Lessons Learned: Logistics

Since I’ve been back in the States, I’ve been making lists of what I should remember to do differently next time. I thought I would share for anyone who’s planning to do similar work in a similar place.

I’ll start with the most practical. One of the biggest surprises in Muhuru was how much time I spent figuring out how to do seemingly simple tasks. Without access to electricity, banks, and an office supply closet, I often felt lost.

7 Logistics changes I will make next time:

1) Take out plenty of cash ahead of time (a trip to the closest ATM took at least half a day).

2) Pay research staff every two weeks (not weekly); Getting correct change is not easy and not fun, so minimizing the frequency would help. For a little extra fee, I might also pay through MPESA (money transfer service associated with the cell phone company).

3) Give research staff cell phone airtime on a regular basis, and ask them to do as much scheduling and arranging logistics as possible (e.g., transportation for fieldwork). They were much better at it and more efficient… things happened much more quickly (and often less expensively) when negotiations were made in the local language.

4) Pack office supplies – tape, folders, paperclips, envelopes, etc…I’ll think ahead about what will make organization easier to make up for limited office and storage space.

5) Print and copy ahead of time.

6) Use text messages and written letters to invite people to meetings or events; communication over the phone was more difficult than in writing or in person, so scheduling based on only phone conversations often led to confusion.

7) Ask for ideas about logistical challenges (scheduling, planning, etc.) from people who are from the community before racking my brain to figure it all out. Often there were systems in place already and/or things to consider that never would have occurred to me.

The Research Teams...Delayed Recognition

Because I had a hard time uploading photos and video in Muhuru, it was difficult to show you who was working on this project. My research team from Muhuru Bay and Egerton University collected all of the data for the qualitative and survey components.

For the qualitative phase, I hired 5 interviewers from Egerton and 5 interviewers from the Muhuru Community. For the survey phase, I hired 5 additional enumerators from Muhuru for a local team of 10.

A glance at some of their work...

Egerton University students translating part of the qualitative interviews, trying to figure out how to say "personal questions" in Dholuo, the local language in Muhuru.




Preparing for a focus group on the WISER site (before there was a roof on our "office"):

Conducting focus groups...but having to build the shelters first

The Muhuru Team traveled ALL OVER Muhuru by motorbike to conduct surveys...hours of riding, walking, coordinating with schools, and searching for homes.

Asking teachers to direct us to homes

Surveys under trees


All of us - Kanyakala ("together" in Dholuo)

Ero Kamano Ahinya!

Back Home...With Data

I am back in the U.S., unpacking and looking forward to analyzing data from the summer. Our hectic schedule with data collection and the DukeEngage program kept me from posting during the last month of fieldwork. So here are a few updates:

1) We completed 325 youth surveys and 324 caregiver surveys (we just couldn't catch that last mom at home!). We were excited to reach our goal - this number will give us enough statistical power to look at the relationships between mental health / family factors and HIV risk behavior. Our high-tech chart here kept us motivated...

2) After calculating some descriptive results from the survey, we held a community results meeting to share preliminary findings. The turn out was good, and people seemed genuinely interested. The meeting ended with a suprisingly animated debate about Voluntary Counseling and Testing...not directly related to our findings, but at least people are passionate about the issues.

3) I formed a Community Advisory Committee to help analyze the data and generate ideas for the intervention strategies we will begin designing over the next 6 months. The group includes health care workers, teachers, pastors, and leaders of community-based organizations that work on issues related to HIV. We held two training meetings covering the basics of HIV prevention, and we will now start a long-distance collaboration. The committee will provide feedback on analysis, generate intervention ideas, and plan for intervention piloting in 2010. Here is the committee at our final planning meeting:

Surveys...Looking Toward Intervention

After completing qualitative interviews, we have begun conducting surveys to gather information about a larger number of youth. Our goal is to include 300 youth in grades 5 through 8 and their caregivers. Youth were randomly selected from school rosters with the goal of recruiting a sample representative of youth in Muhuru. The sample is stratified by location, meaning that more students were selected from more populated areas.

The survey data will provide information to guide the development of strategies to prevent HIV and improve youth well-being in Muhuru. The following are questions the survey data will help address:

• Mental Health: How common is depression among youth? How do youth cope with challenges? What is the rate of exposure to traumatic events and symptoms of traumatic stress?

• Family Support and Communication: Do youth feel supported by their caregivers? How much are parents monitoring the activities of their children? Are youth and parents discussing issues of HIV and AIDS?

• HIV Knowledge: Do youth and caregivers have accurate knowledge about HIV transmission?
• Socioeconomic Factors: How often are caregivers able to provide their children’s basic needs? How are the youth earning money themselves?

• HIV Risk: When do boys and girls become sexually active? Are they using condoms? How many partners do they have? Who are their partners?

How will this information help develop a prevention program??

We will be able to examine how youths’ HIV risk behavior may be related to their mental health, family support/communication, socioeconomic situation, and HIV knowledge. We will then know which factors we should prioritize in an intervention to decrease HIV risk behavior.

One Example: If ratings of communication between parents and youth are highly related to whether youth become sexually active at an early age, improving parent-youth communication is likely to be an important aspect of an HIV prevention program.

For those less interested in these research details and more interested in pictures, I updated my Picasa albums recently: http://picasaweb.google.com/evepuffer

Focusing on Resilience

The transcripts from our qualitative interviews are almost all complete. So I have plenty of bedtime reading and food for thought as we move into the survey phase of the project.

The stories of the youth and parents certainly highlight the risk among youth here. The common cycle of poverty, hopelessness, emotional distress, and risk behavior is clear throughout the interviews. Also clear, however, is the resilience of many youth and families. A few examples:

· A single father who recognizes his daughter’s probable embarrassment to ask for new underwear or sanitary pads -- and gives her pocket money without asking how she spends it.

· An adolescent girl who grows and sells her own vegetables to buy school supplies and soap (and gives the remaining amount to her grandmother who is her caregiver).

· A single mother who distracts her daughter with activities inside the house when other children are walking to school because she doesn’t want her daughter to feel sad about not being able to afford school right now.

· A pastor who is on-call 24 hours a day for a mother whose husband is often drunk and violent when he returns home from his job in a neighboring community.

Stories of resilience provide an exciting starting point for developing intervention ideas -- these families have clearly found creative solutions that work.

Kenyan Feast!

Last Wednesday, Mama Eunice helped me throw a thank-you dinner for my research team. They have been working long hours to transcribe and translate interviews, and I wanted to celebrate the end of qualitative data collection. I asked Mama Eunice to cook, and she made amazing versions of almost every Kenyan food we typically eat. I am in Nairobi now, so I thought I'd show what the food is like.

This first picture has cooked cabbage (one of my favorites) and green grams - which are a lot like lentils.



Below are beef with broth and then mixed cooked bananas and potatoes. Next is chipote - fried round bread (another favorite...great with green grams!).

This is tilapia, fresh from Lake Victoria.








And here are the cooks - Mama Eunice and Vivian












More pictures are on Picasa: http://picasaweb.google.com/evepuffer

Final Focus Groups: Lessons Learned

We held our final focus groups for youth and parents today. Now my research team faces hours of transcribing and translating so I can read the actual responses. Even without having all of the data yet, though, I have learned a few lessons about doing this type of research:

1) Word travels quickly - If you give sodas and transport money after focus groups (and if they're fun), people start inviting their friends and neighbors to attend. Some people even come twice. So much for random selection...but it's nice that people want to come!

2) Hold on to your digital recorders! A purse was stolen from a research assistant yesterday with her pay for the week, her cell phone, and the recorder. It was really terrible for her, but someone spotted the digital recorder being used in the center of town. Apparently the person took it to the cell phone store asking how to use it. The Chiefs of the village found him, and the recorder was returned - luckily no data lost and no confidential data were released. When the recorder was returned, I pressed play and found 27 songs that had been recorded in a matter of hours. The Chiefs and the police are still searching for the person who stole the money...I will write an update if there's any progress.

3) If you see dark clouds, go home immediately. It is not fun to ride on a motorbike in the rain in the dark with lightning. After one bad experience, I just end the interviews early now and send everyone home!

4) Trees are great interview spots. I was very worried about privacy for our interviews before I arrived, but I quickly realized that people feel most comfortable around their homes and they know where to find private spaces that others will respect. Some of the best interview spots actually seem the most open and beautiful - big shady trees, rocks overlooking the lake.

Next time I write, I hope to have an update on what we are learning from the qualitative data!

Psychology Jokes at Dinner

A quick story for those of us in psychology...

One of my research assistants, Keziah, is also the daughter in the family that is hosting us. We don't tend to talk about work much at dinner, but yesterday, her mother mentioned that she had a headache. Keziah then started asking her mother question after question..."Tell me more about your headache....How do you feel about having a headache?...Give me an example of the last time you had a headache..." I quickly realized she was (good naturedly) making fun of our interview supervision earlier that day where I stressed the importance of probing for details and feelings. I was so excited - if you're making clinical interviewing jokes at dinner, I think that's a pretty good sign that you're getting it.

Data Collection - And Translation Continues

We've now had two days of interviewing and one afternoon of focus groups with youth and caregivers. Yesterday, I received final English transcripts from each member of the research team. They have been gathering data all week, but since everything is conducted in Dholuo, this was the first time I was able to read the interview responses. The youth and families are sharing interesting stories and experiences. After spending my time these first days primarily on logistics, it is exciting to read and begin to think about the ways we can use this information for intervention development.

The process of reading the transcripts certainly reminded me how important small differences in language can be - particularly when asking about mental health and relationships. One interview question is:

"Children often have different moods and emotions. Some are happy a lot, while other children feel sad or angry a lot of the time. Tell me about your child's mood and how he/she seems to feel most of the time."

The first time this was translated into Dholuo, we realized it actually said, "Tell me about when your child changes his or her mind." The second version asked specifically about mood swings. After a third translation yesterday, we were finally asking a general question about children's moods - a pretty important question in mental health research, but a concept that was not easily translated.

As I post this, I am trying to upload photos to Picasa...I'll let you know if it works. I've given up on Blogger - my modem is just not fast enough.

Muhuru Update!

Hi everyone. I've been trying to wait to have a good enough connection for photos and videos, but no luck yet. I arrived in Muhuru last Sunday, and things have been moving quickly since then. Here are the highlights...pictures soon!

1. I interviewed 20 applicants for local research interviewers. We held two days of training and evaluation to narrow down to 5 very qualified individuals.
   
2. Research assistants from Egerton joined us in Muhuru today, so the whole team is here. We have another day of back translating and finalizing the measures - then we'll get started with interviews!
   
3. Emily Matthews arrived this week to work with me. Emily is a Duke student who completed an independent study with me this semester. She will be assessing HIV education in the schools in Muhuru. Emily has been a HUGE help with the trainings.
   
4. Bananas are fabulous here, so I've been introducing my Kenyan friends to banana and peanut butter sandwiches - yum!

First Days in Kenya

I arrived in Nairobi on Sunday and spent my first two days recovering from jet lag and running errands. My most exciting purchase: a big fabric tent (complete with retractable net screens on the sides) that will be our "office" on the WISER site. Putting it together will be an interesting team building exercise (there are LOTS of pieces!).

I traveled to Nakuru today to Egerton University to meet five students who will be research assistants for my project. Our first afternoon of training went well, and I am excited to be building a research team. Nakuru is also a beautiful city with a large lake filled with flamingos - yes, flamingos. I was surprised to look out of the car window to see the water covered with thousands of bright pink birds. Quite a sight!

I will be in Nakuru until the weekend to continue training and to work with the students to finish translating our measures from English into Dholuo, the local language in Muhuru Bay. I will then be headed to Muhuru on Sunday. More soon - I'm off to dinner!

So what exactly will you be doing?

Hi everyone! I have been answering this question a lot lately, and I thought I should answer it again briefly before jumping into blogging about my research experiences.

I just arrived in Kenya to begin fieldwork for a research project on HIV prevention for youth. I will be working in Muhuru Bay, a rural village in the Nyanza Province. I am conducting this research as a postdoc at the Duke Global Health Institute and as part of WISER, the Women's Institute for Secondary Education and Research. My mentors on this project are: Dr. Sherryl Broverman and Dr. Kathy Sikkema of Duke University, and Dr. Rose Odhiambo of Egerton University.

The goal of my research is to identify factors related to HIV risk among youth in Muhuru Bay. That is, I want to find out what contributes to HIV risk behavior - the individual, family, and community-level influences that may increase or decrease youths' involvement in risky sexual behavior. Therefore, my research team and I will be assessing factors such as: youth emotional well-being, communication between parents and youth, and the ways that community and church leaders are sending messages to youth about HIV. Over the next three months, we will be conducting surveys and qualitative interviews and focus groups to gather this information.

My hope is that this assessment will allow us to work with community members and leaders to develop an HIV prevention strategy that goes beyond providing youth with information - that involves multiple sectors of the community to support youth in reducing their risk for HIV.

As I blog about the research process, I welcome your thoughts and questions. I would love to hear from you and to keep an online discussion going.