The main activities performed while in the field for data collection included the recruitment and training of qualified and experienced research assistants, gaining access to and recruiting study participants according to specified inclusion and exclusion criteria, finding suitable settings for data collection and creating rapport with the participants and administering the research instruments and carrying out the actual work of data collection.
2.7.1 Recruitment and Training of Research Assistants
The collection of data was carried out by the PI with the help of three research assistants.
These assistants were recruited based on their language competency, research experience and academic qualifications. Prior experience in conducting research with specific emphasis on qualitative methods was required. Each of the research assistants had obtained training in the social sciences whereas two had bachelor's degrees with majors in sociology and anthropology and one had double majors in sociology and economics. Additionally, each of them had been involved in various research studies and had experience with both qualitative and quantitative data collection methods. They had also attended a number of workshops, seminars and trainings on community mobilization, HIV/AIDS behaviour change communication, counseling and gender sensitization. The research assistants were therefore considered to be well qualified for the work.
After the recruitment, the assistants were taken through the problem definition, the purpose and objectives, the research questions, the methodology, the sampling procedure and sample size, the methods of data collection and the ethical guidelines of the study. A practical session on how to conduct interviews was also held. During this session, the PI took the assistants through all the data collection instruments. This was to ensure that the meaning of every
59 major concept in the instruments was clearly understood by all. The instruments were translated into the local language as most of the study participants were not fluent in the English language. Methodologically, translation was to ensure that a standard way of phrasing the questions and clarifying the concepts was developed. This standardization was necessary in order to guarantee consistency, reliability and validity of the data collection process. The translated instruments did not deviate in any way from the ethically approved English version except for being translated into the local language. The research team pretested the instruments among themselves to ensure that the items were clear and free from ambiguities.
The research assistants were finally trained on how to operate the digital audio-recording devices to be used to record the patients’ interviews, FGDs and KIIs.
2.7.2 Recruitment of Research Participants
The process of gaining access to the health facilities and the study participants and of getting to collect data for this study was a multistage process that involved getting through a bureaucratic chain of gate keepers from the national to the health facility level (Green and Thorogood, 2009). Lessons learned in this study revealed that gaining access is at best a continuous process that can be drawn out as it involves relationships and interactions with people in totally different institutional and cultural contexts (Butler-Kisber, 2010). For this study, the process began by applying for and obtaining ethical clearance from Kenyatta University Ethical Review Committee (KU-ERC) and research authorization from National Council for Science and Technology (NCST) as has been discussed in sub-section on Research Authorization and Ethical Clearance.
After all official and ethical procedures from the national and district levels were fulfilled, appointments were booked with the PSC Coordinators of both facilities in order to discuss the modalities and details of the research. The PSC Coordinators represented the lowest level of gatekeepers who interact directly with the PLHIV and whose support and advice is key in assuring success in this kind of research (Green and Thorogood, 2009). The PSC coordinators are responsible for all aspects of the treatment and care programmes for PLHIV in these two facilities. In the discussions, the PI first introduced himself, his institutional affiliation and the purpose for visiting the facility.
The PI then proceeded to describe the purpose and objectives of the study and the kind of assistance he expected from the PSC coordinators. Further issues that were discussed in details were: the characteristics of the eligible research participants; the inclusion criteria; the process of informed consent; how confidentiality of data would be assured; how the data
60 would be collected; and how the results of the study would be shared with the facilities and participants. Logistical matters including the locations and timings for the interview and FGD sessions and other issues that required clarification and prior planning before the start of data collection were also addressed.
The PI shared with the PSC Coordinators the proposed plan for conducting the study including the number and characteristics of participants for the different methods of data collection (PLHIV in-depth interviews, FGDs and KIIs). After deliberations and some adjustments to the proposed plans, final and concrete appointments for the data collection were made. In many cases, appointments for FGDs were fixed to coincide with the regular PSGs meeting days that already existed as part of their normal activities. This was to ensure as little interruption to the participants' everyday pattern of life as possible. In the case of St.
Joseph's Nyabondo, a member of staff of the PSC actually accompanied the PI and his assistant to two venues of PSG meetings where two FGDs were to be held. These FGDs were held some distance away from the hospital. Otherwise all the other sessions for PLHIV in-depth interviews, FGDs, and KIIs were held within the health facilities. The two PSC coordinators and their personnel helped in the recruitment of the study participants, in fixing of meeting appointments with the participants and in mobilizing them for these appointments.
The process of gaining access to the research participants is outlined in Table 2-2.
Table 2-2: Stages in accessing research site, research participants and data collection
Stage Activities Key Results
Stage I Application for ethical approval Ethical approval document (s) Stage II Application for research authorization Research authorization letter and
permit Stage III Reporting to relevant district officials
District Commissioner
District Education Officer
District Medical Officer of Health
Endorsements from relevant government ministries
Stage IV Holding formal discussions with PSC coordinators
Negotiated concrete data collection plan
Stage V Negotiating access to participants
Conducting interviews, FGDs and KIIs
Informed consent forms;
Audio-records of interviews, FGDs and KIIs
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2.7.3 Inclusion and Exclusion Criteria
PLHIV recruited were those above 18 years old; who were participating in the care, treatment and support programmes in one of the two facilities; who had received a positive HIV diagnosis of at least six months; who belonged to and were active members of a patients' support group (PSC) and who were able to communicate fluently in either English, Kiswahili or Dholuo language. Since participation was voluntary and based on informed consent, only those who were willing participated.
PLHIV were excluded from the study if they were under 18 years of age. Those who were not willing to freely discuss their illness experience due to issues with disclosure were also not selected to take part in the study. Since living with HIV is an emotive issue, those who were undergoing emotional or psychological and even social and physical distress at the time of the study were excluded from participating in the study. Those who were not able to communicate effectively in either Dholuo, English or Kiswahili were similarly not eligible to participate. The decisions concerning those who participated in the study were arrived at in consultations with the PSC Coordinators.
2.7.4 Setting for Data Collection
As it is desirable to get a quiet and private place for conducting interviews, FGDs and KIIs (Green and Thorogood, 2009), the interviews were mostly done in the context of the health facilities except in the case of two focus group discussions in St. Joseph's Nyabondo that were held away from the health facility. Due to lack of free rooms, the sessions were mostly conducted on verandas of buildings or under trees separated from the out-patient area. This was to ensure privacy and also to avoid distraction.
At both health facilities, however, the team had to contend with a noisy environment, which sometimes necessitated pausing both the interview and the recording for short periods of time.
The PI and his assistants had to equally put up with other continuous interruptions like noise from animals, the blowing of the wind, and noise from traffic or other activities. However, the interruptions due to the noises were not very disruptive. Some of the interview sessions were slightly affected and in some cases, there were some inaudible portions but these were not serious such as to distort the flow of the participants’ illness accounts. Nonetheless, such portions necessitated more concentrated attention during transcription so as to ensure accuracy.
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2.7.5 Rapport and Administration of the Tools
Rapport with the research participants was initially ensured through methods of access and was mainly by way of their trusted service providers. Being within the context of the health care provision gave the study an aura of legitimacy. The PI and his assistants introduced themselves before the start of every encounter and briefly introduced the purpose of the study and generally informed the participants of the intended goals and benefits as outlined in the consent form document. Thereafter, consent was sought from the participants. Once consent was granted, the participants were invited to feel free and to audibly discuss the issues at hand. They were assured of confidentiality and anonymity.
The team adopted a non-judgmental attitude since the issue handled—living with HIV—is a highly emotive and sensitive topic. The team was careful not to appear to be unsympathetic and insensitive to the status of the participants. The team showed genuine interest in the participants’ responses and encouraged them to talk freely about their experiences. The researchers were also sensitive with regard to the use of time and endeavored to take the shortest time possible.
Attention had been paid to devising alternative ways of phrasing questions to ensure clarity.
In asking questions, it was evident that some items were still not very clear and the concepts were somehow not easy for some respondents to grasp. To surmount these problems, the PI and his assistants interpreted the questions in a way that made sense to the interviewers. After the initial interviews, the general responses were emerging and these led the team on what to expect for various questions, thereby helping clarify difficult questions to the respondents.
The PI and the research assistants quickly adapted to these interpretations and would foresee the trouble spots and prepared for them in advance (Green and Thorogood, 2009).
The research team had to however remain vigilant and attentive to emerging meanings and interpretations. Some of the methods of phrasing questions, such as those mentioned by Green and Thorogood (2009), were adopted. These include: use of open-ended items; being non-judgmental and espousing an open-minded attitude; use of non-leading questions and reducing specialized terms to a minimum. Appropriate probes and prompts were included to encourage the participants to tell their stories. This was achieved through interrupting the respondents as least as possible, using prompts and “non-verbal cues such as head nodding”, and through using probes like “anything else?”, “what happened”... (Green and Thorogood, 2009). In a few cases, some of the research assistants occasionally used leading questions
63 especially where they expected a particular answer. However, these occurred mostly as follow-up questions and not as main questions.