Qualitative research in rural settings: what does it take?
As a Research Assistant with the NHIR Group on Stillbirth Prevention and Management in Sub-Saharan Africa at the University of Manchester, an important part of my role was to conduct in-depth interviews with parents who had experienced a stillbirth in a rural area in Central Uganda. It was a tough but important learning experience for understanding the informed consent process, time required and issues around access to participants.
Challenges in data collection.
Firstly, to obtain informed consent I needed to give information about the study, to allow the participants to understand what taking part in the study would entail so they could offer their voluntary agreement. The participant information sheet was translated to the local language to ensure that participants get the same information about the study. During the consenting process, it was necessary for me to explain some aspects of the study, answer questions and be open to discussions that arose. It was not always easy to communicate research information because most people in rural areas had not been exposed to research and did not immediately understand why research was necessary. I sometimes faced suspicion especially around signing/ providing thumbprint on forms necessary to record consent, this is because families are only asked to sign in situations such as obtaining bank loans and making land sale agreements which are viewed negatively in the society. I experienced a situation where the participant refused to consent because he suspected that I might have hidden intentions. I later learnt that due to the rampant land grabbing going on in the area, the participant feared that appending a thumbprint would cost him his plot of land. Success was dependent on giving enough time for discussion and explanation
Secondly, in rural Ugandan districts, transport and travel was an issue, locating participants was sometimes difficult, even with addresses of parents who had agreed to take part. Community leaders and members of the Village Heath Teams (VHTs) were a great help with recruitment and locating the families. I learnt that in order to interview the required number of participants, I needed to plan properly for time and transport.
Despite the challenges in identifying participants obtaining informed consent and locating the homes, the participants who were successfully recruited were generally open, very welcoming and willing to talk freely about their experiences of care after stillbirth. We obtained rich information about cultural beliefs and practices regarding stillbirths because participants were more at ease to talk about their experiences.
To conduct successful research in a rural setting, you have to be ready to give the potential participants enough time, explain to them what research is, why studies are conducted and also provide detailed information about the study. It is also important to give participants time to think about the research and discuss with spouses or family members so that they can make informed decisions. Patience and commitment are key when conducting studies in rural areas due to the potential barriers involved. Giving voices to rural parents’ experiences is crucial to ensure full understanding of how care in this area can be improved.
By Allen Nabisere (Research Assistant, Uganda)