Presentation by Clare Chandler Lead Society Scientist, ACT Consortium Senior Lecturer in Medical Anthropology at London School of Hygiene & Tropical Medicine

1. Listening to Your Audience:
Qualitative Research in Malaria Interventions
Clare Chandler
Lead Social Scientist for the ACT Consortium 2008-2013
Answering key questions on malaria drug delivery 1
London School of Hygiene & Tropical Medicine

2. Intervention design steps
LISTENING
at the heart of our intervention design approach

3. New publication
• The work required to design
interventions should not be
underestimated
• The process should be recognized
not only as technical, but the result
of micro and macro social,
political and economic contexts
• Reporting of interventions should
encompass the development
process.

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Why listen?
Interventions often assume we know what is good for people
Often informed by surveys (eg Knowledge
Attitudes and Practices) which aim to
identify barriers to people doing what we
believe to be correct/appropriate
Limitations…
● Pre-defined, closed-ended questions
● Administered in a standardized way for a
wide variety of respondents
● Analysed remotely
● Difficult to identify underlying reasons for
health problems: social, political,
economic
● Difficult to hear respondents’ priorities

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Why listen?
Picture courtesy of Ane Haaland

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How to listen?
Our methods intended to take the local seriously
Emphasised
● Letting respondents lead
● Social construction of the interview
● Iterative interpretation process
How?
● Intensive training for all research staff
(training materials available on
www.actconsortium.org)
● Continued engagement with research
process and ongoing analysis
● In-depth observation where possible

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Who to listen to?
Range of ‘stakeholders’ – and not just informing/consulting – part
of the design process
This means some of our research ideas were not included.. E.g.
● See DiLiberto et al 2015 ‘Behind the Scenes of the PRIME Intervention’ in
Global Health Action
But components included should be acceptable
& sustainable… at least in that context
●Not necessarily off-the-shelf – what is deemed
appropriate in one place may not be elsewhere.
●Emphasises need for a local needs
assessment and stakeholder engagement if
using our materials elsewhere

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Listening through design and testing
Workshops – to digest formative research, ideas from literature
and theory
Pilots – to test out activities, materials, practicalities
● Eg. In peer group workshops
Seat in circle / tables / lines?
Role plays in groups?
Trainer standing or sitting?
How to follow the manual?

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Listening in evaluation
Looking for intended changes
Most significant change..
‘The most important thing I got is when I
have mRDT’
‘It has added on our workload… it
becomes hectic for me’
Picking up unintended
consequences
‘It is the hernia which is bothering the
child. We only talked about the fever’
‘We are using the mRDTs to scrutinize
the (patients)… so you find people are
getting discouraged to come’

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Acknowledgements
Core social science team:
Clare Chandler, Joanna Reynolds, Eleanor Hutchinson, Rachel Hall-Clifford
In-country social science teams:
Tanzania: Judith Meta, Fortunata Nasuwa, John Kessy, Adiel Mushi, Peter
Mangesho, Isolide Massawe, Kaseem Juma, Emmy Metta, Angela Kimweri and
Denise Allen;
Uganda: James Kizito, Christine Nabirye, Susan Naiga, Miriam Kayendeke, Lilian
Taaka, Loy Sentumbwe, Grace Nyabwolo, Asaph Turinde
Ghana: Evelyn Ansah, Samson Akanpigbiam and Frank Baiden
Cameroon: Robert Marie Mba, Ndong Ignatius Cheng, Joelle Pamen Ngako,
Rachel Nguella, Albertine Lele, Joel Ambebilla, Mirabel Ayuk, Sarah Ndive, Theresia
Njuabe and Abanda Ngu Njei
Nigeria: Nkoli Ezumah and Ogochukwu Ezeoke
South Africa: Elizabeth Allen
Afghanistan: Tamanna Ahmad, Karimullah Karimullah, Mohibullah Motahed, Nadia
Anwari and Molly Wood.

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Please send
questions & comments to
#actdiagnosis
@ACTconsortium
debora.miranda@lshtm.ac.uk