Diaries in social science and health research

From Benjaminhughes.net

Diaries as a research method in social science and health

Biographers, historians and literary scholars have long considered diary documents to be of major importance for telling history. More recently, sociologists have taken seriously the idea of using personal documents to construct pictures of social reality from the actors' perspective. In contrast to these 'journal' type of accounts, diaries are used as research instruments to collect detailed information about behaviour, events and other aspects of individuals' daily lives. Self-completion diaries have a number of advantages over other data collections methods. First, diaries can provide a reliable alternative to the traditional interview method for events that are difficult to recall accurately or that are easily forgotten. Second, like other self-completion methods, diaries can help to overcome the problems associated with collecting sensitive information by personal interview. Finally, they can be used to supplement interview data to provide a rich source of information on respondents' behaviour and experiences on a daily basis. The 'diary interview method' where the diary keeping period is followed by an interview asking detailed questions about the diary entries is considered to be one of the most reliable methods of obtaining information. This paper is based on a review of the extensive, but patchy literature on the use of diaries in sociological research. It explores some of the themes arising from this review in the context of health care. The focus on healthcare is used to illustrate the examples detailed, but also the author intends to use diary methods in future health care studies.

Contents

History of the diary method

There is a long history of using diaries as a basis for social research, an example being the mass-observation studies completed in the UK in the second world war. Here a large number of ordinary people were recruited to keep diaries of everything they did for one day a month, and were asked to report on special days such as bank holidays. Analysis of the diaries was used to show how the British public was reacting to the struggle of the war (Calder and Sheridan, 1984)

The most popular topic of investigation using diaries for economists, market researchers, and more recently sociologists, has been the way in which people spend their time. Accounts of time use can tell us much about quality of life, social and economic well-being and patterns of leisure and work. The 'time-budget' schedule, pioneered by Sorokin in the 1930s (Sorokin & Berger 1938) involved respondents keeping a detailed log of how they allocated their time during the day. More qualitative studies have used a "standard day" diary which focuses on a typical day in the life of an individual from a particular group or community.

Categorization of diary methods followed shortly after, and Allport (1943) identified 3 distinct models of diary familiar in everyday life: the intimate journal, in which private thoughts and opinions are recorded, uncensored; the memoir - an 'impersonal' diary, often written with an eye to publication; and the log, which is a kind of listing of events, with relatively little commentary. While the memoir may assume an audience, the log and the intimate journal are essentially private documents, written primarily for the diarists themselves. They are therefore constructed within the diarist's own frame of reference and can assume a forgiving, understanding reader (Allport, 1943; Jackson, 1994) for whom there is no need to present a best face. The use of such documents is common within historical and anthropological research, but has been rather neglected within sociology (Plummer, 1983). There is however, a strong tradition of autobiographical and diary-based research within the feminist research (Personal Narratives Group, 1989; Swindells, 1995; Stanley, 1995). However, within this literature, there is relatively little discussion of the scope for diary-based research. For example, a trawl through the journal Auto/Biography 1992 - 6 revealed only one study which used diaries - in this case the published diaries of Anais Nin (Jackson, 1994). Despite the extensive history of the use of diaries in social science, within applied qualitative research, the use of diaries is relatively rare. The method of choice for applied qualitative research tends to be the in-depth interview (Silverman, 1996).

Advantages of the diary method and types employed

There are a number of advantages to using diaries, first they provide a useful method of collecting data from the perspective of the employee. Whereas in participant observation the researcher cannot help imposing to some extent his own frame of reference as data is collected (Easterby-Smith, Thorpe & Lowe, 2002). Second a diary approach allows the perspectives of many different participants to be compared simultaneously. Thirdly it allows the researcher to collect other relevant information while the study is being completed. As such it is a practical alternative when the researcher is not able to invest personally in an extended longitudinal study.

Diaries have a contribution to make to sociological research which differs from life history accounts or in-depth interviews more commonly used in the literature on autobiography and on qualitative social research methods. Diaries track the 'contemporaneous flow of public and private events' (Plummer, 1983: p. 170). They are not given 'all of a piece' - such as a life history might be - but rather are written discontinuously, either daily or over longer intervals of time (Allport, 1943) and as such provide a record of an ever-changing present. Rather than documenting the present, other autobiographical texts or life documents - such as letters, for example, tend towards making retrospective sense of a whole life or towards retelling significant moments - of epiphany or crystallization. This proximity to the present, the closeness between the experience and the record of experience means that there is the perception at least that diaries are less subject to the vagaries of memory, to retrospective censorship or reframing than other autobiographical accounts. At one level diary keeping by organizational members can be a simple journal or record of events. This approach is sometimes used by management services practitioners to measure certain activities to improve their work, or reflect on their work such as in time management analysis (Stewart, 1967, 1982). Diaries may be open format, allowing respondents to record activities and events in their own words, or they can be highly structured where all activities are pre-categorised. In the highly structured catagory, there are a number of common diaries used such as time-budget diaries. One of the most fruitful time-budget endeavours, initiated in the mid 60s, has been the Multinational Time Budget Time Use Project (Szalai 1972). Its aim was to provide a set of procedures and guidance on how to collect and analyse time-use data so that valid cross-national comparisons could be made. This group has contributed much to our knowledge of time budget methodology, and for researchers wishing to conduct their own survey into time use, writings published by this group should be their first port of call (Harvey 1990).

Diary design and format

Diaries can be quantitative or qualitative depending on the kind of information that is recorded. Diary surveys often use a personal interview to collect additional background information about the household and sometimes about behaviour or events of interest that the diary will not capture (such as large items of expenditure for consumer expenditure surveys). A placing interview is important for explaining the diary keeping procedures to the respondent and a concluding interview may be used to check on the completeness of the recorded entries. Often retrospective estimates of the behaviour occurring over the diary period are collected at the final interview (Easterby-Smith, Thorpe & Lowe, 2002).

Major recent developments include the use of electronic forms of data collection and multilevel models in data analysis. Diaries represent several areas of research opportunities: 1. in technology, combining electronic diary reports with collateral measures such as ambulatory heart rate; 2. in measurement, switching from measures based on between-person differences to those based on within-person changes; and 3. in research questions, using diaries to (a) explain why people differ in variability rather than mean level, (b) study change processes during major events and transitions, and (c) study interpersonal processes using dyadic and group diary methods. Detailed diary design

Diaries may be open format, allowing respondents to record activities and events in their own words, or they can be highly structured where all activities are pre-categorised. An obvious advantage of the free format is that it allows for greater opportunity to recode and analyse the data. However, the labour intensive work required to prepare and make sense of the data may render it unrealistic for projects lacking time and resources, or where the sample is large. Although the design of a diary will depend on the detailed requirement of the topic under study, there are certain design aspects which are common to most. The institute of diary methods at the university of surrey offers a number of practical tips for designing highly structured diaries (Corti, 1993). These include:

  • An A4 booklet of about 5 to 20 pages is desirable, depending on the nature of the diary. Disappointing as it might seem, most respondents do not carry their diaries around with them."
  • The inside cover page should contain a clear set of instructions on how to complete the diary. This should stress the importance of recording events as soon as possible after they occur and how the respondent should try not to let the diary keeping influence their behaviour.
  • A model example of a correctly completed diary should feature on the second page.
  • Depending on how long a period the diary will cover, each page denoting either a week, a day of the week or a 24 hour period or less. Pages should be clearly ruled up as a calendar with prominent headings and enough space to enter all the desired information (such as what the respondent was doing, at what time, where, who with and how they felt at the time, and so on).
  • Checklists of the items, events or behaviour to help jog the diary keeper's memory should be printed somewhere fairly prominent. Very long lists should be avoided since they may be off-putting and confusing to respondents. For a structured time budget diary, an exhaustive list of all possible relevant activities should be listed together with the appropriate codes. Where more than one type of activity is to be entered, that is, primary and secondary (or background) activities, guidance should be given on how to deal with "competing" or multiple activities.
  • There should be an explanation of what is meant by the unit of observation, such as a "session", an "event" or a "fixed time block". Where respondents are given more freedom in naming their activities and the activities are to be coded later, it is important to give strict guidelines on what type of behaviour to include, what definitely to exclude and the level of detail required. Time budget diaries without fixed time blocks should include columns for start and finish times for activities.
  • Appropriate terminology or lists of activities should be designed to meet the needs of the sample under study, and if necessary, different versions of the diary should be used for different groups.
  • Following the diary pages it is useful to include a simple set of questions for the respondent to complete, asking, among other things, whether the diary keeping period was atypical in any way compared to usual daily life. It is also good practice to include a page at the end asking for the respondents' own comments and clarifications of any peculiarities relating to their entries. Even if these remarks will not be systematically analysed, they may prove helpful at the editing or coding stage.
  • Diary keeping period: The period over which a diary is to be kept needs to be long enough to capture the behaviour or events of interest without jeopardising successful completion by imposing an overly burdensome task. The OPCS National Travel Survey and the Adult Dietary Survey use seven day diaries, while the UK Family Expenditure Survey uses a fourteen day recording period. For collecting time-use data, anything from one to three day diaries may be used. Household expenditure surveys usually place diaries on specific days to ensure an even coverage across the week and distribute their field work over the year to ensure seasonal variation in earnings and spending is captured. “

Weaknesses with diary methods

In addition to the types of errors encountered in all survey methods, diaries are especially prone to errors arising from respondent conditioning, incomplete recording of information and under-reporting, inadequate recall, insufficient cooperation and sample selection bias (Corti, 1993). Reporting errors: In household expenditure surveys it is routinely found that the first day and first week of diary keeping shows higher reporting of expenditure than the following days. This is also observed for other types of behaviour and the effects are generally termed "first day effects". They may be due to respondents changing their behaviour as a result of keeping the diary (conditioning), or becoming less conscientious than when they started the diary. Recall errors may also extend to 'tomorrow' diaries. Respondents often write down their entries at the end of a day and only a small minority are diligent diary keepers who carry their diary with them at all times. Expenditure surveys find that an intermediate visit from an interviewer during the diary keeping period helps preserve 'good' diary keeping to the end of the period.

Literacy

All methods that involve self-completion of information demand that the respondent has a reasonable standard of literacy. Thus the diary sample and the data may be biased towards the population of competent diary keepers (Easterby-Smith, Thorpe & Lowe, 2002).

Participation

The best response rates for diary surveys are achieved when diary keepers are recruited on a face-to-face basis, rather than by post. Personal collection of diaries also allows any problems in the completed diary to be sorted out on the spot. Success may also depend on the quality of interviewing staff who should be highly motivated, competent and well-briefed. Appealing to respondent's altruistic nature, reassuring them of confidentiality and offering incentives are thought to influence co-operation in diary surveys (Corti, 1993). The FES gives a 10 pound postal order for completion of their fourteen day diary and other surveys offer lottery tickets or small promotional items.

Relative cost of diary surveys

The diary method is generally more expensive than the personal interview, and personal placement and pick-up visits are more costly than postal administration. For the majority of OPCS diary surveys, interviewers usually make at least two visits and are often expected to spend time checking the diary with the respondent. If the diary is unstructured, intensive editing and coding will push up the costs. However, these costs must be balanced against the superiority of the diary method in obtaining more accurate data, particularly where the recall method gives poor results. The ratio of costs for diaries compared with recall time budgets are of the order of three or four to one (Juster & Stafford 1985).

Analysing diaries: coding, editing and processing

The amount of work required to process a diary depends largely on how structured it is. For many large scale diary surveys, part of the editing and coding process is done by the interviewer while still in the field. Following this is an intensive editing procedure which includes checking entries against information collected in the personal interview. For unstructured diaries, involving coding of verbatim entries, the processing can be very labour intensive, in much the same way as it is for processing qualitative interview transcripts (Corti, 1993). Using highly trained coders and a rigorous unambiguous coding scheme is very important particularly where there is no clear demarcation of events or behaviour in the diary entries. Clearly, a well designed diary with a coherent pre-coding system should cut down on the degree of editing and coding.

Computer software for processing and analysis

Probably the least developed area relating to the diary method is the computer storage and analysis of diary data. One of the problems of developing software for processing and manipulating diary data is the complexity and bulk of the information collected. Although computer assisted methods may help to reduce the amount of manual preparatory work, there are few packages and most of them are custom built to suit the specifics of a particular project. Time-budget researchers are probably the most advanced group of users of machine readable diary data and the structure of these data allows them to use traditional statistical packages for analysis. More recently, methods of analysis based on algorithms for searching for patterns of behaviour in diary data are being used (Coxon 1991). Software development is certainly an area which merits future attention. For textual diaries, qualitative software packages such as The ETHNOGRAPH can be used to code them in the same way as interview transcripts (Fielding & Lee 1991).

Where are diary methods applied?

Two other major areas where diaries are often used are consumer expenditure and transport planning research. For example, the U.K. Family Expenditure Survey (OPCS) uses diaries to collect data for the National Accounts and to provide weights for the Retail Price Index (Corti, 1993). In the National Travel Survey (OPCS) respondents record information about all journeys made over a specified time period in a diary. Other topics covered using diary methods are social networks, health, illness and associated behaviour, diet and nutrition, social work and other areas of social policy, clinical psychology and family therapy, crime behaviour, alcohol consumption and drug usage, and sexual behaviour. Diaries are also increasingly being used in market research.

Diary methods in health

There is a fairly large body of applied social research in the health field which have used structured diaries, in which informants are invited to 'log' items from a list of health action they have undertaken, rather than open diaries. In particular, health diaries have been argued to present the optimum way of investigating helpseeking for episodes of illness for reasons which resonate with the discussion of the autobiographical literature above - namely the ability to capture events close to when they unfold and the potential to trace events over continuous time (Verbrugge, 1980; 1985; Mechanic, 1989). The literature on both qualitative and quantitative methods has highlighted the value of diaries in recording routine or everyday processes (Pavis et al, 1996; Verbrugge, 1980). These qualities have been identified as important because it has been argued that health care utilization often involves the consideration of symptoms which are trivial and therefore easily forgotten - especially if they have not been treated by a professional and therefore lack medical legitimization. Therefore there is a need for prospective data to track events as closely as possible to when they occur (Verbrugge, 1980). In addition, a longitudinal, prospective design has the potential to link demand for care to the experience of illness as well as to relatively stable characteristics such as health status/attitudes and to trace decision-making processes over time. To a certain extent, the methodological stance adopted by health service researchers here is that diaries are a substitute for accurate scientific observation, in settings from which the 'scientist' is absent. The potential to use diaries as a vehicle for research informants to observe situations which researchers cannot access has been explicitly drawn out within the context of ethnographic research (Zimmerman and Wieder, 1977). Zimmerman and Wieder advocate asking informants to keep diaries on the subject to be studied. The written accounts are then elaborated or developed in an in-depth interview based on the diaries. Thus diaries form part of a research process, in which informants actively participate in both recording and reflecting upon their own behaviour.

The 'diary-interview' method is useful in accessing phenomena which are not amenable to observation because they are unfocused or take place outside set time or environmental boundaries and are likely to be altered by the presence of an observer (Zimmerman and Wieder, 1977). Tracing decision-making processes outside an institutional setting (in the community) would be even more problematic. Yet need and demand for primary care are most usefully investigated from a lay or community-based perspective (Rogers and Elliott, 1997). Research based on records of consultations with primary care professionals or on fieldwork with informants using formal services can offer only an incomplete picture of health care use. The majority of illness episodes do not come to the attention of health professionals - indeed, within primary care, health professionals see only the tip of the illness iceberg (Dunnell and Cartwright, 1972; Scambler et al, 1981). Symptoms are managed not only by bio-medical professionals within the formal health services but also through self- care, treatment by lay others and alternative healers. Lay decision-making about health and illness is socially situated and context specific. In designing a study on the use of formal and informal care, the aim was to develop methods capable of reflecting the diverse and highly individualistic ways in which people respond to illness and the role of biographical, environmental and social contexts in shaping helpseeking. The following discussion of the data from the pilot study illuminate the potential of the 'diary-interview' method, outlined above, to do this, drawing out the particular advantages of less structured format and the research process within which the open diary was nested.

Conclusion

To date, solicited diaries have been relatively neglected as a social science research method. This is particularly true within the field of health research. Yet, these narrative approaches can provide invaluable insights into the health behaviours of individuals and how these are played out across time and space. Through the gathering of chronologically organised data about daily activities, diaries can act as both a record and reflection of the health experiences, activities and life-worlds inhabited by older people.

--Ben 19:32, 9 August 2008 (UTC) This is open content on this site...if you don't agree with something, change it!

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