Experiences of an another public health researcher: Stories from the field

Rukhshan Fahmi

“How do you see yourself after these months of your research work?” My mentor asked me few days ago. My reply was, “as a more matured researcher.”

Indeed, when I run through my observation notes that I wrote from my experiences of the research work that I am solely conducting, I come across a number of strategies that I learned and adapted to accumulate more enriched kinds of data. The study I am doing focuses on lower-income parents’ health-seeking behavior for their hydrocephalic children. I intend to understand the parents’ attitude and the challenges they face while seeking health care from medical professionals.

Learning the Landscape

Firstly, because I need to understand their information needs before designing communication materials to assist them in their health care decision for their hydrocephalic children. Secondly, I did not find any recent or old studies that exclusively cover this topic. So, I needed to understand the actual scenario by investigating myself. And to investigate I chose to do in-depth interviews of the research subjects. But this time, the whole preparation process was different. This time there was no one to execute some of the steps beforehand for me like getting permission to work at the study site. No team to chat about the data on the way to the site and after data collection. This time I was on my own.

Like a hiker in Santiago, I am rambling, tumbling, and grappling to reach the endpoint of my pilgrimage. As I made each step, I realized that my strategies are not new but very normal for researchers who are working at research sites for some time. These are like oral stories that are passed down from seniors to juniors through sharing their experiences at tea times. These are never written down because some opinions can be personal, thoughts people might get criticized for. But then again, we are humans, and it is okay to express opinions even when those are negative, otherwise how can we clarify our thoughts and rectify our next steps? So, in this short blogpost I want to share my small understandings that raised from the project that changed my views and understanding as a researcher.

Gathering the Whole Picture

Compared to a survey, interviewing or ‘scrutinizing a person to get the whole picture’ as I would put it, is much harder. In a survey, there are a certain number of answers prepared beforehand for each question. Upon reaching someone to be surveyed, a surveyor merely has to tick the right answer from the list as per their opinion. Here, the surveyor does not have to think much to acquire the answers because the person who prepared the questionnaire has done this part already, making the next step easier. But in the case of interviewing, the challenge starts after the development of the interview guideline. These guidelines contain open-ended questions, which means the answers can lead to any direction. We may have some ideas about the directions, but one can hardly be assured about the route.  In my case, my interviewees never failed to amuse me with completely unexpected answers!

“You can never be sure on what to expect until you finish conducting the third interview with your respondent,” a quotation that I eventually invented based on my experiences with interviewing and kept reminding myself of prior to each qualitative study I had ever designed.

In the case of this study, while developing guidelines for my target group, I had relied on published literatures that depicted health-seeking behaviors of lower-income parents for their children. The literatures mostly presented that lower-income parents from Bangladesh are more likely to prefer traditional ‘medicine men’ before qualified doctors. This behavior eventually cost their child’s health. A major challenge for a child to get treatment that ensues in disability. So, with these mental notes I went to interview low-income parents and unconsciously expected to come across these types of stories. But surprisingly each of them stated that they directly came to medical personnel and laughed about the idea of visiting traditional ‘medicine men.’ The people I came across had already put their faiths in doctors. In this case, where should I direct my questions and find the right paths to the answers?

Visualizing the Patient Journey

These are the crucial moments an interviewer has to handle technically. As intently the interviewer listens to the interviewee, at the same time the interviewer’s brain has to multitask. Firstly, the interviewer has to visualize the story as a picture puzzle, so the missing piece can be identified. In my case, I visualized the first phases of their journeys, not the later parts. Until I quickly calculated and made a decision of changing track. My study’s broader focus was on the challenges the parents face in attaining health care for their hydrocephalic children. The challenges can appear at any stages while seeking health care. Influenced by the studies, I was focusing on an earlier stage; but what about the next stages? Like, what happens after they reach hospitals? They maybe were reaching hospitals at the earliest stage of disease, but it did not ensure that they did not face any hurdle on receiving the treatment. In fact, many of the parents had their share of struggles after reaching the hospitals that delayed their baby’s treatment. So, I probed on those challenges, and I found the route to my objective!

Keeping an Angle of Objectivity

Secondly, the interviewer has to avoid bias. When it comes to bias, young researchers may get introduced with the term but hardly receive explanations on how the bias gets formed. Researchers feel shy about being biased, viewing those as the shortcomings of their thought process. But in most cases bias does not form from personal beliefs but from collective beliefs or cultural beliefs. In most cases, the interviewers are natives who grew up in a society that harbored ideas and beliefs about which they acquire from their fellow societal members. These beliefs eventually become general knowledge or common reality. So, sometimes it can create hurdles for a researcher. Some ideas are so obvious that our minds do not let us probe, because we already know the answer! But research demands written documentation of narrations from the subject and the current reality. In my case, I got slightly biased because I grew up seeing many lower-income parents frequently turning to traditional ‘medicine men’ and there were literatures to back that up. But then, as I interviewed, I discovered the new normal, a change that happened within the ten years post these publications. So, I suggest that whatever idea or cultural conceptions appear inside the brain against each question, do not throw them away, rather neatly organize those in shelves inside your brain and then create an empty self for new realities. Then you have more space for new ideas for your brain without throwing any concepts away. This helps one to picture the changes of one’s own society and articulate one’s understanding of an issue.

Staying Focused

Last but not the least, the interviewer must keep reminding oneself about the research objective, so, on the verge of excitement, the interviewee does not start giving data that is completely irrelevant to the study objective. Often absent-mindedness of the interviewer can result in attainment of such unusable data. The interviewer might assume that the recording of the incessant talking of the interviewee means accumulation of huge data and can let the brain relax. This is the part where the novice interviewees make the major mistakes; because it is not until the analysis, they come to realize their mistakes. During analysis the main question remains ‘how does this data relate to your research objective?’ Those times these researchers can feel helpless. So, to be better safe than sorry, one must always bring the research objective against every data one receives while interviewing.

To conclude I will say that in-depth interviewing can sound a very tough and hectic job which may appear to some as running inside the brain to and fro. But I would suggest viewing it as driving a car on a pleasure trip. If you are carefully drive, keeping all the rules in your mind, you will eventually reach your desired destination.