An International Research Consortium to Maximise Benefits & Equity of HIV Treatment & Care Systems

A new manual to support self-training and teaching of qualitative research methods has been launched by the Evidence for Action research consortium. The manual is aimed primarily at non- social scientists working in low- and middle-income settings. It provides an accessible, interesting, and clear guide to using qualitative research methods in applied health settings.
The manual is organised around three main goals:

• To introduce qualitative thinking in research;
• To assist in planning, choosing, and using qualitative research methods in health-related studies and;
• To enable the management of qualitative data with a view to preliminary analysis.

The manual was developed by Karina Kielmann, Fabian Cataldo and Janet Seeley. All three authors have been working in health and development for many years, and draw extensively on their own experience of teaching and using qualitative research methods. Short, informative texts that introduce key concepts are combined with examples, visual illustrations, and exercises to enhance learning. The manual provides feedback on the exercises as well as a list of further resources. The manual may be used as an introductory or refresher self-learning guide, or in support of short-term training in qualitative research methods for applied health research.

Download full Introduction to Qualitative Research Methodology training manual screen version (pdf, 1,778kb), print version (pdf, 1.5mb) or by chapter:

• Introduction to Qualitative Research Methodology: Introduction (pdf, 300kb)
• Introduction to Qualitative Research Methodology: Chapter 1: The Qualitative Lens (pdf, 130kb)
• Introduction to Qualitative Research Methodology: Chapter 2: The Quantitative - Qualitative Continuum (pdf, 181kb)
• Introduction to Qualitative Research Methodology: Chapter 3: Issues in the Design of Qualitative Research (pdf, 158kb)
• Introduction to Qualitative Research Methodology: Chapter 4: Interviews (pdf, 352kb)
• Introduction to Qualitative Research Methodology: Chapter 5: Group Interviews (pdf, 269kb)
• Introduction to Qualitative Research Methodology: Chapter 6: Observation (pdf, 192kb)
• Introduction to Qualitative Research Methodology: Chapter 7: Fieldwork (pdf, 271kb)
• Introduction to Qualitative Research Methodology: Chapter 8: Ethics and Logistics of Data Collection (pdf, 253kb)
• Introduction to Qualitative Research Methodology: Chapter 9: Steps Towards Data Analysis (pdf, 79kb)
• Introduction to Qualitative Research Methodology: Next steps, exercises and feedback to exercise, references etc. (pdf, 91kb)

There are 7000 new HIV infections every day, 99 per cent of maternal deaths happen in developing countries and access to sexual and reproductive health services is woefully inadequate. Evidence can help to improve policies and health services but too often it doesn’t get used. A special supplement of the journal Health Research Policy and Systems provides crucial lessons on translating research into policy and practice for a lasting impact.

The supplement has been produced by the Sexual Health and HIV Evidence into Policy (SHHEP) initiative, which Evidence for Action was part of. The Supplement brings together the experiences of academics and communications professionals from Africa (South Africa, Malawi, Tanzania, Kenya, and Ghana) and Asia (Bangladesh and India) to explore how they have influenced decision makers. Whilst each paper is context and issue specific the lessons learned are relevant for researchers, practitioners, donors and policy makers working elsewhere and on topics other than health.

“Research should play a crucial role in improving health but it doesn’t always have the impact that it should. Communicating research findings is not about spin - it is about getting the evidence into the hands of people who need it and helping them to put it into practice. The Supplement gives guidance on how to do that. The issues that are important here - sex, access to health care and violence - are often highly political, and approaches to communicating research need to take this into account,” said Dr Sally Theobald, one of the editors from Liverpool School of Tropical Medicine.

Topics covered by the papers include:

• How an approach to safe sex which focuses on pleasure rather than disease and death can strengthen HIV prevention interventions.
• How researchers working to improve the health of orphans and vulnerable children affected by HIV in Ghana formed a close relationship with Government health and social welfare departments.
• Building trust between researchers, community members and policymakers in herpes simplex virus treatment trials for HIV prevention in South Africa.
• Assessing the impact of a new report ‘Reviewing Emergencies’ for Swaziland, which documented the impact of HIV on this small country.
• Work to engage the media about sexual and reproductive health in Kenya where researchers worked with the popular soap opera Makutano Junction on story lines that tackled issues like rape and homosexuality.
• How researchers in Bangladesh brought together journalists, public health workers and academics to discuss sexuality and rights issues with sexual minorities, for example gay men and lesbians.
• An examination of the process through which the evidence related to HIV–HSV-2 interactions influenced policy at the international level and was then transferred to national level in Ghana.
• National policy development for cotrimoxazole prophylaxis in Malawi, Uganda and Zambia.
• An examination of the Regional Network on AIDS, Livelihoods and Food security’s role in influencing.
• How to design and implement communications strategies in multi-partner research programmes.

In their foreword to the Supplement Professor Chris Whitty (Director Research and Evidence Division) and Dr. Sue Kinn (Head of Health Research) from the UK Department for International Development comment, “The papers in this special supplement focus on lesson learning on getting research into policy and practice. They highlight the range of methodologies and approaches researchers and communication specialists have used in different contexts to try to ensure research does not simply gather dust on library shelves but feeds into and is relevant to policy and practice in different contexts. I hope that the innovative approaches and promising ways forward, presented in these papers, will inspire and motivate others.”

The supplement is free to access and download.

Evidence for Action has now been going for five years, thanks for funding from the Department for International Development. In this time we have carried out research on 76 research projects in Africa and Asia. We have produced more than 300 publications on major questions relating to HIV treatment and care systems. Our work has contributed to improving policies and practices at local, national and international levels. Funding for the programme finishes on 30th June. The Final Report (pdf, 1,183kb)  of the programme gives details of the work we have been doing, and what impact this has had so far. This report is quite lengthy and detailed, so if you want more concise information on our main findings, the Key Messages Report (pdf, 2MB) may be a better place to start.

The partners will continue working on outputs and publications from the programme, which will be added to the website as they become available, but the News section of the website will not be updated regularly.

Improved access to services for the prevention of mother-to-child transmission of HIV (PMTCT) has decreased vertical HIV transmission. However parallel attention to women’s access to HIV care and treatment for themselves has often been lacking. A study in Naivasha district, Kenya, used a combination of review of routine hospital data and a prospective follow-up study. It focused on maternity services, including ANC and delivery, in the two main government hospitals in the district. It established that the proportion of women who tested HIV positive in maternity services who went on to be assessed as to whether they needed lifelong highly active antiretroviral therapy (HAART) for their own health was very low. There was considerable further attrition between women being assessed as needing HAART and actually being started on HAART.
Between 2008 and 2010, 1,129 women tested HIV positive in Naivasha district’s two main government hospitals. Based on the levels of immunosuppression among this population, if they had all registered at the hospitals’ HIV clinic, done CD4 tests and, if necessary, started HAART 513 would have started treatment. Instead, 6 months after their diagnosis with HIV, only 27 (just 5%) had started HAART.

Qualitative research and health systems analyses have pinpointed key client, health system, and societal factors that act as barriers to women starting HAART. The research also identified potential solutions that are needed to allow women to successfully negotiate the chain of steps between being diagnosed with HIV and successfully starting on HAART if needed.

More information about this project can be found in a new case study (pdf, 133kb), and a policy brief (pdf, 132kb) that discusses the implications of this research together with a similar study in Mwanza, Tanzania.