Maryline Mireku, 08 August 2014

Conducting research is a bit like a ‘dating relationship’ between a researcher and the community. When two people are dating they get to know each other better, they share experiences, the relationship becomes two-way such that whatever either of the party does has an effect on the other party and will affect subsequent relationships. What happens when it is time to withdraw from the community? How do you avoid creating disappointment and resentment? How do you avoid being the ‘bad date’? These are some of the issues we have been dealing with in the first phase of the REACHOUT context analysis of community health work in Kenya.

Participation and stakeholder engagement has been central to the research process

In order to effectively get good feedback from participants it is advisable for a researcher to create rapport with study participants. Researchers develop field protocols which describe how they will conduct community entry and exit. Having a community entry plan is imperative for all researchers because it is the only way one will gain access to research participants is by mobilizing communities for research acceptance. LVCT Health recognizes the importance of discussing research not only with those who can influence policy but also to everyone involved and soliciting people’s inputs to shape the process. The District Health Management Team (DHMT) in our focus sub-counties (Njiru and Kasarani in Nairobi) have been a key stakeholder in the REACHOUT research process.

A lack of researcher feedback is the norm

As part of our feedback to stakeholders we were invited to attend the DHMT management meetings. The meetings were held in the DMOH’s (District Medical Officer’s) office in the District Hospitals.

We were given a time slot to present the study findings despite their long list of agenda items. In Njiru there were 17 members present while in Kasarani there were 14. Since we had limited time we only provided a brief background of the study, participants involved and key findings.

As we sat outside the DMOH’s office waiting to be invited into the Njiru DHMT meeting, one Community Health Worker (CHW) walking along the hall recognized my colleagues (Jane Thiomi, the LVCT Nairobi Regional Manager and Dorothy Njeru, Jane’s Deputy). He was involved in mobilizing the community for uptake of Home Based Testing and Counseling (HBTC). The CHW was so happy to see us he came and welcomed us. After waiting for more than two hours we were invited into the meeting. We informed the DHMT of our plan to involve their site in the next phase of the REACHOUT intervention and were given the go ahead to proceed with our plans. The Njiru DHMT members were very pleased that we had come back for dissemination of study findings. They confirmed the findings and were grateful for a hard copy of the report. We took their e–mail addresses and promised to send soft copies to their mails.

According to DHMT members a lack of feedback from researchers has become the norm. One commented, “People (researchers) come here and drop letters (of seeking authority to conduct research) and after giving them a go-ahead that’s the last time you see them.” After the meeting one of the DHMT members followed me down the hall way and reminded me in a stern manner, “make sure you send the report to our mails.” When I sent the mail I got a reply from him, “thank you for keeping your word.”

Just like the Njiru team, the Kasarani DHMT members were equally happy about the dissemination of the study findings: “This (the report) provides evidence of the work we do here.” “It is very good to know that you are actually going to provide feedback all the way down to the grass root level”.

Trouble on the horizon

However when we informed the Kasarani DHMT that their site was not going to be an intervention site they were disappointed: “You cannot tell us that we are not okay then leave us.” “Does that mean we should continue grappling with the challenges we have since you did not consider us as an intervention site?”

We explained to the Kasarani team that they were not badly off compared to the other sites which we had chosen for the intervention but that we would try and ensure that they also reaped the benefits of the research. Our experience in Kasarani brings in an important aspect of stakeholder engagement: beneficence. Research ethics calls for researchers to practice beneficence but the chances of this are low if you have an incomplete exit strategy. LVCT Health’s research exit strategy is two phased. In the first phase we inform stakeholders of the completion of data collection and when we hope to have the findings out. The second phase entails dissemination of findings and discussion with the stakeholders on the way forward and action points informed by the results of the study.  

Building good relationships

Developing rapport with study participants means researchers are engaged in a ‘relationship’ with them. Rather like the dating analogy that we used above. Unfortunately most researchers do not recognize the importance of feeding back their findings to those who were involved as participants and explaining the reasons for the decisions that they make. Researchers collect data and develop recommendations but rarely get back to the participants. It is like a bad relationship where one partner suddenly walks out on the other without feedback. This has dire consequences on the one who is walked out on (the community) and will reflect on subsequent relationships they get into e.g. lack of trust and commitment.

From our experience we urge other researchers to:

  • Put in place research processes which mobilise and engage participants in a process of mutual learning
  • Disseminate findings regularly
  • Prioritise the community and participants as the first beneficiaries of your feedback
  • Tailor dissemination to your audience type, make it understandable and don’t shy away from difficult conversations
  • Work on your communication skills – during dissemination time constraints might require a planned 15 minute presentation to be given within 5 minutes. How are you going to handle this? How will you react if your audience is hostile

In the end we continue to have harmonious relationships in both sub-districts. One research participant stated, “We hope other researchers will follow your example and also come and share their findings.” And another reassured us that our results were useful, “We now have a basis from where we can refer from as we plan our work.”

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