In this section, I will briefly present the most central issues within the ethnographic methodology relevant to this research. This involves a short presentation of the municipality as the study’s setting, the act of gaining access to the participants and municipality, a presentation of substudies 1 &
2, including methods used, and finally consideration of the researcher role.
Within the ethnographic methodology, special attention is given to how social life is constructed and how individual relationships, individual actions, and personal experiences work together. Ethnography allows for a special native point of view that is from an inside perspective, which can only be accessed through participation in the world of others’, by assuming the reality of others’
(Hastrup, 2010a).
Ethnography may provide a nuanced understanding of an organisation and allow for comparison between what people say and what they do (Hastrup, Rubow, & Tjørnhøj-Thomsen, 2017). Thus, this methodology seemed appropriate to explore how an organisation’s formal structures influence the possibilities in supporting healthcare needs and how professional knowledge is locally produced in different settings. Using ethnography seemed a relevant choice because, as argued by Hastrup (2010a), it allows an attention to the human being as part of the social community. Participant observations and
ethnographic interviews with socially marginalised men and ethnographic interviews with municipal employees were chosen as methods to explore the actors’ different perceptions. This ethnographic research has involved a constant to-and-from (an iteration), participating, observing, writing, reflecting, reading, thinking, talking, and listening in a circular, rather than a linear, way (O’Reilly, 2012). The ethnographic research strategy took form as the stepping-in-stepping-out ethnography, described by Madden (2010) as an engagement the researcher enters when working in familiar settings, thus only spending some of the day “in the field” and afterwards returning to their homes. As an example, participant observations in this study were primarily carried out at two bench sites repeatedly, which will be further elaborated later in this chapter, under substudy 1.
THE MUNICIPALITY AS STUDY SETTING
The overall setting was Aalborg Municipality, which has approximately 200,000 inhabitants. Aalborg Municipality is the third-largest municipality in Denmark. For many years, Aalborg was known as “The town with the smoking chimneys” – a thriving industrial city, where over half of the city’s workforce followed the factory sirens every morning and flocked to assembly lines and machines. Spritten, Eternitten, and C.W. Obel’s tobacco factory were some of the best-known factories, but there were hundreds of large and small industrial companies in Aalborg. Aalborg’s business has been characterized by heavy industry and large unskilled workplaces, and Aalborg’s working population was generally poorly educated compared to the rest of the country. Now most of the major industrial workplaces that were once Aalborg’s landmarks are gone. They have either succumbed to competition or have moved production abroad – especially to Asia. Although new large industrial companies have arrived, it is a fact that only 15 percent of Aalborg’s population now works with crafts and industry. On the other hand, 60 percent are engaged in administration and service (Nordjyllands Historiske Museum, n.d.).
The municipalities have used several different organisational models to solve their obligations for health promotion (Hansen, 2014). In Aalborg, the community health system [Det nære sundhedsvæsen] is responsible for the municipality’s health, employment, and social sectors (Aalborg Kommune, 2015). Thereby health is an area of responsibility for the entire municipality.
Aalborg Municipality has, among other things, established several community health centres to support the political goal that health services shall be adaptable to all citizens by being flexible and accessible (Sundheds- og Kulturforvaltningen, 2014). The municipality offers a wide range of health-promotion and disease-preventative options for its citizens, with advanced efforts located in various communities. That way the citizens may be treated or get support at home or in the local community, thus benefitting from proximity and continuity (Sundheds- og Kulturforvaltningen, 2014; Toke &
Vestergaard, 2017). To support marginalised citizens, the municipality offers services such as the Outreach Team that offer health and social services to socially marginalised citizens and bridge to other parts of the overall healthcare and welfare system (Aalborg Kommune, 2015, 2019).
GAINING ACCESS TO THE FIELD AND THE PARTICIPANTS
To ensure close links with the municipality, a support monitor group was assigned to this study. The members of the group were senior managers and specialists within social and healthcare practices in two municipal departments, the Department of Health and Culture and the Department of Family and Employment. These two departments offer a wide range of health and social services in the municipality. As such, the socially marginalised men would at some point be in contact with one of these departments. The purpose of the support monitor group was to qualify my inquiries and curiosity, to give me insight into the municipal context, and to provide contact with gatekeepers.
This was considered a strength because I was unfamiliar in different ways with the context of the municipality.
Substudy 1: The monitoring group provided contact information to four employees from two departments and one employee from an external organisation with a municipal cooperation agreement. Subsequently, the monitor group acted as gatekeepers to the field and the participating men. The gatekeepers all had professional backgrounds in either health or social work and had profound interests in the target group of this research.
Substudy 2: The monitoring group provided contact information to both employees and managers who already had contact with socially marginalised men or would like to have contact with them because of services that might benefit the socially marginalised men. Three from the monitoring group acted as both gatekeepers and participants.