Why are people living with HIV in the Democratic Republic of Congo (DRC) waiting so long to seek treatment? How are Syrian families in Lebanese refugee camps coping with the consequences of their displacement? And what role can cultural mediation play in helping migrants and refugees in Italy?
More and more studies supported by MSF’s Operational Research Unit Luxembourg (LuxOR) and Southern Africa Medical Unit (SAMU) use qualitative research methods. They are aiming to better understand the perceptions and experiences of individuals and communities in humanitarian settings. In the traditionally quantitative domain of operational research, a qualitative approach promises insights beyond trends and numbers.
In her role as a Qualitative Research Mobile Implementation Officer with LuxOR and SAMU, Emilie Venables recently conducted a series of in-depth interviews with people living with HIV in Kinshasa (DRC), and is mentoring several other qualitative research projects across MSF programmes.
You spoke to patients and health-care workers in DRC to find out why people wait so long to be tested and treated for HIV. Can you share some of the findings and challenges of these qualitative interviews?
There are several complex reasons why people delay seeking treatment, and they involve factors at individual, community and health-care system levels. In Kinshasa, there is still a lot of stigma associated with HIV for individuals and in the community, which makes people scared to seek assistance. People fear being associated with something they believe to be shameful, and do not want to disclose their HIV status to others. This means that they do not get access to the support and medical care they need.
The church plays an important supporting role for many people in Kinshasa as a place of community, but there are also pastors who advise people not to take their medication, claiming instead that they can ‘cure’ HIV. At the level of the health-care system, in some clinics, health-care workers were reported to delay diagnosing HIV so that they could make a profit from offering other tests and diagnoses. As treatment is free after patients are diagnosed with HIV, there may be a financial incentive to delay the diagnosis.
In Lebanon and Italy, several qualitative research projects are focusing on migrants and refugees. What are the objectives of these studies?
The studies in Lebanon emerged from an operational research workshop held in Beirut in 2016. Participants from several MSF projects in Lebanon came together to develop research protocols, two of which focused on mental health.
In several refugee camps around Beirut, MSF is providing mental health services to Syrian and Palestinian refugees, many of whom have been living there for several years. One study is looking at the deeper consequences of being stranded in a refugee camp, particularly mental health issues and violence within families. The findings will help the MSF teams better understand the population they are working with and improve the services they offer.
In Italy, I looked at the role that cultural mediators play in MSF’s assistance to migrants and refugees. Cultural mediators provide invaluable support in communicating and interacting with beneficiaries, and we are looking to better understand their role and experiences. Data is currently being analysed and a paper is about to be written-up.
What are the advantages of qualitative methods and how can they complement quantitative studies?
Qualitative research asks the question ‘why?’. It helps us to understand the communities we work with in a way that statistics are not always able to do. I am not in favour of a strict division between quantitative and qualitative research, though – we are developing more and more mixed-method studies which combine numbers and words to give a full story of what is happening in our projects.
For example, a project might report that they are seeing very few men attending their clinics for HIV testing but they don’t know why: this is where qualitative research can shed light on the story behind the numbers and provide a more comprehensive picture of what is happening.
Are there specific challenges associated with conducting qualitative operational research?
There are a lot of challenges involved with conducting qualitative research in the field, but it is always possible to find a creative solution for them! It can be difficult to explain qualitative research to communities in a way that makes sense to them, so a lot of time and effort goes into discussing the studies with participants and ensuring they understand why we are there and what the research study will involve.
Finding people with the relevant skills and expertise to conduct studies can also be challenging, which is why we have developed a qualitative research SORT-IT (Structured Operational Research Training Initiative) which ran for the first time in 2016. This course supports participants through the process of developing a protocol, going through an ethical review and conducting fieldwork, as well as analysing and publishing the data.
Fieldwork can be quite daunting for people doing interviews or focus group discussions for the first time, so the LuxOR team visits researchers in the field and offers them on-the-ground support. The participants on the course held in South Africa conducted studies in countries including Greece, Italy, Serbia, and Mozambique on a range of topics including migration and adherence to treatment for HIV.
It is really great to see how the work in the qualitative research course is grounded in operational needs – they all answer very urgent and practical questions. And they will be able to feed findings back into their projects – making a real difference for staff working on the ground and for the beneficiaries.
What are the next steps for the studies in DRC, Lebanon and Italy?
The study in DRC is the most advanced one and is currently being written up for publication in a peer-reviewed journal. The team in Kinshasa has already begun implementing the findings and sharing them with partners and a stigma awareness campaign is planned in DRC for World AIDS Day 2017.
The studies in Lebanon are ongoing and we look forward to the results.
* Main picture: During disembarkation operations in Trapani, Guebré Ibrahim Cissé, an MSF cultural mediator from Gambia, helps an unaccompanied 15-year-old boy from Nigeria who lost his parents during the desert crossing. © Alessandro Penso/MSF