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Listening to Your Audience: Qualitative Research in Malaria Interventions
Clare Chandler
Lead Social Scientist for the ACT Consortium 2008-2013
Answering key questions on malaria drug delivery 1
London School of Hygiene & Tropical Medicine
Intervention design steps
LISTENING
at the heart of our intervention design approach
New publication
• The work required to design interventions should not be underestimated
• The process should be recognized not only as technical, but the result of micro and macro social, political and economic contexts
• Reporting of interventions should encompass the development process.
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Why listen?
Interventions often assume we know what is good for people
Often informed by surveys (eg Knowledge Attitudes and Practices) which aim to identify barriers to people doing what we believe to be correct/appropriate
Limitations…●Pre-defined, closed-ended questions●Administered in a standardized way for a
wide variety of respondents●Analysed remotely●Difficult to identify underlying reasons for
health problems: social, political, economic
●Difficult to hear respondents’ priorities
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Why listen?
Picture courtesy of Ane Haaland
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How to listen?
Our methods intended to take the local seriously
Emphasised●Letting respondents lead●Social construction of the interview●Iterative interpretation process
How?●Intensive training for all research staff
(training materials available on www.actconsortium.org)
●Continued engagement with research process and ongoing analysis
●In-depth observation where possible
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Who to listen to?
Range of ‘stakeholders’ – and not just informing/consulting – part of the design process
This means some of our research ideas were not included.. E.g.
●See DiLiberto et al 2015 ‘Behind the Scenes of the PRIME Intervention’ in Global Health Action
But components included should be acceptable & sustainable… at least in that context
●Not necessarily off-the-shelf – what is deemed appropriate in one place may not be elsewhere. ●Emphasises need for a local needs assessment and stakeholder engagement if using our materials elsewhere
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Listening through design and testing
Workshops – to digest formative research, ideas from literature and theory
Pilots – to test out activities, materials, practicalities
●Eg. In peer group workshops
Seat in circle / tables / lines?Role plays in groups?Trainer standing or sitting?How to follow the manual?
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Listening in evaluation
Looking for intended changes
Most significant change..‘The most important thing I got is when I have mRDT’‘It has added on our workload… it becomes hectic for me’
Picking up unintended consequences
‘It is the hernia which is bothering the child. We only talked about the fever’‘We are using the mRDTs to scrutinize the (patients)… so you find people are getting discouraged to come’
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AcknowledgementsCore social science team:Clare Chandler, Joanna Reynolds, Eleanor Hutchinson, Rachel Hall-Clifford
In-country social science teams:Tanzania: Judith Meta, Fortunata Nasuwa, John Kessy, Adiel Mushi, Peter Mangesho, Isolide Massawe, Kaseem Juma, Emmy Metta, Angela Kimweri and Denise Allen; Uganda: James Kizito, Christine Nabirye, Susan Naiga, Miriam Kayendeke, Lilian Taaka, Loy Sentumbwe, Grace Nyabwolo, Asaph TurindeGhana: Evelyn Ansah, Samson Akanpigbiam and Frank BaidenCameroon: Robert Marie Mba, Ndong Ignatius Cheng, Joelle Pamen Ngako, Rachel Nguella, Albertine Lele, Joel Ambebilla, Mirabel Ayuk, Sarah Ndive, Theresia Njuabe and Abanda Ngu NjeiNigeria: Nkoli Ezumah and Ogochukwu EzeokeSouth Africa: Elizabeth AllenAfghanistan: Tamanna Ahmad, Karimullah Karimullah, Mohibullah Motahed, Nadia Anwari and Molly Wood.
