Rapid Ethnographic Assessment

Toolkit for understanding implementation context on short timelines

Who is this toolkit for?

This toolkit is designed for researchers with knowledge of implementation science and qualitative methods. Because REA is a team-based approach, a group with complementary skills and expertise in both areas can be effective at using this toolkit and applying the methodology.

If implementation practitioners are interested in REA, we recommend that they partner with qualitative methods experts who can guide rigorous data collection, analysis, and interpretation.

Getting Started

What is rapid ethnographic assessment (REA)?

REA stands for rapid ethnographic assessment (National Cancer Institute, 2020). The goal of REA is to understand what a culture is like from the insider’s perspective by gathering information within a short time frame to promote action (Nevedal et al., 2021; Rashid et al., 2019).

REA has its roots in classic, or conventional, ethnography and shares many of its principles, assumption, and procedures (Whitehead, 2022). More than a methodology, ethnography has distinctive attributes of ontology and epistemology.

Often used in social science research, ethnography is a holistic approach to the study of cultural systems and of sociocultural contexts, processes, and meanings within those systems. It is an open-ended, emergent learning process that relies heavily on qualitative methods, especially fieldwork, but can also include quantitative methods. Chapter 2 in this toolkit contains more about key features of ethnography.

Why use REA?

REA can be an effective method in implementation science research (McCullough et al., 2015), and serve to:

  • Capture, document, and encourage reflection on implementation processes, especially those centered on individual interactions
  • Observe and document fidelity to interventions and understand the implementation context of one or multiple settings
  • Understand the reasons an intervention may have been adapted to a particular context. REA enables capturing nuances in the environment and people’s motivations and actions
  • Learn about diverse stakeholders’ perspectives, especially those often overlooked (for example, frontline health care professionals or administrative staff)
  • Uncover unseen determinants of implementation, meaning features of the setting that people who work in it use but "take for granted" and may no longer notice
  • Assess effectiveness of implementation strategies (McCullough et al., 2015) and gain insights that can be quickly applied to improve design and implementation of interventions
     

When to use REA?

REA takes the key features of ethnography and adapts them to short timelines and a need for quick, actionable results (Vindrola-Padros, 2021). The main goal of using REA in implementation science is to efficiently gather data to understand barriers and facilitators (determinants of practice) in the clinic context. A secondary goal is to document flows of people, work, and communication to identify opportunities for evidence- based implementation strategies. Achieving both goals requires a deep-rooted grasp of the culture and experience of a clinical context. This toolkit is your introduction to using REA to support success in implementation science projects.

What is included in this toolkit?

This toolkit introduces the REA methodology for application in implementation studies. We provide a general background that highlights some of REA’s core tenets, examples from the implementation science literature, and practical guidance to help you use REA in your work.

How should I use this toolkit?

This toolkit gives you foundational principles, methods, and tools for using REA effectively. The content is organized in stand-alone sections that can be read and applied on their own but are especially helpful when used in the context of the full methodology. That is because REA is an immersive, multi-method approach based on unifying principles and activities that should be efficiently combined and coordinated to obtain good results. Still, we intend the information we provide to prove useful in the “real world” where various constraints can affect how the toolkit is read and REA employed – keep reading to learn how you can streamline and speed up your review of toolkit material and get started with REA!

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Funding acknowledgment

Funding for this toolkit comes from the National Institute of Mental Health (P50MH12621) and  the National Cancer Institute (P50CA244432).