TRAINING

Report on Structural Training Project (PSF Programme)

Introduction

The project SOCIAL SCIENCES & HEALTH RESEARCH CAPACITY-BUILDING IN VIENTIANE, LAOS (SHSL-Capacity) is a Lao-French cooperation initiative aiming at developing an annual offer of intensive training and multidisciplinary methods and tools related to social sciences in health research. The project will be implemented with the support of the University of Health Science (UHS), and the Lao Public Health Institute (LaoTPHI), the Faculty of Social Sciences at the National University of Laos, the Education Consulting Center (ECC), the University of Montréal (Department of History CETASE) and IRD/ TransVIHMI.

This demand takes place in an overall context of lack of specific skills in social science research, especially in the field of qualitative health research. This issue has been identified by the researchers of the University of Health Sciences in Vientiane.

2. Implemented activities

A forum theatre session was facilitated by Sarah Muller, a forum theater specialist, an afternoon on day 2.

In each session, the participants were engaged in role-plays or working groups in order to allow them to explore and better understand the practices and methods proposed by the trainers.

The participants were satisfied of the quality of the training and many of them provide positive feedbacks highlighting that they did not had the opportunity to learn about qualitative research. It is to say that many participants are familiar with quantitative survey and have almost no experience in conducting qualitative research. This first training was also a space for exchanging research experiences and build progressively a researcher’s collective that could be engaged in the long-term in different stages of action-research projects such as the HEALTH Project. This objective has been explained to the participants and it has also reinforced their motivation and level of participation.

Luang Namtha area raises various questions related to health issues in the field of MCH, HIV and TB. Malaria issues needs to be updated. This part of Northern Laos has been for years the field of various rapid social changes especially due to the proximity with China Border. In early 2000, the emergence of the Special Economic Zone in Boten brought first a casino, an activity that contributed to reallocating the villagers already living on site who were resettled outside of the zone. The casino activities also contributed to the emergence of various traffic and sex works. The commercial market is largely dominated by the Chinese, and local people have a minimal commercial role. Through their transnational networks, Chinese entrepreneurs are the main beneficiaries of the economic benefits of the North-South Corridor linking Kunming (Yunnan, China) to Bangkok (Tan, 2014). In 2011, the closing of the casino by the Chinese government helped to change the settings again. Boten became a new location for Chinese entrepreneurs in the field of transportation, logistics, and real estate. This has brought people in the area, and somehow various opportunities for Lao young people around who are working for those compagnies. While some are still farmers in the area, many, among the youth, move for higher waged labor in Boten. All of those social changes have some positive impacts for some people involved in the trend brought by those new trades, for others, life has become much more difficult, as in the Boten area, they do not have access to environmental resources which was earlier their only mode of subsistence.

During 4 days, the research team supervised Dr. Souvanxay Phetchanpheng and Leeyay Sayaxang from ECC has been able to experiment the lessons learnt from the previous training and test the data collection tools designed during the previous workshop implemented on 14 December. They had also the opportunity to try observation techniques and informal interviews with different persons living in between Nateuy and Boten such as truck drivers, construction workers, sex workers, guesthouse owners and adolescents out of school.

In total the team has conducted 31 formal interviews, 15 informal interviews, 10 registered observations and 2 FGD.

3. Discussion and recommendation

The capacity building process for 15 initial junior researchers on qualitative research has allowed for many of them to experiment research methods and skills that they did not were familiar with before.

It is mainly by using a learning by doing approach that the junior researchers have been able to gained new skills and knowledge.

Their involvement in an action-research project such as the HEALTH project allows this go-and-back between theory and practice. Sign of the positive feedback from the junior researchers, we observe a good level of participation and attendance in the 2 workshops where all the participants were invited.

This can be considered as a positive indicator when we know that an important turn-over exist among Lao government staff attendance in the training initiated by the projects.

In terms of skills gained by the participants, the ethnographic survey and the participatory video analysis workshop allowed us to observe some effective practices but also some gaps among the 4 junior researchers who have been able to participate to the ethnographic survey.

The effectives practices observed among the junior researchers:

The preparation to the interview is generally well mastered. They are able to inform the respondent of the interview purpose and ask the authorization for audio recording the interview
They generally know how to identify the key informant to interview
They understand the necessity to use open questions as much as possible and when possible when conducting a semi-structured interview
Capacity to use a simple and direct language; talks to people on their level; no technical words are used
They generally ask about one idea at a time
They try to not influence people in their answers
They respect respondent’s opinions (no judgement)
They encourage respondent to give his/her opinions
They understand and know how to use the snow ball technique in order to reach other potential key informants mentioned during an interview
To visit, to see someone else or a place indicated by the respondent when possible
Capacity to keep the right distance during the interview: not too far and not too close. A social distance between 2 persons is generally between 1 and 4 meters (Hall’s 4 distances)

The main areas that need to be improved among our junior researchers are the following ones:

The interviewers are not always able to ensure that confidentiality is respected during the interview (e.g. not perturbed by other people, discussion is not listened by others…). A topic such as Tuberculosis is a sensitive topic in these communities as it is a communicable disease. Thus, it requests more confidentiality and isolation from others community members when conducting interviews.
The knowledge of the questionnaire is not always sufficient and there are still many junior researchers who need to refer regularly to the questionnaire for conducting an interview. This has the negative effect to disrupt the “normal” process of a discussion
Second questioning is generally not used by the junior researchers while it could help them to get more details and explanations. Many respondent’s answers are still too short. The junior researchers have still some challenges to find a way to get longer answers
They still face some challenges to adapt the questions and way to ask questions according to different situations
Sometimes, some junior researchers don’t provide enough time to the respondent for thinking and answering their questions
Capacity to observe/read the level of comfort or lack of comfort of the respondent during the interview (see the 2 photograms below)
Think to ask about some short stories related to the topic discuss
To skip some questions when the answer has already been provided
“Listen than speak”

STRUCTURAL TRAINING PROJECTS
(PSF PROGRAMME)
SOCIAL SCIENCES & HEALTH RESEARCH CAPACITY-BUILDING

What are the specific goals?

The specific goals of the qualitative study are to:

·Observe and document health practices and health systems within the local communities and in particular their reproductive and sexual health practices, condom access, breastfeeding (colostrum), abortion pills, ways of delivery (where, how, with whom, why), postnatal care;

·Observe and document gender, ethnic and power dynamics within the village;

·Observe and document the level of digital equipment use and literacy (as the project aims at providing mobile education techniques);

·Map the existing resources, needs and priorities described by villagers and village authorities in terms of prevention and management of MCH HIV, TB and malaria.

Methodology

The main approach is centred on collecting testimonies from the families, especially mothers and adolescents, health staff from local health centers, village authorities and other stakeholders from different communities and different cultural backgrounds.

This study seeks to integrate several testimonials and ethnographic observations that will serve as a basis for understanding the health practices and health systems within the communities; the local knowledge and beliefs about illness; the gender, ethnic and power dynamics within the communities; the existing resources, needs and priorities in terms of prevention and management of MCH HIV, TB and malaria.

What is the qualitative survey approach?

The approach of a qualitative survey is close with an ethnographic research where researchers observe and/or interact with people in their real-life environment.

Ethnographers often live amongst a group/society for long time (few months, a year or more), in order to learn about them.

The objective is to spend time as much as possible in the village in order to learn about their knowledge, attitudes and practices towards specific life aspects.

Understand subjective experiences, beliefs, and concepts,

Gain in-depth knowledge of a specific living context of the targeted communities

TOOLS

A qualitative research can combine several methods such as desk research, semi-structured interviews, observations and focus group discussions.

Each interview should be audio recorded in order to not lose any important data.

General recommendations for using the tools

Keep the language simple and direct is very important

Talk to people on their level

Always ask about one idea at a time

Try to not influence people in their answers

Adapt the tools and way to ask questions according to different situations

Respect their opinions: we are not judges; our first mission is to undertand people better in order to find the most appropriate solutions to their problems.

MIX OBSERVATIONS AND INTERVIEWS

FOCUS GROUP DISCUSSION

A discussion group is a group of individuals with similar interest who gather either formally or informally to bring up ideas, solve problems or give comments.

Time needed: 1 to 2 hour/s

Resources needed: 1 facilitator who can speak the local language, 1 observer who record the discussion (recorder or taking notes)Recommendation: Sometimes it can be better to conduct FGD by gender and by age during the group discussion