Wednesday, 1 February 2017

The hurdle of hesitance

by Azmat Budhani

People's fear of health related interventions is not new. Spoof by British satirist James Gillroy depicting people's fear of small pox vaccines, 1802
Photo credit: Wikimedia Commons

As a researcher, I have often dealt with non-responses or respondent hesitancy in fieldwork. Earlier, I used to think that this hesitancy can only be minimized by building personal rapport through multiple visits. Over the years though, I have come to appreciate the role survey design plays in participant engagement. Our LANSA study, for example, seeks to investigate the impacts of women’s agricultural work on their own and their children’s nutrition levels. For this survey, we took the mother of an infant as the key respondent. Placing her instead of the head of household (who in most cases are male breadwinners for the family) on the top of the household roster had important implications for our fieldwork, as discussed in an earlier blog. Despite the process of anthropometric measurement being fairly clinical, or even intrusive, we found a majority of mothers eager to cooperate. They were keen to provide any information that could potentially benefit the health and future well-being of their children. Women tried to navigate constraints put by male community leaders and heads of households. One mother, for example said, ‘’My husband works in the Pakistan Army. He does not like NGOs. However, I am willing to participate.”

Concerns expressed by male community leaders and household head usually came from a mistrust of our intentions. We were told for example, “I would allow you to interview and measure my child and wife if you were from a governmental department, but not if you are from a non-governmental entity.” A man affiliated with a well-organized religious and political group said, “You are surveying here because your donor will supply foreign medicines to our children and women. We will not allow you to work here in our village.”

We addressed these concerns using two main strategies. First, we identified active and influential male members of the community and built their understanding of our research objectives. These male members helped us motivate our target respondents’ families to allow women to participate. Second, we hired well educated and experienced field researchers with gender, caste and ethnic identities similar to our research participants. They found a common ground about the health and well-being of young children, which helped develop a natural rapport between researcher and respondent.

Time itself led to greater trust. The survey was conducted in two rounds. In the first round, communities raised questions regarding the benefit and possible outcomes of our interviews and anthropometric surveys. When we returned later last year for the second round of the survey, which was followed by a set of engagement activities to share our baseline results in selected communities, we saw mistrust gradually fade away with each repeated interaction. It seemed that in most cases people were not opposed to our research objectives, but simply guarding their self-interest against possible exploitation.