Transcript Mendenhall: Expanding the Research Team

Session 6
Expanding the Research Team
Emily Mendenhall, PhD, MPH
Assistant Professor of Global Health
School of Foreign Service
Georgetown University
How can anthropologists best
advocate for an expanded role of
anthropologists and other colleagues
from LMICs in global mental health
research?
1. Reflection on where our questions
come from (funders, locals, research)
2. Reflection on what our research
looks like (methods, team)
3. Reflection on what our research
does (more research, interventions,
policy)
4. Reflection on what is left when we
leave (capacity, independence,
evidence, local credibility, global
credibility)
5. Reflection on how funding should
empower collaborators and training of
our research teams (continuing
education, PhD support) and where
that funding should come from
(academia, development, industry)
Why this matters
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Too many lone-wolf anthropologists
Increase in multiple/mixed methods research
Collaborator research should be locally sustainable
Anthropological training should inspire others to
draw from such approaches
• Train more LMIC scholars in social sciences
(beyond interviewing skills)
How It’s Done
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Scrutinize hires for social, analytical skills
In depth training in WHAT as well as HOW
Extensive piloting
Continuous engagement during fieldwork
Reflection over field notes
Engage in analysis and write-up (authorship)
Sustained mentorship beyond project
Questions
• What is our responsibility for collaborating with our
LMIC colleagues? Moral? Financial?
• What are the best strategies to engage with LMIC
colleagues with regard to proposal development, grant
leadership, and manuscript development?
• How do we train LMIC research assistants in social
sciences in a way that enriches their careers?
• Should we prioritize positions and recruit LMIC
students into anthropology PhD programs?
• How do we make a lasting difference in local research
capacity? What should training look like? Funding?
Questions
• What is our responsibility for collaborating with our
LMIC colleagues? Moral? Financial?
• What are the best strategies to engage with LMIC
colleagues with regard to proposal development, grant
leadership, and manuscript development?
• How do we train LMIC research assistants in social
sciences in a way that enriches their careers?
• Should we prioritize positions and recruit LMIC
students into anthropology PhD programs?
• How do we make a lasting difference in local research
capacity? What should training look like? Funding?
Questions
• What is our responsibility for collaborating with our
LMIC colleagues? Moral? Financial?
• What are the best strategies to engage with LMIC
colleagues with regard to proposal development, grant
leadership, and manuscript development?
• How do we train LMIC research assistants in social
sciences in a way that enriches their careers?
• Should we prioritize positions and recruit LMIC
students into anthropology PhD programs?
• How do we make a lasting difference in local research
capacity? What should training look like? Funding?
Questions
• What is our responsibility for collaborating with our
LMIC colleagues? Moral? Financial?
• What are the best strategies to engage with LMIC
colleagues with regard to proposal development, grant
leadership, and manuscript development?
• How do we train LMIC research assistants in social
sciences in a way that enriches their careers?
• Should we prioritize positions and recruit LMIC
students into anthropology PhD programs?
• How do we make a lasting difference in local research
capacity? What should training look like? Funding?
Questions
• What is our responsibility for collaborating with our
LMIC colleagues? Moral? Financial?
• What are the best strategies to engage with LMIC
colleagues with regard to proposal development, grant
leadership, and manuscript development?
• How do we train LMIC research assistants in social
sciences in a way that enriches their careers?
• Should we prioritize positions and recruit LMIC
students into anthropology PhD programs?
• How do we make a lasting difference in local research
capacity? What should training look like? Funding?
The following slides are an example of
training materials
Social Experiences,
Stress, and Diabetes
Research Assistant
Training at
Africa Mental Health Foundation
Background
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Please state your name
Educational Background
Your background in research
Experience in qualitative research
Interest in anthropology and public health
Why you are interested in this project
Future plans
Diabetes in Kenya
• Growing diabetes incidence in emerging economies
• Limited research on non-communicable diseases,
and type 2 diabetes specifically, in Kenya
• Increased number of studies on type 2 diabetes in
sub-Saharan Africa (most in South Africa and
Nigeria); some studies in Kenya
• Although historically a disease of elite; growing
number of people with diabetes among middle class
and working poor in LMICs, including Kenya
• Recent epidemiological study estimates 10%
diabetes prevalence in Soweto
Depression
• Depression and poverty are strongly
correlated
• Depression and stressful experiences are
strongly correlated
• Study by AMHF found one in four primary care
patients are depressed
• Between 25 and 45% of people with diabetes
are depression in LMICs
• Little is known about this relationship in Kenya
Social and Economic Determinants of
Depression and Diabetes
• Social problems like poverty, interpersonal abuse,
family stress, social strain, etc can cause mental
distress
• Economic problems like poverty and lack of
ability to buy healthy foods or live in safe
neighborhoods can cause mental distress
• These factors also contribute to diabetes and
controlling diabetes
• There are important linkages among social
problems, mental health, and chronic illness
The present study
• This study will examine people’s:
– Life experiences
– Living environment
– Depressive state
– Anxiety state
– Biomarkers of stress
Plan
• Recruit 100 people to participate in study
• One RA will be based at Mbagathi Hospital
– Recruitment
• Two RAs will be based at AMHF
– Conducting interviews and writing fieldnotes
• All RAs will be responsible for transcription
and translation of interviews
READ THROUGH INTERVIEW GUIDE
Field Notes
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What are field notes?
What do they capture?
Why do we write them?
What is the first line of data collection?
Field Note Domains
• Context about person
• Information not captured on recorder, such as additional
comments, experiences, relevant information
• Interview guide themes
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Background
Family and social relationships
Living Environment
Stress
Depression
Diabetes
Diabetes Care
Diabetes and Other diseases
Biomarkers
• Height and Weight
– Used to calculate body mass index/obesity
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Systolic Blood pressure
Diastolic Blood pressure
Waist circumference (centripetal obesity)
Hemoglobin A1c (measure of diabetes control
over the past three months)
Qualitative Interviewing
What is Qualitative Research?
What is Qualitative Research?
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Texts
Focus groups
Semi-structured interviews
Grounded theory
Narratives
Finding themes in text
Marking texts for codes
Pictures
Nud*ist
Video tapes
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Content analysis
Ethnography
Words
Open-ended questions
Participant observation
Life histories
Case studies
www.dedoose.com
Values of Qualitative Data
• People value and use qualitative in different
ways, with different goals and expected (or
unexpected) outcomes
Qualitative vs Quantitative
• What do you want to do after you graduate?
• What do you want to do after you graduate?
– A. Sleep
– B. Get a job
– C. Get an internship
– D. Go to graduate school
Producing Qualitative Data
Types and Modes
Interviews
– Unstructured / Semi-structured / Structured / Mixed
– Standardized / Non-Standardized
• All respondents get the same questions
• All respondents get the same questions in the same order
– Mode
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Face-to-face
Phone
Mail
Web-based
Open vs Closed Questions
Open-ended questions
– Advantages
• Captures full range of responses
• In respondent’s own words
• May be most appropriate way of understanding respondents’ categories
– Disadvantages
• Non-responses are difficult or impossible to categorize (e.g., driving)
• Labor intensive to code responses
Close-ended questions
– Advantages
• Fewer non-responses
• Easier to code
– Disadvantages
• Limited to investigator-determined categories
• Limits the range of response variability and richness
Designing Semi-Structured Qualitative
Interviews
Funnel Interviews
– Grand-Tour Question
• “Please recall the last time that you had a cold or the flu and
describe the episode in as much detail as possible.”
• List data: Salient components & larger context
• Relational data: Interaction among salient components
– Mini-Tour Questions
• Signs/Symptoms: “What signs and symptoms did you have?”
[List Data]
• Causation: “What you think caused the illness?” [List Data]
• Treatment: “Please describe what you did about the illness
from start to finish.” [Relational Data: What & When]
• Social Support: “Please describe how other people assisted
you in your illness.” [Relational Data: Who & What]
– Close-Ended Checklists & Survey Items
The Grand-Tour Question
– Question: “Please describe the last time that you had
a cold or the flu.”
– Answer: “This happened exactly 31 days ago. I
remember this so well because the 1st day was also
the 1st day that I quit smoking. My wife and young
child had already been affected and were recovering
from the following symptoms: itchy throat and cough,
stomach cramps, fever. The 1st day was not bad right
away. I called in sick to work but I was really planning
to use the opportunity to study for an exam the next
day. To my surprise, by 5 PM I was bed ridden. The
next day I was worse. I went to my exam, but I
performed poorly. I skipped the rest of my classes. It
was at this time that I realized I could use this as an
opportunity to quit smoking. So far I have been
successful. By Wednesday evening I was fine.”!
Why Use a Grand-Tour Question?
– Grand Tour Question: “Please describe the last time that you had a
cold or the flu.”
– Answer: “This happened exactly 31 days ago. I remember this so
well because the 1st day was also the 1st day that I quit smoking.
My wife and young child had already been affected and were
recovering from the following symptoms: itchy throat and cough,
stomach cramps, fever. The 1st day was not bad right away. I called in
sick to work but I was really planning to use the opportunity to
study for an exam the next day. To my surprise, by 5 PM I was bed
ridden. The next day I was worse. I went to my exam, but I
performed poorly. I skipped the rest of my classes. It was at this time
that I realized I could use this as an opportunity to quit smoking. So
far I have been successful. By Wednesday evening I was fine.”!
• Grand-tour answers often place event in a larger context and
elicit data you would never have thought to ask about.
Probes
• The Silent Probe (non-specific)
– Just remain quiet and wait for an informant to continue. The silence may
be accompanied by a nod or by a mumbled “uh-huh” as you focus on your
note pad.
• The Echo Probe (non-specific)
– Simply repeat the last thing someone has said, and asking them to
continue. “I see. The goat’s throat is cut and the blood is drained into a pan
for cooking with the meat. Then what happens?”
• The Uh-huh Probe (non-specific)
– Encourage an informant to continue with a narrative by just making
affirmative comments, like “Uh-huh,” or “Yes, I see,” or “Right, uh-huh,” etc.
• The Tell-Me-More Probe (non-specific)
– Most common form of probe among experienced interviewers.
Respondents give you an answer, and you probe for more by saying: “Could
you tell me more about that?” Other variations include “Why exactly do
you say that?” and “Why exactly do you feel that way?”
From H.R. Bernard (2002)
More Probes
• The Long Question Probe
– Induce longer and more continuous responses by making your questions longer.
Instead of asking “How do you plant a home garden?” ask “What are all the things
you have to do to actually get a home garden going?” (Similar to grand tour
questions describe above.)
• Probing by Leading
– When you feel as though you have learned something important about a group
and its culture, the next step to test that knowledge—to see if it is idiosyncratic to
a particular informant or subgroup in the culture or if it can be reproduced in
many informants.
• Baiting: The Phased-Assertion Probe
– This is when you act like you already know something in order to get people to
open up. Every journalist (and gossip monger) knows this technique well. As you
learn a piece of a puzzle from one informant, you use it with the next informant to
get more information; and so on. Phased assertion also prompts some informants
to jump in and correct you if they think you know a little, but that you’ve “got it all
wrong.” In some cases, I’ve purposely made wrong assertions to provoke a
correcting response.
From H.R. Bernard (2002)
Good Interviewing Practice
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Be unambiguous. If respondents can interpret a question differently from the meaning
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Use a vocabulary that your respondents understand, but don’t be
condescending. This is a difficult balance to achieve. If you’re studying a narrow
you have in mind, they will. The problem is not easy to solve. A simple question like “Where
did you get your training?” can be very ambiguous.
population (sugar cane cutters, midwives, leather workers), then proper ethnography and
pre-testing with a few knowledgeable informants will help ensure appropriate wording of
questions.
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Remember that respondents must know enough to respond to your
questions.
Make sure there’s a clear purpose for every question you ask (for both you and
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Keep threatening questions short. Questions that are likely to intimidate respondents
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your respondent).
should have long preambles to lessen the intimidation effect. The questions themselves,
however, should contain as few words as possible.
Avoid loaded questions. Any question that begins “Do you think that…”or “Don’t you
agree that . . .” is a loaded question.
Don’t use double-barreled questions. For example: “When did you leave home and
go to work on your own for the first time?” There is no reason to assume, of course, that
someone had to leave home in order to go to work, or that they necessarily went to work if
they left home.
From H.R. Bernard (2002)
Other Aspects of Interviewing
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Do not include too many lead-in (warm-up) questions. Though lead-in questions are
good for building rapport, too many questions, may distract both the interviewer and
the interviewee from the primary focus of the interview schedule.
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Focus the interviewee on the interview. When interviewees (especially children) ask
questions that are off topic, give them brief responses and steer the quickly back. Too
much off track will make the interview more and more difficult.
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Focus on covering the entire interview schedule. Get comfortable with the interview
schedule. Visualize how you plan to conduct the interview. For example, think of the
core survey topics as “places” in a botanical garden that you knows you plan to visit,
and then be be sure that the interview includes this “places”
3.
Stay away from close-ended yes/no questions. For example, do not ask, “Your mom’s
never told you about [how HIV is transmitted]”? Instead ask, “Tell me what you know
about how HIV is transmitted. How did you find out about that? Who told you about
that?”
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Use follow-up questions provided in the interview schedule to help draw the
informant out. What has it been like for you?” And when the interviewee responds,
follow up with, “Can you give me some examples?” Or, “Can you tell me more about
that?”