB) and HIV/AIDS are stigmatized diseases, often accompanied by social judgment and discrimination. Cultural norms and misconceptions may contribute to delayed diagnosis and treatment as individuals fear being labeled as carriers of TB or facing blame and shame in the case of HIV/AIDS.[29] Healthcare providers need to consider and address these cultural barriers to promote timely help-seeking behaviors, which can also facilitate early intervention and improve the efficacy of potential treatments.
Diagnosis delay, the time between symptom onset and receiving a formal diagnosis, can be influenced by cultural factors. Beliefs and practices related to health and illness shape individuals’ interpretations of symptoms, leading to delays in seeking medical attention or misattributing symptoms. The stigma associated with certain health conditions can further contribute to diagnosis delay. For instance, individuals with genetic diseases may face societal stigmatization and discrimination, discouraging them from pursuing genetic testing and diagnosis.[30] This delay in identifying and managing genetic conditions impacts individual health and hinders the effectiveness of targeted therapies and interventions. To promote early diagnosis and facilitate drug development, healthcare systems should emphasize cultural competence, raise awareness, and provide education to overcome cultural barriers.
Treatment adherence, following prescribed regimens, is also influenced by cultural factors. Cultural beliefs and practices surrounding health, illness, and treatment can impact individuals’ trust in Western medicine, leading them to rely on alternative therapies or traditional healing practices. Stigma associated with specific diseases further affects treatment adherence. Individuals with conditions such as HIV/AIDS may face stigma and discrimination, leading to social isolation and challenges in adhering to treatment protocols. Similarly, individuals with genetic diseases may experience internalized stigma, affecting their acceptance of treatment and engagement in care. Understanding these cultural factors is crucial for drug development as it helps researchers tailor interventions and develop therapies that consider cultural beliefs, practices, and values, ultimately improving treatment adherence and health outcomes.
In the context of drug development, understanding cultural factors is vital for several reasons. Firstly, it allows researchers to identify cultural barriers that may hinder the effective distribution and utilization of new drugs. For example, if cultural norms and beliefs discourage individuals from seeking healthcare or adhering to treatment regimens, the successful implementation of new therapies may be compromised. By understanding these cultural factors, drug developers can design strategies to address barriers and ensure the accessibility and acceptance of new medications within diverse cultural contexts.
Secondly, considering cultural factors can guide researchers in developing culturally sensitive drugs and treatment approaches. Different cultures may have unique preferences, practices, and beliefs regarding healthcare and medication. By incorporating cultural perspectives and involving diverse communities in drug development, researchers can create treatments that align with cultural values, enhance patient acceptance, and promote treatment adherence.
Lastly, understanding cultural factors in drug development helps mitigate healthcare access and outcomes disparities. Different cultural groups may face distinct challenges and barriers to healthcare, including accessing and benefiting from new drugs. By recognizing and addressing these disparities, drug developers can strive for equitable healthcare delivery and contribute to reducing healthcare inequalities across diverse populations.
Cultural factors significantly influence help-seeking behaviors, diagnosis delay, treatment adherence, and drug development. Understanding and addressing these factors are vital for healthcare providers, policymakers, and researchers to deliver culturally responsive care, promote early intervention, and develop effective medications. By acknowledging and accommodating cultural diversity, healthcare systems, and drug developers can ensure equitable access to healthcare innovations, improve health outcomes, and contribute to reducing healthcare disparities across cultural contexts.
4. Role of Ethnographic Research in Biopharmaceutical Development
Ethnographic research can play a crucial role in biopharmaceutical development by providing valuable insights into the cultural contexts of patients and facilitating the incorporation of patient perspectives in drug development. In recent years, regulatory authorities have seen the importance of incorporating the patient perspective in drug development; however, ethnographic research has not been widely implemented or emphasized as a standard practice.[31] Despite this recognition of the patient perspective, there is still a gap in understanding patients’ cultural contexts and experiences that can significantly influence treatment outcomes and adherence. Incorporating ethnographic research in biopharmaceutical development can bridge this gap and provide valuable insights that complement existing patient-centered approaches.[32]
The importance of incorporating patient perspectives in drug development cannot be overstated. Patients are the end-users of pharmaceutical products, and their experiences, needs, and preferences should inform the development of new drugs. Historically, drug development has been primarily focused on clinical efficacy and safety, often overlooking the subjective experiences of patients. However, patient perspectives are crucial for understanding the real-world impact of diseases, the burden of symptoms, treatment expectations, and quality of life considerations. By actively involving patients in the drug development process, pharmaceutical companies can develop products more aligned with patients’ needs and improve treatment outcomes.
Ethnographic research offers a valuable methodology for gaining insights into patients’ cultural contexts, beliefs, and practices.[33] This research approach involves immersing researchers in patients’ natural settings and social environments, allowing for a deep understanding of their daily lives, experiences, and cultural norms. Ethnographic researchers observe and interact with patients, their families, and healthcare providers, capturing rich qualitative data beyond clinical parameters. By understanding patients’ cultural contexts, including their values, beliefs, socioeconomic factors, and social support networks, researchers can identify barriers and facilitators to treatment adherence, cultural variations in symptom perception, and preferences for healthcare delivery. Such insights are crucial for developing patient-centered interventions and tailoring treatment approaches to specific cultural groups.
Ethnographic research enhances the understanding of patient preferences, beliefs, and treatment experiences in several ways. Firstly, it helps uncover the intricate relationship between cultural beliefs and health behaviors. Cultural beliefs and values significantly shape individuals’ attitudes toward healthcare, including their expectations of treatment outcomes, trust in healthcare providers and decision-making processes.[34] Ethnographic research allows researchers to identify and understand these cultural factors, enabling the development of interventions that align with patients’ beliefs and preferences.
Secondly, ethnographic research sheds light on the social dynamics and support systems influencing patients’ treatment experiences.[35] It reveals the role of family, community, and traditional healers in healthcare decision-making and treatment adherence. This understanding can inform strategies to leverage existing support systems and foster culturally appropriate interventions.
Lastly, ethnographic research provides insights into the lived experiences of patients, going beyond clinical data to capture the emotional, social, and practical challenges they face.[36] This knowledge helps pharmaceutical companies and healthcare providers develop interventions that address the holistic needs of patients and improve treatment outcomes.
Ethnographic research is invaluable in biopharmaceutical development as it facilitates the incorporation of patient perspectives, provides insights into patients’ cultural contexts, and enhances understanding of patient preferences, beliefs, and treatment experiences.[37] By actively involving patients and understanding their cultural contexts, pharmaceutical companies can develop drugs that better meet patients’ needs, improve treatment outcomes, and enhance patient satisfaction. Ethnographic research enables a comprehensive understanding of patients’ experiences, including their cultural beliefs, social support networks, and treatment journeys, ultimately leading to the development of patient-centered interventions that address the unique needs of diverse patient populations. By embracing ethnographic research, biopharmaceutical development can become more inclusive, patient-centric, and effective in improving health outcomes.
Additionally, ethnographic research can play a significant role in the design of clinical trials.[38] Clinical trials are essential for evaluating the safety and efficacy of new drugs, but they often face challenges related to patient recruitment, retention, and adherence to the study protocol. Ethnographic research can help address these challenges and improve the design and implementation of clinical trials.
By conducting ethnographic research, researchers can deeply understand the target population’s cultural beliefs, attitudes, and practices related to healthcare and clinical research. This knowledge can inform the development of recruitment strategies that are culturally sensitive and tailored to the specific population. Furthermore, ethnographic research can identify potential barriers to participation in clinical trials, such as cultural stigmas, language barriers, or distrust of the healthcare system.[39] By understanding the cultural contexts and practices surrounding clinical research, researchers can design recruitment strategies that are culturally sensitive and respectful.
In addition to improving recruitment, ethnographic research can enhance patient retention and adherence in clinical trials. By understanding the target population’s cultural contexts and social dynamics, researchers can identify factors that may influence patients’ willingness to continue or adhere to the study protocol.[40] By incorporating this knowledge into the trial design, researchers can develop interventions or support systems that address these factors and improve patient retention and adherence.
Moreover, ethnographic research can provide insights into the preferences and perspectives of patients regarding clinical trial design and procedures. By actively involving patients in the research process, researchers can gain valuable input on study duration, visit frequency, data collection methods, and outcome measures. This patient-centered approach ensures that clinical trials are designed to meet the needs and preferences of the target population, ultimately leading to more meaningful and relevant outcomes.
Ethnographic research also has the potential to improve the interpretation and generalizability of clinical trial results. By understanding the cultural contexts and practices of the study population, researchers can better interpret the findings and contextualize the results within the broader socio-cultural framework. This helps avoid misinterpretation or oversimplification of the data and allows for a more nuanced understanding of the impact and effectiveness of the intervention being tested.
Overall, ethnographic research plays a crucial role in biopharmaceutical development by providing insights into the cultural contexts of patients and facilitating the incorporation of patient perspectives in drug development. It helps pharmaceutical companies understand patients’ needs, preferences, and experiences, leading to the development of more patient-centered interventions and improved treatment outcomes. Furthermore, ethnographic research can enhance the design and implementation of clinical trials, improving patient recruitment, retention, and adherence and ensuring that trial results are meaningful and relevant. By embracing ethnographic research, biopharmaceutical development can become more inclusive, culturally sensitive, and effective in improving health outcomes for diverse patient populations.
5. Implications for Global Health
Incorporating ethnographic research into biopharmaceutical development can significantly contribute to global health efforts. By gaining a deeper understanding of patients’ cultural contexts, beliefs, and practices, researchers can develop medications and interventions that are more responsive to the diverse needs of populations worldwide. This approach promotes health equity by addressing the unique challenges faced by different communities and reducing health disparities globally.
Ethnographic research provides valuable insights into the social, cultural, and environmental factors that influence health-seeking behaviors, treatment decisions, and medication adherence. By immersing researchers in the communities they study, ethnographic research allows for a comprehensive understanding of the cultural norms, values, and practices that shape individuals’ perceptions and experiences of health and disease. This understanding is crucial for developing medications that are not only clinically effective but also culturally sensitive and appropriate.
One key contribution of ethnographic research is its ability to uncover barriers to healthcare access and utilization. Researchers can identify structural obstacles that prevent individuals from accessing essential medications and healthcare services by exploring the social determinants of health, such as socioeconomic status, education, and cultural beliefs.[41] This knowledge helps inform the development of interventions that address these barriers and promote equitable access to healthcare, particularly in underserved populations.
Moreover, incorporating ethnographic research in biopharmaceutical development facilitates the development of patient-centered medications. By understanding patients’ perspectives, preferences, and treatment experiences, researchers can design medications that align with patients’ needs and expectations. This patient-centric approach improves treatment outcomes and enhances patient satisfaction. For example, through ethnographic research, pharmaceutical companies can uncover patient preferences for dosage forms, administration routes, or cultural considerations in medication design, leading to more effective and culturally appropriate treatments.
Ethnographic research also plays a role in challenging cultural misconceptions and reducing stigma. By identifying cultural beliefs surrounding health and disease, researchers can design educational initiatives that promote accurate information and dispel myths. This can increase awareness, improve health-seeking behaviors, and enhance medication adherence. In global health efforts, addressing cultural beliefs and stigma is particularly relevant in areas where misconceptions hinder the adoption of preventive measures or treatment-seeking behavior.
Incorporating ethnographic research into biopharmaceutical development strengthens community engagement and partnerships. By involving local communities in the research process, researchers can foster trust, build relationships, and develop acceptable and relevant interventions to the community’s cultural context. This participatory approach ensures that interventions are implemented respecting cultural practices and values, leading to increased acceptance and sustainability. Collaborating with community leaders, healthcare providers, and traditional healers can enhance the effectiveness and reach of interventions in diverse cultural settings.
Furthermore, incorporating ethnographic research into biopharmaceutical development contributes to global health efforts by promoting health equity, addressing cultural barriers, and developing patient-centered interventions. By understanding the unique needs and challenges of diverse populations, researchers can develop medications and interventions that are more effective, culturally sensitive, and equitable. This approach enhances access to healthcare, improves treatment outcomes, and fosters a more inclusive and equitable global health landscape. By embracing ethnographic research, biopharmaceutical development can contribute significantly to improving the health and well-being of populations worldwide.
6. Conclusion
Ethnographic research holds immense importance in various domains, such as clinical research, drug development, and global health initiatives. By recognizing and embracing the potential of ethnographic research, we can actively reduce health disparities and promote health equity. One fundamental aspect where ethnographic research proves invaluable is understanding cultural contexts surrounding healthcare practices and experiences. Cultural factors significantly influence health beliefs, behaviors, and patterns of seeking healthcare. By acknowledging and incorporating this understanding, clinical researchers and drug developers can design interventions and medications sensitive to different cultures, respectful, and aligned with diverse populations’ unique needs and preferences. This approach effectively addresses cultural barriers to care, fosters patient trust, and cultivates meaningful patient-provider relationships, ultimately reducing disparities.
Ethnographic research also enables the tailoring of interventions to specific populations and contexts. By gaining insights into the distinct challenges marginalized communities face, researchers can develop targeted strategies that address the underlying social determinants of health. This approach moves beyond a one-size-fits-all mentality and promotes contextually appropriate, effective, and sustainable interventions. By recognizing and addressing the specific needs of different populations, ethnographic research plays a pivotal role in reducing health disparities and advancing health equity.
Moreover, embracing ethnographic research empowers marginalized communities by involving them in the research process and amplifying their voices. Active engagement with communities allows researchers and drug developers to build trust, strengthen partnerships, and ensure that interventions are developed in collaboration with the intended beneficiaries. This participatory approach not only promotes community ownership and cultural appropriateness but also fosters the sustainability of interventions. It acknowledges that communities possess valuable insights into their own experiences and can contribute meaningfully to research and decision-making processes.
Ethnographic research also serves as a powerful tool in identifying and addressing barriers to healthcare access. Through this research, barriers such as financial constraints, transportation issues, and cultural or language barriers can be uncovered. This knowledge then informs the design of interventions to overcome these barriers and improve access to healthcare services. Given that marginalized populations often face multiple barriers to care, addressing these systemic issues is essential in reducing disparities in healthcare access and advancing health equity.
Furthermore, ethnographic research provides invaluable insights into how patients perceive, understand, and engage with healthcare information and communication.[42] This understanding enables the development of effective communication strategies that consider cultural nuances, health literacy levels, and preferred communication channels. By improving health communication, ethnographic research contributes to better patient understanding, engagement, and adherence to treatment plans, leading to improved health outcomes and reduced disparities.
Accepting the role of ethnographic research in clinical research, drug development, and global health initiatives is crucial for reducing health disparities and promoting health equity. By understanding cultural contexts, tailoring interventions, empowering marginalized communities, addressing barriers to access, and enhancing health communication, ethnographic research ensures that healthcare interventions are inclusive, effective, and equitable. By embracing the potential of ethnographic research, significant strides in reducing health disparities can be made and working towards a more equitable and just healthcare system.
Conflict of Interest
The authors declare no conflict of interest.
Acknowledgment
I acknowledge all the support from Euclid University and my supervising professor, Prof. Laurent Cleenewerck.
References
Aragon, Pepe. “Culture, Beliefs, Attitudes, and Stigmatized Illnesses” (n.d.). Accessed May 25, 2023. https://library.achievingthedream.org/herkimerhealth/chapter/culture-beliefs-attitudes-and-stigmatized-illnesses/.
Arnault, Denise Saint. “Cultural Determinants of Help Seeking: A Model for Research and Practice.” Research and theory for nursing practice 23, no. 4 (2009): 259–278. Accessed May 25, 2023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2796597/.
Awaisu, Ahmed, Banan Mukhalalati, and Mohamed Izham Mohamed Ibrahim. “Research Designs and Methodologies Related to Pharmacy Practice.” Encyclopedia of Pharmacy Practice and Clinical Pharmacy (2019): 7–21. Accessed May 25, 2023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7149347/.
Biehl, Joao, and Adriana Petryna, eds. When People Come First: Critical Studies in Global Health. Princeton, New Jersey: Princeton University Press, 2013.
Bieler, Patrick, Milena D. Bister, Janine Hauer, Martina Klausner, Jörg Niewöhner, Christine Schmid, and Sebastian von Peter. “Distributing Reflexivity through Co-Laborative Ethnography.” Journal of Contemporary Ethnography 50, no. 1 (February 1, 2021): 77–98. Accessed May 25, 2023. https://doi.org/10.1177/0891241620968271.
Bittker, Bobbi M. “The Ethical Implications of Clinical Trials in Low- and Middle-Income Countries.” Human Rights Magazine, June 14, 2021. Accessed May 24, 2023. https://www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/the-truth-about-science/the-ethical-implications-of-clinical-trials/.
Black, Georgia B., Sandra van Os, Samantha Machen, and Naomi J. Fulop. “Ethnographic Research as an Evolving Method for Supporting Healthcare Improvement Skills: A Scoping Review.” BMC Medical Research Methodology 21, no. 1 (December 5, 2021): 274. Accessed May 24, 2023. https://doi.org/10.1186/s12874-021-01466-9.
Bloomberg, Linda Dale, and Marie Volpe. Completing Your Qualitative Dissertation: A Roadmap from Beginning to End. 4th ed. Thousand Oaks, California: SAGE Publications, Inc., 2019.
Campbell, Iain H, and Igor Rudan. “Effective Approaches to Public Engagement with Global Health Topics.” Journal of Global Health 10, no. 1 (n.d.): 01040901. Accessed May 24, 2023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7101214/.
Chidyaonga-Maseko, Fresier, Maureen Leah Chirwa, and Adamson Sinjani Muula. “Underutilization of Cervical Cancer Prevention Services in Low and Middle Income Countries: A Review of Contributing Factors.” The Pan African Medical Journal 21 (2015): 231. https://pubmed.ncbi.nlm.nih.gov/26523173/.
Emmerich, Anne, Anthony Fatalo, and Bijay Acharya. “Pharmacology: Cultural and Genetic Considerations.” In Stigma and Prejudice: Touchstones in Understanding Diversity in Healthcare, edited by Ranna Parekh and Ed W. Childs, 353–374. Current Clinical Psychiatry. Cham: Springer International Publishing, 2016. Accessed May 24, 2023. https://doi.org/10.1007/978-3-319-27580-2_20.
Farmer, Paul, Arthur Kleinman, Jim Kim, and Matthew Basilico, eds. Reimagining Global Health: An Introduction, 2013.
Faure, Marlyn C., Nchangwi S. Munung, Ntobeko A. B. Ntusi, Bridget Pratt, and Jantina de Vries. “Considering Equity in Global Health Collaborations: A Qualitative Study on Experiences of Equity.” PLOS ONE 16, no. 10 (October 7, 2021): e0258286. Accessed May 24, 2023. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0258286.
Fischer, Leah S., Gordon Mansergh, Jonathan Lynch, and Scott Santibanez. “Addressing Disease-Related Stigma During Infectious Disease Outbreaks.” Disaster medicine and public health preparedness 13, no. 5–6 (December 2019): 989–994. Accessed May 24, 2023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6889068/.
Ganguly, Biraj. “Unlocking the Potential of Ethnography in Healthcare and Pharmaceutical Research.” Phronesis Partners, n.d. Accessed May 25, 2023. https://phronesis-partners.com/insights/unlocking-the-potential-of-ethnography-in-healthcare-and-pharmaceutical-research/.
van der Geest, Sjaak, and Anita Hardon. “Social and Cultural Efficacies of Medicines: Complications for Antiretroviral Therapy.” Journal of Ethnobiology and Ethnomedicine 2, no. 1 (November 7, 2006): 48. Accessed May 27, 2023. https://doi.org/10.1186/1746-4269-2-48.
Giacomini, Mita K. “The Rocky Road: Qualitative Research as Evidence.” BMJ Evidence-Based Medicine 6, no. 1 (January 1, 2001): 4–6. Accessed May 24, 2023. https://ebm.bmj.com/content/6/1/4.
Hansen, Marianne Botoft, Lotte Stig Nørgaard, and Christine Erikstrup Hallgreen. “How and Why to Involve Patients in Drug Development: Perspectives From the Pharmaceutical Industry, Regulatory Authorities, and Patient Organizations.” Therapeutic Innovation & Regulatory Science 54, no. 3 (May 1, 2020): 577–585. Accessed May 28, 2023. https://doi.org/10.1007/s43441-019-00090-6.
Hoogdalem, Ewoud-Jan van, John P. Jones Iii, John Constant, and Meguru Achira. “Science-Based Ethnic Bridging in Drug Development; Review of Recent Precedence and Suggested Steps Forward.” Current Clinical Pharmacology 14, no. 3 (n.d.): 197–207. Accessed May 24, 2023. https://www.eurekaselect.com/article/97896.
Jones, Janice, and Joanna Smith. “Ethnography: Challenges and Opportunities.” Evidence-Based Nursing 20, no. 4 (October 1, 2017): 98–100. Accessed May 24, 2023. https://ebn.bmj.com/content/20/4/98.
Lavizzo-Mourey, Risa J., Richard E. Besser, and David R. Williams. “Understanding and Mitigating Health Inequities — Past, Current, and Future Directions.” New England Journal of Medicine 384, no. 18 (May 6, 2021): 1681–1684. Accessed May 25, 2023. https://doi.org/10.1056/NEJMp2008628.
Li, Shuangyu, Katherine Miles, Riya E. George, Candan Ertubey, Peter Pype, and Jia Liu. “A Critical Review of Cultural Competence Frameworks and Models in Medical and Health Professional Education: A Meta-Ethnographic Synthesis: BEME Guide No. 79.” Medical Teacher 0, no. 0 (February 8, 2023): 1–23. Accessed May 25, 2023. https://doi.org/10.1080/0142159X.2023.2174419.
Lindskog, Hayden, Maria Strom, and Christian Zerbi. “Using Ethnography to Translate Behavior to Value in Medical Devices.” McKinsey & Company. Last modified January 4, 2021. Accessed May 28, 2023. https://www.mckinsey.com/industries/life-sciences/our-insights/using-ethnography-to-translate-behavior-to-value-in-medical-devices.
Lock, Margaret, M Austin Argentieri, and Alexandra E Shields. “The Contribution of Ethnography to Epigenomics Research: Toward a New Bio-Ethnography for Addressing Health Disparities.” Epigenomics 13, no. 21 (November 2021): 1771–1786. Accessed May 28, 2023. https://www.futuremedicine.com/doi/full/10.2217/epi-2020-0009.
Lynch, Elizabeth, and Douglas Medin. “Explanatory Models of Illness: A Study of within-Culture Variation ଝ” (2006).
Memon, Rakhshi, Muqaddas Asif, Ameer B. Khoso, Sehrish Tofique, Tayyaba Kiran, Nasim Chaudhry, Nusrat Husain, et al. “Recognising Values and Engaging Communities across Cultures: Towards Developing a Cultural Protocol for Researchers.” BMC Medical Ethics 22, no. 1 (April 26, 2021): 47. Accessed May 24, 2023. https://doi.org/10.1186/s12910-021-00608-4.
Molyneux, Sassy, and P. Wenzel Geissler. “Ethics and the Ethnography of Medical Research in Africa.” Social Science & Medicine 67, no. 5. Part Special Issue: Ethics and the ethnography of medical research in Africa (September 1, 2008): 685–695. Accessed May 24, 2023. https://www.sciencedirect.com/science/article/pii/S0277953608001172.
Morgan-Trimmer, Sarah, and Fiona Wood. “Ethnographic Methods for Process Evaluations of Complex Health Behaviour Interventions.” Trials 17, no. 1 (May 4, 2016): 232. Accessed May 25, 2023. https://doi.org/10.1186/s13063-016-1340-2.
Mukerji, Reshmi, and Janet M. Turan. “Exploring Manifestations of TB-Related Stigma Experienced by Women in Kolkata, India.” Annals of Global Health 84, no. 4 (November 5, 2018): 727–735.
Nunn, Rebecca. “‘It’s Not All in My Head!’ – The Complex Relationship between Rare Diseases and Mental Health Problems.” Orphanet Journal of Rare Diseases 12, no. 1 (February 27, 2017): 29. Accessed May 24, 2023. https://doi.org/10.1186/s13023-017-0591-7.
Nyblade, Laura, Melissa A. Stockton, Kayla Giger, Virginia Bond, Maria L. Ekstrand, Roger Mc Lean, Ellen M. H. Mitchell, et al. “Stigma in Health Facilities: Why It Matters and How We Can Change It.” BMC Medicine 17, no. 1 (February 15, 2019): 25. Accessed May 24, 2023. https://doi.org/10.1186/s12916-019-1256-2.
O’Connell, Mary Beth, Eli J. Korner, Nathaniel M. Rickles, Jeri J. Sias, and American College of Clinical Pharmacy. “Cultural Competence in Health Care and Its Implications for Pharmacy.” Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy 27, no. 7 (2007): 1062–1079. Accessed May 24, 2023. https://onlinelibrary.wiley.com/doi/abs/10.1592/phco.27.7.1062.
O’Toole, Jennifer K., Wilma Alvarado-Little, and Christy J. W. Ledford. “Communication with Diverse Patients: Addressing Culture and Language.” Pediatric Clinics of North America 66, no. 4. Hospital Medicine and Clinical Education (August 1, 2019): 791–804. Accessed May 27, 2023. https://www.sciencedirect.com/science/article/pii/S0031395519300331.
Research, Center for Drug Evaluation and. “FDA Patient-Focused Drug Development Guidance Series for Enhancing the Incorporation of the Patient’s Voice in Medical Product Development and Regulatory Decision Making.” FDA (April 6, 2023). Accessed May 24, 2023. https://www.fda.gov/drugs/development-approval-process-drugs/fda-patient-focused-drug-development-guidance-series-enhancing-incorporation-patients-voice-medical.
Sangasubana, Nisaratana. “How to Conduct Ethnographic Research.” The Qualitative Report 16, no. 2 (March 2011): 567–573. https://files.eric.ed.gov/fulltext/EJ926307.pdf.
Shapiro, Ari. “Irrational Choices, Unfathomable Outcomes: Patient Ethnographies In Pharmaceutical Research.” Ethnographic Praxis in Industry Conference Proceedings 2005, no. 1 (2005): 173–178. Accessed May 24, 2023. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1559-8918.2005.tb00019.x.
Smith-Morris, Carolyn, Gilberto Lopez, Lisa Ottomanelli, Lance Goetz, and Kimberly Dixon-Lawson. “Ethnography, Fidelity, and the Evidence That Anthropology Adds: Supplementing the Fidelity Process in a Clinical Trial of Supported Employment.” Medical Anthropology Quarterly 28, no. 2 (2014): 141–161. Accessed May 24, 2023. https://onlinelibrary.wiley.com/doi/abs/10.1111/maq.12093.
Stangl, Anne L., Valerie A. Earnshaw, Carmen H. Logie, Wim van Brakel, Leickness C. Simbayi, Iman Barré, and John F. Dovidio. “The Health Stigma and Discrimination Framework: A Global, Crosscutting Framework to Inform Research, Intervention Development, and Policy on Health-Related Stigmas.” BMC Medicine 17, no. 1 (February 15, 2019): 31. Accessed May 24, 2023. https://doi.org/10.1186/s12916-019-1271-3.
Stellmach, Darryl, Isabel Beshar, Juliet Bedford, Philipp du Cros, and Beverley Stringer. “Anthropology in Public Health Emergencies: What Is Anthropology Good For?” BMJ Global Health 3, no. 2 (March 1, 2018): e000534. Accessed May 13, 2023. https://gh.bmj.com/content/3/2/e000534.
Zhong, Adrina, Benedict Darren, Bethina Loiseau, Li Qun Betty He, Trillium Chang, Jessica Hill, and Helen Dimaras. “Ethical, Social, and Cultural Issues Related to Clinical Genetic Testing and Counseling in Low- and Middle-Income Countries: A Systematic Review.” Genetics in Medicine 23, no. 12 (December 2021): 2270–2280. Accessed May 24, 2023. https://www.nature.com/articles/s41436-018-0090-9.
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[1] Center for Drug Evaluation and Research, ‘FDA Patient-Focused Drug Development Guidance Series for Enhancing the Incorporation of the Patient’s Voice in Medical Product Development and Regulatory Decision Making’, FDA, 6 April 2023, https://www.fda.gov/drugs/development-approval-process-drugs/fda-patient-focused-drug-development-guidance-series-enhancing-incorporation-patients-voice-medical.
[2] Laura Nyblade et al., ‘Stigma in Health Facilities: Why It Matters and How We Can Change It’, BMC Medicine 17, no. 1 (15 February 2019): 25, https://doi.org/10.1186/s12916-019-1256-2.
[3] Denise Saint Arnault, ‘Cultural Determinants of Help Seeking: A Model for Research and Practice’, Research and Theory for Nursing Practice 23, no. 4 (2009): 259–78, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2796597/.
[4] Sjaak van der Geest and Anita Hardon, ‘Social and Cultural Efficacies of Medicines: Complications for Antiretroviral Therapy’, Journal of Ethnobiology and Ethnomedicine 2, no. 1 (7 November 2006): 48, https://doi.org/10.1186/1746-4269-2-48.
[5] Jennifer K. O’Toole, Wilma Alvarado-Little, and Christy J. W. Ledford, ‘Communication with Diverse Patients: Addressing Culture and Language’, Pediatric Clinics of North America, Hospital Medicine and Clinical Education, 66, no. 4 (1 August 2019): 791–804, https://doi.org/10.1016/j.pcl.2019.03.006.
[6] Linda Dale Bloomberg and Marie Volpe, Completing Your Qualitative Dissertation: A Roadmap from Beginning to End, 4th ed. (Thousand Oaks, California: SAGE Publications, Inc., 2019).
[7] Nisaratana Sangasubana, ‘How to Conduct Ethnographic Research’, The Qualitative Report 16, no. 2 (March 2011): 567–73, https://files.eric.ed.gov/fulltext/EJ926307.pdf.
[8] Janice Jones and Joanna Smith, ‘Ethnography: Challenges and Opportunities’, Evidence-Based Nursing 20, no. 4 (1 October 2017): 98–100, https://doi.org/10.1136/eb-2017-102786.
[9] Patrick Bieler et al., ‘Distributing Reflexivity through Co-Laborative Ethnography’, Journal of Contemporary Ethnography 50, no. 1 (1 February 2021): 77–98, https://doi.org/10.1177/0891241620968271.
[10] Shuangyu Li et al., ‘A Critical Review of Cultural Competence Frameworks and Models in Medical and Health Professional Education: A Meta-Ethnographic Synthesis: BEME Guide No. 79’, Medical Teacher 0, no. 0 (8 February 2023): 1–23, https://doi.org/10.1080/0142159X.2023.2174419.
[11] Sarah Morgan-Trimmer and Fiona Wood, ‘Ethnographic Methods for Process Evaluations of Complex Health Behaviour Interventions’, Trials 17, no. 1 (4 May 2016): 232, https://doi.org/10.1186/s13063-016-1340-2.
[12] Ari Shapiro, ‘Irrational Choices, Unfathomable Outcomes: Patient Ethnographies In Pharmaceutical Research’, Ethnographic Praxis in Industry Conference Proceedings 2005, no. 1 (2005): 173–78, https://doi.org/10.1111/j.1559-8918.2005.tb00019.x.
[13] Shapiro.
[14] Morgan-Trimmer and Wood, ‘Ethnographic Methods for Process Evaluations of Complex Health Behaviour Interventions’.
[15] Ahmed Awaisu, Banan Mukhalalati, and Mohamed Izham Mohamed Ibrahim, ‘Research Designs and Methodologies Related to Pharmacy Practice’, Encyclopedia of Pharmacy Practice and Clinical Pharmacy, 2019, 7–21, https://doi.org/10.1016/B978-0-12-812735-3.00602-6.
[16] Biraj Ganguly, ‘Unlocking the Potential of Ethnography in Healthcare and Pharmaceutical Research’, Phronesis Partners (blog), accessed 25 May 2023, https://phronesis-partners.com/insights/unlocking-the-potential-of-ethnography-in-healthcare-and-pharmaceutical-research/.
[17] Fresier Chidyaonga-Maseko, Maureen Leah Chirwa, and Adamson Sinjani Muula, ‘Underutilization of Cervical Cancer Prevention Services in Low and Middle Income Countries: A Review of Contributing Factors’, The Pan African Medical Journal 21 (2015): 231, https://doi.org/10.11604/pamj.2015.21.231.6350.
[18] Rakhshi Memon et al., ‘Recognising Values and Engaging Communities across Cultures: Towards Developing a Cultural Protocol for Researchers’, BMC Medical Ethics 22, no. 1 (26 April 2021): 47, https://doi.org/10.1186/s12910-021-00608-4.
[19] Mary Beth O’Connell et al., ‘Cultural Competence in Health Care and Its Implications for Pharmacy’, Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy 27, no. 7 (2007): 1062–79, https://doi.org/10.1592/phco.27.7.1062.
[20] Georgia B. Black et al., ‘Ethnographic Research as an Evolving Method for Supporting Healthcare Improvement Skills: A Scoping Review’, BMC Medical Research Methodology 21, no. 1 (5 December 2021): 274, https://doi.org/10.1186/s12874-021-01466-9.
[21] O’Connell et al., ‘Cultural Competence in Health Care and Its Implications for Pharmacy’.
[22] Risa J. Lavizzo-Mourey, Richard E. Besser, and David R. Williams, ‘Understanding and Mitigating Health Inequities — Past, Current, and Future Directions’, New England Journal of Medicine 384, no. 18 (6 May 2021): 1681–84, https://doi.org/10.1056/NEJMp2008628.
[23] Arnault, ‘Cultural Determinants of Help Seeking’.
[24] Pepe Aragon, ‘Culture, Beliefs, Attitudes, and Stigmatized Illnesses’, accessed 25 May 2023, https://library.achievingthedream.org/herkimerhealth/chapter/culture-beliefs-attitudes-and-stigmatized-illnesses/.
[25] Aragon.
[26] Elizabeth Lynch and Douglas Medin, ‘Explanatory Models of Illness: A Study of within-Culture Variation ଝ’, 2006.
[27] Leah S. Fischer et al., ‘Addressing Disease-Related Stigma During Infectious Disease Outbreaks’, Disaster Medicine and Public Health Preparedness 13, no. 5–6 (December 2019): 989–94, https://doi.org/10.1017/dmp.2018.157.
[28] Arnault, ‘Cultural Determinants of Help Seeking’.
[29] Reshmi Mukerji and Janet M. Turan, ‘Exploring Manifestations of TB-Related Stigma Experienced by Women in Kolkata, India’, Annals of Global Health 84, no. 4 (5 November 2018): 727–35, https://doi.org/10.9204/aogh.2383.
[30] Adrina Zhong et al., ‘Ethical, Social, and Cultural Issues Related to Clinical Genetic Testing and Counseling in Low- and Middle-Income Countries: A Systematic Review’, Genetics in Medicine 23, no. 12 (December 2021): 2270–80, https://doi.org/10.1038/s41436-018-0090-9.
[31] Marianne Botoft Hansen, Lotte Stig Nørgaard, and Christine Erikstrup Hallgreen, ‘How and Why to Involve Patients in Drug Development: Perspectives From the Pharmaceutical Industry, Regulatory Authorities, and Patient Organizations’, Therapeutic Innovation & Regulatory Science 54, no. 3 (1 May 2020): 577–85, https://doi.org/10.1007/s43441-019-00090-6.
[32] Margaret Lock, M Austin Argentieri, and Alexandra E Shields, ‘The Contribution of Ethnography to Epigenomics Research: Toward a New Bio-Ethnography for Addressing Health Disparities’, Epigenomics 13, no. 21 (November 2021): 1771–86, https://doi.org/10.2217/epi-2020-0009.
[33] Carolyn Smith-Morris et al., ‘Ethnography, Fidelity, and the Evidence That Anthropology Adds: Supplementing the Fidelity Process in a Clinical Trial of Supported Employment’, Medical Anthropology Quarterly 28, no. 2 (2014): 141–61, https://doi.org/10.1111/maq.12093.
[34] Morgan-Trimmer and Wood, ‘Ethnographic Methods for Process Evaluations of Complex Health Behaviour Interventions’.
[35] Black et al., ‘Ethnographic Research as an Evolving Method for Supporting Healthcare Improvement Skills’.
[36] Hayden Lindskog, Maria Strom, and Christian Zerbi, ‘Using Ethnography to Translate Behavior to Value in Medical Devices’, McKinsey & Company, 4 January 2021, https://www.mckinsey.com/industries/life-sciences/our-insights/using-ethnography-to-translate-behavior-to-value-in-medical-devices.
[37] Research, ‘FDA Patient-Focused Drug Development Guidance Series for Enhancing the Incorporation of the Patient’s Voice in Medical Product Development and Regulatory Decision Making’.
[38] Black et al., ‘Ethnographic Research as an Evolving Method for Supporting Healthcare Improvement Skills’.
[39] Hansen, Nørgaard, and Hallgreen, ‘How and Why to Involve Patients in Drug Development’.
[40] Hansen, Nørgaard, and Hallgreen.
[41] Paul Farmer et al., eds., Reimagining Global Health: An Introduction, 2013, 351.
[42] Sassy Molyneux and P. Wenzel Geissler, ‘Ethics and the Ethnography of Medical Research in Africa’, Social Science & Medicine, Part Special Issue: Ethics and the ethnography of medical research in Africa, 67, no. 5 (1 September 2008): 685–95, https://doi.org/10.1016/j.socscimed.2008.02.023.
