MORE than 10 years have elapsed since the 1995 Fourth World Conference on Women adopted the Beijing Declaration,1 bringing the rights and voices of women to the attention of the entire world. Since that time, considerable effort has been expended to promote the rights of women in the United States. Yet racial and ethnic minority women, and women who live in poverty, complete less formal education, or are uninsured, remain at greater risk for health problems and incur multiple and diverse barriers in accessing health services in a timely manner.2 Consequently, US national research priorities reflect the elimination of racial and ethnic health disparities3 and encourage the study of complex health problems among underserved and marginalized women.4 For example, migrant farmworker women experience disproportionate health disparities5 and are among the most economically disadvantaged (ie, 75% of families earn less than $10,000 annually, with widespread unemployment several months of the year6), least insured, and most medically underserved7 groups of women.

The transient nature of migrant farmwork, the variable migration patterns of farmworkers, and their reluctance to speak with outsiders may have limited research with this population. Some investigations have failed to include migrant farmworker women and excluded unemployed women who accompany employed male family members, significant others, or friends.8 What is known about this group of women through government and private reports indicates that they are outnumbered by men (80%).6,9 However, an accurate estimate of the number of women who participate in migrant farmwork is not clear. Most (81%) migrant farmworkers are foreign-born and of Mexican origin (ie, migrant farmworkers whose cultural origins can be traced to Mexico),6 with 95% born in Mexico and 2% in other Latin American countries. Migrant farmworker women are more likely (33%) than men (20%) to have been born in the United States and less likely (44%) than men (61%) to be undocumented citizens. These women are also more likely (74%) than men (27%) to live with their nuclear families, and recent findings10 suggest that migrant families, rather than individual farmworkers, are now migrating together. More (91%) farmworker mothers live with their children compared to farmworker fathers (42%) during migration.6 In spite of an obvious presence of women and their involvement in migrant farmwork as employees or as companions, they remain underresearched, leaving gaps in the literature.

As investigators begin to fill these gaps, they may encounter multiple challenges as they conduct research with marginalized or underserved groups, particularly when they differ from their participants in gender or sexual identity, culture, primary language, or in social, economic, ethnic, or racial group membership.11 One consideration that researchers may factor in is researcher positionality, which refers to the researcher's physical and psychological distance/connection including status or position12 with respect to his or her research participants. Researcher positionality, a theme in classic sociological,13,14 educational,15 organizational,12,16 and feminist literature,17-19 may influence how trusting relationships that facilitate entree14,20 into a community are established and how participants are recruited and retained.12 Similarly, positionality differences may affect the formation of relevant research questions21 and the accurate interpretation or dissemination of findings.22 These aspects of research may be increasingly paramount with funded investigations. Although several articles13,14,16,23-30 have argued for the merit of researcher positionality (eg, insider/outsider), it may be more beneficial to examine a research method that employs both an insider and outsider perspective. One method, insider/outsider team research (IOTR), brings outsiders together with insiders as coresearchers.12,31 This article (a) reviews the historical context surrounding the development of IOTR; (b) discusses characteristics and phases of IOTR; and (c) illustrates practical considerations and management strategies of IOTR used in a small-scale study with Mexican and Mexican American migrant farmworker women.

HISTORICAL CONTEXT

The IOTR approach has a foundation in the sociological literature,13,32 such as Merton's landmark essay published in 1972.13 Merton analyzed differences between the researchers' position (in terms of insider/outsider) and the communities they studied. His work was published following a period of social unrest and discrimination that occurred on university campuses in the 1960s when "scholars from previously silenced groups were arguing that academic discourse reflected the issues, relevancies and concerns of (primarily) white male academics."33^(pp362-363) At this same time, researchers were attempting to provide a legitimate voice for students from diverse racial, ethnic, social, and class backgrounds.15 Merton considered outsiders to be objective scientists and insiders to be holders of monopolistic or privileged forms of knowledge and concluded that researchers hold multiple social group affiliations. He proposed that the solution was for insiders and outsiders in the academy to unite in refraining from adopting a single, essentially ethnocentric perspective.

Later in the 1980s organizational scientists16 focused on epistemological discussions relating to modes and aims of inquiry and the types of knowledge generated with respect to the researcher's physical and psychological distance in inquiry. Evered and Louis16 suggested that inquiry from an insider perspective was valuable and could contribute to praxis or local theory. Continuing this work in the 1990s, Louis and Bartunek12 proposed that insiders and outsiders work together in teams to bring the 2 modes of inquiry together. Meanwhile, discussions in other disciplines were taking place regarding a legitimate alternative to the traditional logical positivist orientation that could give credit and value to the contributions of insiders.31

One group that supported the value of an insider's perspective was feminist qualitative researchers.34,35 Among other points, feminist researchers advocated for the mutual creation of data between researcher and participants18,19 and for the acknowledgment that women were the best informants of their own experiences.34 Collins,14 a Black woman feminist, analyzed the experiences of Black women sociologists, concluding they were outsiders within as she illustrated their marginalization in university settings. She also suggested that researchers were both insiders and outsiders, simultaneously members of a group and yet apart from the group, not exclusively one or the other; she also suggested one could not claim insider status solely on the basis of race or ethnicity. Rather, she proposed that a researcher's life experiences sensitized him or her to concerns (eg, Black oppression) and shaped his or her inquiry and knowledge.

In the late 20th century, Banks,15 an educator who studied African American communities, expanded on the insider/outsider discussion by proposing a typology of 4 categories of insider/outsider researcher: the indigenous-insider, the indigenous-outsider, the external-insider, and the external-outsider. The categories were based on 2 dimensions: origins of the researcher (ie, indigenous or external) and the researcher perspective (ie, insider or outsider). Indigenous persons socialized within a primary "ethnic, racial, and cultural community" internalized the community's "values, perspectives, ways of knowing, behaviors, beliefs, and knowledge,"15^(p7) more than did persons external to their primary community. Banks proposed that researchers could change or modify their insider/outsider positions as a result of new institutionalized knowledge, paradigms, and commitments.

Banks described the indigenous-insider researcher as a legitimate member of one's primary community and culture who endorses the community's "values, perspectives, behaviors, beliefs, and knowledge"15^(p7) and speaks with authority about the community. In contrast, the external-outsider is not socialized within the studied community, holds little understanding of or appreciation for the community's values, and subsequently makes erroneous interpretations of findings in the community. The external insider is also not socialized into the community studied, but because of life experiences internalizes the values, beliefs, and knowledge of an adopted community while rejecting many values, beliefs, and knowledge of the culture in which he or she was raised. Banks added that a community may come to perceive the researcher as an adopted member, while his or her original community may come to perceive him or her negatively. In contrast, the indigenous-outsider is a person socialized into a primary community but as a result of cultural assimilation and socialization also belongs to an outside community; he or she is often perceived with contempt by his or her primary community but held in esteem by the mainstream community. Banks illustrated his typology with categorical exemplars of noted scholars who studied discrimination and racism. In summary, Banks supported the role of an outsider researcher and encouraged outsiders not to avoid or fear studying communities because of outsider status or criticism. He also cautioned outsiders to be cognizant of their personal status and to identify insider community members to assist them with interpretation and facilitation of an adopted-insider status. While not intended to be a thorough review of the historical development of IOTR, this account provides a backdrop for the historical context in which IOTR evolved.

DEFINITION, CHARACTERISTICS, AND STAGES

Bartunek and Louis defined IOTR as an approach to research "in which members of settings under study work together, as co-researcher, with outsiders."31^(p3) Together, insiders and outsiders construct knowledge and contribute to the public understanding of phenomena and events within settings. Membership as insider or outsider indicates the positions of team members relative to one another and to the community studied. Insiders are team members who generally have a long-term membership within a study setting, while outsiders have formal research education and are more detached from the study setting.

The IOTR approach shares several overlapping characteristics with other insider/ outsider research strategies, including participant observation, action research, participatory research, and community-based participatory research.12,22,36 Insider/outsider collaboration is a part of all of the aforementioned research strategies. However, IOTR is distinguished from participant observation in its explicit collaboration and integration of insider/outsider perspectives throughout all phases of the research process, rather than in a limited use of key informants as providers of data. Much like action research, IOTR can also focus on informing and changing practice or taking action as an ultimate outcome, which has been particularly helpful in organizational research. In contrast to participatory research, which has a definite goal of intervention and may not focus on contributing to scholarly products or theory development, IOTR has as a primary concern contributing to science and generation of knowledge.31 There are also similar characteristics between IOTR and the principles of community-based participatory research,36 which is rooted in the social sciences and recently highly recognized in the healthcare literature. In summary, the IOTR31 approach is characterized by a research team that is composed of insiders and outsiders who differ in their physical and psychological connectedness to the research setting. Teams are created intentionally on the basis of these differences (eg, life experiences and interpretive perspectives), and members work jointly as coresearchers throughout all phases of the research process. They identify relevant questions, plan for collection and analysis of data, contribute to analysis of findings, and share decision making about dissemination of the findings.

Bartunek and Louis31 identify 10 stages in conducting an IOTR project: (1) composing a team, (2) establishing relationships between insiders and outsiders, (3) formulating research questions, (4) designing data collection, (5) collecting data, (6) analyzing and interpreting data, (7) writing reports and presenting results, (8) taking action in the setting, (9) making scholarly contributions, and (10) tracking collaborative outcomes. The phases of IOTR may not occur in chronological sequence, and several stages may take place simultaneously.

THE STUDY

The following qualitative study of Mexican and Mexican American migrant farmworker women is an example of processes, issues, and challenges that occur in IOTR. A thorough description of the study procedures and sample are discussed elsewhere,37 but a brief description follows. A purposive theoretical sample of 21 predominately middle aged (M = 40.10 years, SD = 12.44 years), married (n = 20, 95.2%) women, who were mothers (n = 10, 47.62%), grandmothers, and great-grandmothers (n = 4, 19.05%), was obtained. Slightly more than half (n = 11, 52.00%) of the women were born in the United States. However, the majority (n = 18, 85.70%) currently resided in the lower Rio Grande Valley region of Texas when they were not migrating. None of the women had completed high school (M = 7 years, SD = 4.01 years), and 2 had not received any formal education.

Following approval from a university institutional review board, women were recruited from local Catholic churches that provided Spanish-speaking church services for Mexican, Mexican American, and Central American migrant farmworkers who migrated to the Northern Great Lakes region of the United States for migrant farmwork. In the study's qualitative descriptive design, semistructured interviews were conducted in a language of the women's choice (n = 9 Spanish, n = 12 English). Interviews were audiotaped and transcribed verbatim first into the language recorded, compared to audiotapes, and then transcribed into English for interviews recorded in Spanish. With the exception of those who experienced unexpected relocations (n = 4), the majority (n = 17) of the women were interviewed twice, allowing for validation of interviews and clarification of questions. Although participants were asked to schedule 1 hour for the interview, first interviews ranged from 40 minutes to 3 hours (M = 93 minutes) and second interviews ranged from 25 minutes to 76 minutes (M = 40 minutes). All of the women requested that interviews take place in their casitas (small trailers or wooden framed cabins located in rural migrant farm camps).

Major findings identified in this investigation37 illustrated that the women perceived health in 3 broad categories: being at peace, performing role responsibilities, and absence of illness. Within each of these categories, gender, migration, and social, political, and economic contextual factors influenced their conceptualizations during migration. In this study, the women explained that they conceptualized their health during a migration experience differently than they did when they were not migrating. They also found that their self-confidence, sense of freedom, and decision making increased during migration. They associated these changes with their roles as employees. They explained that employment did not necessitate learning English, but they identified lacking English skills as a limitation in acquiring resources and a factor in increasing their dependence on others.

Another finding in this study was their identification of discrimination, racism, and bias that they experienced in local communities in myriad settings. In spite of these experiences, women often attempted to negate the experience, explaining that this was not taking place in their current settings (ie, a good camp rather than a bad camp) or that their current mayordomos (boss) was good (rather than discriminatory). The findings reflected subtle and overt but pervasive discrimination experienced by these women who were living in predominately Anglo communities. For example, they recalled instances where clinic staff refused to assist them in completing forms, or where caregivers avoided touching them or their children during examinations, and situations where their wages were withheld excessively for assistance with transportation. Several women discussed how they felt sad that they were unable to participate in religious services during migration when few services are provided in Spanish. They associated this with a lack of priority given to Spanish speakers in Anglo communities. Ironically, these women were part of an annual workforce who contributed to the production and harvest of 45 crops with an estimated field value of $2 billion for this state.38 The women also described living in a constant state of alertness that was focused on detecting subtle changes in agricultural produce that could influence employment and lead to sudden or unexpected moves to another location. Although many of the findings in this investigation may not have been novel and may have been expected, what is unique in this study is the process that was utilized in constructing the knowledge.

CONSIDERATIONS AND STRATEGIES WITH IOTR

In this section of the article, considerations and strategies applicable to IOTR in the current study are discussed. Select concerns regarding composing a team and developing relationships, formulating research questions, as well as practical and ethical considerations are included.

Assembling a team

As with all studies involving a research team, there were considerations regarding team membership. Bartunek and Lewis31 explain that research teams may be initiated by insiders but more typically it is done by outsiders. In the current study, the principal investigator (PI) initiated the research and selected team members. In assembling this team, the PI sought consultation with an expert in nursing research and decided on 2 additional team members including 1 bilingual insider to accompany the PI on all interviews and serve as a translator if necessary and 1 bilingual transcriptionist, an insider/outsider. Using an IOTR approach does not limit or stipulate the number of team members, but in this study limited funding and the ability to equitably compensate team members influenced the size of the research team.

Team members may vary considerably in terms of physical and psychological connections with the research setting and with respect to knowledge of the phenomenon of interest, but the more the diverse experience histories within a research team, the more are the diverse possibilities and potential interpretations.12 In the current study, the PI, a nurse educator/researcher with experience in parish and outreach community health nursing with Mexican and Mexican American migrant farm families, served as an adopted insider and guided a migrant women's health-promotion group.

Considerations in selecting an insider include identifying an individual who possess the knowledge, values, beliefs, and trust of the studied community; the ability to be sensitive to or appreciate the community's perspectives; and the ability to work well with others.31 The insider also need to be available to participate in the research. During summer months, migrant communities expressed concerns about employment, and depending on the weather, agriculture, and employment opportunities, needed to quickly relocate to secure employment.6 Identifying an insider who had experience as a migrant farmworker woman but who was not currently migrating proved to be most helpful. The insider also needed to possess bilingual Spanish-English language skills and be familiar with cultural or linguistic nuances and any idiomatic expressions common to Mexican and Mexican American migrant farmworkers. The insider needed to be accepting of the migrant farmer lifestyle5 and be aware of how growing seasons, employment schedules, and transportation might influence data collection. The insider who was eventually selected was a settled-out (previous migrant farmworker woman now a permanent local resident) Mexican American migrant farmworker woman. Two years earlier, she and her family decided to stop migrating and to live in a local Spanish-speaking community. She had experience the previous summer working as a paid interpreter for a local healthcare agency but was unemployed at the time of this study. She attended Spanish church services and a women's health-promotion group that the PI facilitated.

Team members may vary by the degree they participate in the study.39 This study, which focused on collecting data during a migration experience, required a timely turnaround of transcriptions between first and second interviews. The transcriptionist was more peripheral to the settings but needed to have appropriate bilingual and transcription skills, be available in the summer months, and have a sense of respect and sensitivity for the women's stories. A bilingual male high-school Spanish teacher with immersion experiences in Mexico and volunteer experience with migrant families was selected as the transcriptionist. As a male he was an outsider but his role in volunteer work provided him with some insider knowledge. However, he provided the unique advantage of marginality, or a third eye perspective.12

Formulating research questions

In mainstream positivist approaches to research, the PI typically formulates the research questions or hypotheses.31 In this instance, the research questions evolved from discussions held with a women's health-promotion group, facilitated by the PI at a local Catholic church that several migrant farmworker women attended. The insider selected for this investigation actively participated in this group. She comfortably shared her perspectives and experiences and was supportive of other participants in the group. The women frequently posed questions related to signs and symptoms of illnesses and access to or use of local healthcare services. In postmeeting discussions, the insider and the PI discussed possible reasons the women had difficulty making healthcare decisions during migration. This led to joint development of a research question that asked how women conceptualized their health during migration.

Insider-outsider working relationships

Bartunek and Lewis31 explain that greater differences in the backgrounds (eg, education, culture, language, race, gender, and class) and experiences of insiders and outsiders can lead to greater challenges and tensions. In the current study, team meetings were used for members to become acquainted, to review guidelines for the ethical conduct of research, to discuss procedures, and to establish goals and expectations. In spite of common concerns and values, some differences emerged. For example, the PI expressed a desire to plan and conduct the interviews in a setting that was quiet and free from distraction. The insider presented a somewhat differing perspective, explaining that the women may be unable to eliminate family distractions and domestic responsibilities (eg, laundry, light cooking, caring for children) as a result of their employment and household responsibilities. She advocated for refraining from insisting on a quiet location and for respectful attention to the needs of the participants as the primary concern. We agreed to attempt to conduct interviews within a quiet area but also agreed to respect the women's responsibilities, reinforcing the option to stop interviews if necessary. Another strategy we adopted was taking a bolsa de juguetes (toy bag) with us, which we could offer to small children to encourage quiet play during a mother's interview.

Tensions between insiders and outsiders can arise when there are differing perspectives.28 Such a tension was verbalized about the location of team meetings. The transcriptionist and the insider, who lacked transportation, lived more than an hour apart. Negotiations resulted in an understanding of how each member could contribute to the research effort. The team agreed that the transcriptionist could attend team meetings less frequently but needed to provide written transcriptions for our review and discussions. In turn, the PI agreed to provide transportation for the insider during all interviews. In another example, the insider provided an awareness of identity and power differentials when she suggested that the researchers should wear work clothes during interviews to show respect for the families returning from a day's work in the fields. Clearly, developing working relationships is time-consuming and requires sensitivity and ongoing dialogue throughout all phases of the research process.28,31

Practical and ethical concerns

Differences in education, knowledge, language, culture, and beliefs between insider and outsider team members may lead to potential ethical problems and tensions germane to IOTR.31 For example, in the current study, participants were recruited following church services, where the insider was familiar with the local minister. To prevent potential coercion during recruitment, we spoke with the minister prior to the study announcement to avoid possible endorsements that could make potential participants uncomfortable. Issues of confidentiality may arise when participants disclose personal or sensitive information to a research team that has earned their respect and trust (confianza).40 When participants disclosed discriminatory or exploitative experiences, they quickly stipulated that these practices were not taking place in current employment settings. Later, during postinterview debriefings, the insider explained that the women may have been disclosing current abuses but feared repercussion.

Bartunek and Lewis31 suggest the possibility of a subtle form of deception in IOTR, particularly when there are asymmetrical language skills. Although there were no overt examples of deception in the current investigation, comments from one participant as the study goals were explained reflected her perception of her relative importance of the research and her desired research outcome. This participant from Mexico questioned if the research would be sent to the President of the United States and if the report may influence the status of border crossings into the United States from Mexico. This reflects how an outsider's perception and a true insider's perception can be inconsistent. The onus of responsibility is with the PI to explain and to clarify research goals. Following translation and discussion, we reiterated the purpose of the study and reminded the woman that the findings would be shared with a community health clinic and with a women's health-promotion group the following summer. Although this woman agreed to participate in the study understanding that the final report would not be provided to the US government, she expressed many concerns and fears about unauthorized border crossings driven by economic needs and reiterated her wishes for border legislation to facilitate employment opportunities in the United States.

There is also the possibility for misrepresentation or inaccurate interpretation of findings in IOTR. For example, in part of an interview probing a comment regarding migration, the transcriptionist had recorded verbatim: "It is easy you know, because it is well, it is a line in the water." Appearing out of context, this sentence was confusing to the transcriptionist and the PI. During a team meeting, the insider clarified the idiom by pointing out that the Texas-Mexico border is sometimes referred to as a line down the middle of the Rio Grande. The insider, who recognized the significance of this historical context, was able to explain this to others on the team.

Another challenge in conducting IOTR is the likelihood that an outsider can "go native" or that an insider will become a stranger, or when the 2 completely accept the other's perspective.31 Should this occur, the study may be deprived of the asset of having unique perspectives. The team discussed this potential problem early in the study: though the PI followed the scripted interview guide in Spanish, she did not engage in matching body language or other behaviors. The insider pointed out the need to add eye contact or gestures to the PI's expressions and make changes in body positioning so that the interviews conveyed sincerity and respect.

This study, like all investigations, was not without flaws and shortcomings. Without substantial funding to support a more extensive research team with multiple insider/outsider perspectives and expert consultants, this IOTR had limited insider/outsider perspectives. Studies conducted in rural settings are also limited in available resources (eg, transcriptionists), particularly during the growing season. The findings, which were presented to the local community health center and a faith-based clinic, may have encouraged administrators to include evening hours during the migration season and expand community outreach nursing services. Still, it was not a simple task to coordinate the sharing of findings with the participants, the true insiders. We (PI and insider team member) jointly presented findings to the women's health-promotion group the following summer. The mobile and sporadic nature of migrant farmwork did not allow for the majority of the participants to attend this presentation. Acquiring their input at this meeting may have added greater depth and richness to our work. Future researchers employing an IOTR approach with migrant groups may want to invest more time and resources preparing insiders to feel comfortable and confident in disseminating findings at a later time. Finally, if the research were conducted on a larger scale, more active involvement with community health agencies may encourage improved reciprocal relationships that could lead to better health outcomes for this group of women.

CONCLUSION

Merton13 argued that the nature of boundaries separating insiders from outsiders was malleable and that "as situations involving different values arise, different statuses are activated changing the lines of separation.^(p28) In this investigation, we noticed that boundaries shifted between the adopted outsider and the insider; we did not exist within mutually exclusive categories.14,15 The insider developed a unique and confident ability to contribute to the research process, as evidenced in the interpretations she offered. The insider has since offered that the research process made her more aware of how her life experiences, culture, and economic conditions have influenced her thinking and her assumptions regarding her own health and regarding outsiders. Upon self-reflection, the PI appreciated multiple perspectives provided by the insider and the participants. Despite the researcher's adapting her attire to better match a farmworker's lifestyle and her advancing language skills, at least one of the participants identified the researcher as a powerful person. The persistent visibility of the markers of power points to the ever-present possibility that power differentials can be abused and exploited.41 Health professionals and researchers must be responsible for raising awareness, preventing, and/or remedying potential exploitations of power. All researchers, including adopted insiders, can reflect a very different message than they intend if they are unaware of personal and insider perspectives.

This small-scale investigation provided an opportunity to use IOTR in a fundamental way. Perhaps because of the small scale of the study, there was an emphasis on an experience of IOTR within the context of the investigation. What became clear during this experience was that the women existed in a type of borderland42 where 2 groups were attempting to exist in the same space. The women described issues of discrimination, exploitation, and racism that served to reinforce their fears and a desire for invisibility. The challenge for the adopted insider was to remain faithful to their words19 and to avoid the temptation to speak for them as someone who may know what is best for them. The IOTR approach structured a thorough discussion of these issues. The insider team member and the true insiders, the participants, could both affirm and reproach the PI when the interpretation was correct. The interactive nature of IOTR can lead to revelations of personal privilege43 to which many are blind when they are not true insiders.

REFERENCES