COVID-19 is here with us, and with it, the obvious need for change. The stipulated guidelines by the Kenya Ministry of Health on social distancing and increased hand hygiene aimed at reducing the risk of getting this new infectious disease have led to new policies being effected. One of the new changes is working from home, which like many organizations, the African Population and Health Research Center (APHRC)) – AIGHD’s research partner on several projects – has embraced and implemented. This has led to the cessation of work in fieldwork stations and initiated discussions on adapting to alternative data collection methods.
Adaptation
One key adaptation has been changing data collection methods from interviewee or household face-to-face interviews to remote phone interviews. Initially, in most projects, the data collection method was face-to-face with research teams visiting and surveying interviewees or households. One of the first projects implemented by APHRC and AIGHD that adapted successfully to this new data collection method is the Innovative Partnership for Universal Sustainable healthcare (I-PUSH). The project entails a longitudinal data collection technique on high-frequency financial and health events in sampled households in Kakamega and Kisumu Counties.
Lessons learned
One major learning from this transition is that the project team changed the way activities were done. These included remote training of the field workers on phone interview ethics and re-administering consent from respondents on the new method and techniques of phone interviews. The project team, including the field team leaders, had to increase fieldwork monitoring, considering less physical contact between field workers and their team leaders. For a successful transition, there was also a need to meet some requirements. For starters, the field team needed sufficient airtime and data bundles. Luckily, the project had been providing transport allowance for the face-to-face household interviews; thus, this cost was diverted to communication allowance to facilitate the shift.
Challenges
The project needed to consider those that did not have access to phones – about 29% of the sampled population. This group comprised of those who totally could not access phones, those who relied on their family members, neighbors, nearby shops, and the community health volunteers (CHVs). This was a challenge in providing a conducive environment for the interviews as confidentiality and privacy may not be guaranteed. This continued reliance led to those availing the phones opting out, citing disruptions on their time and inconvenience.
The other challenge encountered because of the new normal, was the quality of the data collected. During face-to-face interviews, it was easier to capture the moods, attitudes, and surroundings of the participants, adjust accordingly, and probe more to get accurate data. When using telephone interviews, this is not as easy to achieve and the field workers can easily offend or appear to be insensitive to the study respondents.
During the face-to-face meetings, the participants easily kept to their appointments and the field workers could ascertain if the person was available for the interview or not. This is a challenge that the field teams have had to deal with as some of the participants indicated being busy and not able to do the interviews while others have their phones off during the scheduled interview times.
Attrition rates also seem to increase more when using this method. This was attributed to the weak connection between the field interviewers and the respondents and increased mental stress because of some respondents losing their livelihood due to the COVID-19 crisis. Apparently, in face-to-face interview, the field workers were able to relate more closely with the respondents and had formed social connections with respondents and this friendship had motivated the respondents to continue participation.
Mitigation strategies
Data quality involves sufficient spot checks, sit-ins, and even mirror interviews. This is more effective in face-to-face interviews where the team leaders or supervisors can visit the different households and engage the respondents on the interviews conducted. Again the face-to-face had given the team leader/supervisor an angle of seeing and judging the truthfulness of the answers by the respondents as well as observing the environment around the respondents and work out of field interviewers. This advantage is not there in telephone interviews, which leads to questions on the validity of respondents’ answers. Having a good rapport and extra sensitivity to the respondents by both the field workers and the team leaders/supervisor has helped mitigate this in the I-PUSH project.
To address the issue of most participants not having access to phones, the project managed to secure phones for about 100 participants enabling them to participate actively in interviews. This then needs to be considered carefully in the planning to move to phone-to-phone interviews during the new normal.
The research team came up with a tracking tool to keep track of all the people not interviewed during the week. This involved the field interviewer recording the number of times they had tried calling the respondent. The field interviewer is supposed to call at least 7-9 times with a time gap of 3 hours during the day. This increases the probability of reaching the respondents who indicated being busy or whose phones were off.
To curb and or support the mental stress that might result because of the COVID-19 situation, the project team developed a psychosocial guide and a mental health assessment tool for the field workers. The team then trained the field workers on the use of the guide and followed up on the results of the assessment, which the team leaders administered to each individual field interviewer.
Though challenges are bound to come up occasionally in the process of adapting to the new normal, persistence, perseverance and commitment have proved to work in paving way for successful adaptation.
“It is not the strongest of the species that survives, nor the most intelligent. It is the one that is most adaptable to change.” – Charles Darwin
*****The APHRC-AIGHD i-PUSH reach project team would like to acknowledge the Dutch National Postcode Lottery, the Joep Lange Institute, and the Dutch Ministry of Foreign Affairs through the Health Insurance Fund for their generous funding of the i-PUSH evaluation study. We also acknowledge the implementing partners, namely: PharmAccess Foundation and AMREF Health Africa.