Conducting health survey research in a deep rural South African community: challenges and adaptive strategies

Health Research Policy and Systems

Lucie Cluver⁵  Caroline Kuo⁴  Lebo Sello³  Tyler Lane²  Marisa Casale¹ 

[1] Department of Psychology, University of Cape Town, Rondebosch, Cape Town, 7701, South Africa;Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford, OX1 2ER, United Kingdom;Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Private Bag X54001, Durban, 4000, South Africa;Department of Behavioral and Social Sciences and Alcohol Research Center on HIV, Brown University, Box G-S121-4, Providence, RI 02912, USA;Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, Cape Town, 7701, South Africa

关键词: Rural fieldwork;    Fieldwork challenges;    Field research;    Community research partnerships;   

Others  :  809812
DOI  :  10.1186/1478-4505-11-14

 received in 2012-11-06, accepted in 2013-03-28,  发布年份 2013

【 摘 要 】

Background

In many parts of the developing world, rural health requires focused policy attention, informed by reliable, representative health data. Yet there is surprisingly little published material to guide health researchers who face the unique set of hurdles associated with conducting field research in remote rural areas.

Methods

In this paper we provide a detailed description of the key challenges encountered during health survey field research carried out in 2010 in a deep rural site in KwaZulu-Natal, South Africa. The aim of the field research was to collect data on the health of children aged 10 to 17 years old, and their primary adult caregivers, as part of a larger national health survey; the research was a collaboration between several South African and foreign universities, South African national government departments, and various NGO partners. In presenting each of the four fieldwork challenges encountered on this site, we describe the initial planning decisions made, the difficulties faced when implementing these in the field, and the adaptive strategies we used to respond to these challenges. We reflect on learnings of potential relevance for the research community.

Results

Our four key fieldwork challenges were scarce research capacity, staff relocation tensions, logistical constraints, and difficulties related to community buy-in. Addressing each of these obstacles required timely assessment of the situation and adaptation of field plans, in collaboration with our local NGO partner. Adaptive strategies included a greater use of local knowledge; the adoption of tribal authority boundaries as the smallest geopolitical units for sampling; a creative developmental approach to capacity building; and planned, on-going engagement with multiple community representatives.

Conclusions

We argue that in order to maintain high scientific standards of research and manage to ‘get the job done’ on the ground, it is necessary to respond to fieldwork challenges that arise as a cohesive team, with timely, locally-relevant, and often creative, solutions. Budgeting sufficient time and project resources for capacity building and community buy-in processes is also essential when working in remote communities unaccustomed to research. Documenting and sharing field experiences can provide valuable information for other researchers planning to conduct fieldwork in similar contexts.

【 授权许可】

   
2013 Casale et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Health Systems Trust: The District Health Barometer 2008/09. http://www.hst.org.za/sites/default/files/dhb0809_intro.pdf webcite
• [2]Gaede B, Versteeg M: The State of the Right to Health in Rural South Africa. South African Health Review (Chapter 9)http://www.hst.org.za/publications/south-african-health-review-2011 webcite
• [3]Shisana O, Rehle T, Simbayi L, Zuma K, Jooste S, Pillay-van-Wyk V, Mbelle N, Van Zyl J, Parker W, Zungu N, Pezi S, SABSSM III Implementation Team: South African National HIV Prevalence, Incidence, Behaviour and Communication Survey 2008: A Turning Tide Among Teenagers?. Cape Town: HSRC Press; 2009.
• [4]Clark S, Collinson M, Kahn K, Drullinger K, Tollman S: Returning home to die: circular labour migration and mortality in South Africa. Scand J Publ Health 2007, 69:35-44.
• [5]Versteeg M, Couper I: Position Paper: Rural Health - Key to a Healthy Nation. Johannesburg: Rural Health Advocacy Project; 2011.
• [6]Rural Health Advocacy Project: KZN Department of Health Adopts Ground-breaking Rural-friendly Community Service Officers Policy. http://www.rhap.org.za/ webcite
• [7]Casale M, Flicker S, Nixon S: Fieldwork challenges: Lessons learned from a North–south public health research partnership. Heal Promot Pract 2011, 12:734-743.
• [8]Mathee A, Harpham T, Naicker N, Barnes B, Plagerson S, Feit M, Swart A, Naidoo S: Overcoming fieldwork challenges in urban health research in developing countries: a research note. Int J Soc Res Methodol 2010, 13(2):171-178.
• [9]Gokah T: The Naive researcher: doing social research in Africa. Int J Soc Res Methodol 2006, 9(1):61-73.
• [10]Dawad S, Veenstra N: Comparative health systems research in a context of HIV/AIDS: lessons from a multi-country study in South Africa, Tanzania and Zambia. Health Res Pol Syst 2007, 5:13. BioMed Central Full Text
• [11]Falagas M, Bliziotis I, Kondilis B, Soteriades E: Eighteen years of research on AIDS: contribution of and collaboration between different world regions. AIDS Res Hum Retrovir 2006, 22(12):1199-1205.
• [12]Volmink J, Dare L: Addressing inequalities in research capacity in Africa. BMJ 2005, 331:705-706.
• [13]Katsouyanni K: Collaborative research: accomplishments & potential. Environ Heal 2008, 7:3. BioMed Central Full Text
• [14]El Ansari W, Weiss E: Quality of research on community partnerships: developing the evidence base. Heal Educ Res 2006, 21:175-180.
• [15]Gonzalez-Block M: The state of international collaboration for health systems research: what do publications tell? Health Res Pol Syst 2006, 4:7. BioMed Central Full Text
• [16]University of Michigan: Guidelines for Best Practice in Cross-Cultural Surveys. Second edition. http://ccsg.isr.umich.edu/pdf/00FullGuidelines3.pdf webcite
• [17]KwaZulu-Natal Department of Health: Manguzi hospital. http://www.kznhealth.gov.za/manguzihospital.htm webcite
• [18]Statistics South Africa: Community Survey 2007. http://www.statssa.gov.za/community_new/content.asp webcite
• [19]Umhlabuyalingana Local Municipality: Final draft IDP 2010/11. http://ebookbrowse.com/kzn271-umhlabuyalingana-idp-1011-pdf-d242191931 webcite
• [20]Statistics South Africa: Census. 2001. http://www.statssa.gov.za/publications/CensusKey/CensusKey2001.pdf webcite
• [21]Everatt D, Smith M, Khanya-aicdd A: Building sustainable livelihoods in Umkhanyakude. The Department of Social Development's study on the ISRDP and URP. catalog.ihsn.org/index.php/catalog/2842/download/43344
• [22]Department of Health: The National HIV and Syphilis Prevalence Survey South Africa. Pretoria: Department of Health; 2008.
• [23]Noble M, Babita M, Barnes H, Dibben C, Magasela W, Noble SN P, Phillips H, Rama S, Roberts B, Wright G, Zungu S: The provincial indices of multiple deprivation for South Africa 2001. Oxford: Centre for the Analysis of South African Social Policy, University of Oxford; 2006.
• [24]Statistics South Africa: Census 2001: Investigation into Appropriate Definitions of Urban and Rural Areas for South Africa: Discussion Document. Pretoria: Statistics South Africa; 2003.
• [25]Tholulwazi Uzivikele: Programmes. What we do. http://www.tuproject.org/programmes-what-we-do.html webcite
• [26]Roper L: Achieving successful academic-practitioner research collaborations. Dev Pract 2002, 12(3/4):338-345.
• [27]Adams A, Miller-Korth N, Brown D: Learning to work together: developing academic and community research partnerships. Wis Med J 2004, 103(2):15-19.
• [28]Emanuel E, Wendler D, Killen J, Grady C: What makes clinical research in developing countries ethical? the benchmarks of ethical research. Perspective 2004, 189:930-937.
• [29]Jentsch B: Making Southern realities count: research agendas and design in North–South collaborations. Int J Soc Res Methodol 2012, 7(3):259-269.
• [30]White F: Capacity-building for health research in developing countries: a manager's approach. Pan Am J Public Health 2002, 12(3):165-172.
• [31]Ghaffar A, IJsselmuiden C, Zicker F: Changing Mindsets: Research Capacity Strengthening in Low and Middle-Income Countries. http://www.who.int/tdr/publications/documents/changing_mindsets.pdf webcite
• [32]Nchinda T: Research capacity strengthening in the South. Soc Sci Med 2002, 54(11):1699-1711.
• [33]Bates I, Taegtmeyer M, Squire B, Ansong D, Nhlema-Simwaka B, Baba A, Theobald S: Indicators of sustainable capacity building for health research: analysis of four African case studies. Health Res Pol Syst 2011, 9:14. BioMed Central Full Text
• [34]Council for International Organizations of Medical Sciences: International Guidelines for Ethical Review of Epidemiological Studies. Geneva: Council for International Organizations of Medical Sciences; 1991.
• [35]Weijer C, Goldsand G, Emanuel E: Protecting communities in research: current guidelines and limits of extrapolation. Nat Am 1999, 23:275-280.
• [36]Kaufman C, Ramarao S: Community confidentiality, consent, and the individual research process: implications for demographic research. Popul Res Pol Rev 2005, 24(2):149-173.
• [37]Nyambedha E: Ethical dilemmas of social science research on AIDS and orphanhood in Western Kenya. Soc Sci Med 2008, 67(5):771-779.
• [38]Crigger N, Holcomb L, Weiss J: Fundamentalism, multiculturalism and problems of conducting research with populations in developing nations. Nurs Ethics 2001, 8(5):459-468.