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.