Troubling ruling discourses of health: Using institutional ethnography in community-based research

This article responds to a recent call for detailed analyses of research processes that link the intellectual resources of the academy with communities and popular movements. Our discussion focuses on our experiences with the Making Care Visible (MCV) Project, a community-based, qualitative research initiative conducted in Toronto, Canada, that explored the work people living with HIV/AIDS (PHAs) do to look after their health. This article focuses on the doing of the MCV Project and, in particular, on our use of the concept 'health work'. Our central aim is to demonstrate how the concept methodologically grounded the politics of our research efforts at various stages of our work. To this end, we describe how we used the concept in starting our research, selecting participants and carrying out interviews. Drawing on interview excerpts from Making Care Visible: Antiretroviral Combination Therapy and the Health Work of People Living with HIV/AIDS, we also describe a set of reading practices that helped produce an analysis of the social organization of health work and the ruling character of formal discourses of knowledge about treatment decision making. Overall, our discussion suggests how a particular form of critique is made possible by the conceptual coordination of research practice through the notion of health work.