Methodological Tools

Within anthropological research, surveys can be an effective tool for gathering data. Partnering this data collection technique with other anthropological methods-such as participant observation, interviews, focus group discussions, and more broadly, ethnographic methods-works to build a rich data set. Indeed, since the 1980s anthropologists have advocated the need for multiple quantitative, qualitative, and ethnographic methods in collecting HIV/AIDS-related data, and increasingly pushed public health practitioners in these directions.

The initial link in this section of the webpage is to a Household Livelihood Security Assessment survey instrument kindly shared by an AARG member. AARG encourages members to share and discuss other methodological tools. If you would like to post a methodological tool you have used in your research please pass this along to the email listserv or directly to Susan Pietrzyk at, who will post it within this section of the AARG webpage.

Following the link to the survey instrument is a small sample of references that highlight the importance of thoughtful research methods. These articles and the many more similar types of articles available provide a sense of the methodological frameworks grounding the analysis presented.

Household Livelihood Security Assessment
To access this document click here.

This survey tool was developed for CARE Zimbabwe for its annual household livelihood assessment which it has been conducting since 2005. The goal is to collect a broad range of information from households in areas where CARE has programming to assess overall livelihood and food security for the purposes of program design. The strength of the survey is in its ability to assess food security by examining all sources of food access. The greatest challenge with the instrument is the time it takes to complete the interview. Numerous internal reports for CARE as well as several academic publications have been produced using longitudinal data collected from several livelihood surveys.

(Note from Copyright Holder: I release copyright on the Household Livelihood Survey tool. I give permission to anyone interested in using to tool full rights to do so. If you choose to use the survey, please give acknowledgement to John Mazzeo and CARE Zimbabwe.)

Bailey, Ajay and Inge Hutter (2008) Qualitative to Quantitative: Linked Trajectory of Method Triangulation in a Study on HIV/AIDS in Goa, India. AIDS Care 20(9): 1119-1124. Article Abstract

With 3.1 million people estimated to be living with HIV/AIDS in India and 39.5 million people globally, the epidemic has posed academics the challenge of identifying behaviours and their underlying beliefs in the effort to reduce the risk of HIV transmission. The Health Belief Model (HBM) is frequently used to identify risk behaviours and adherence behaviour in the field of HIV/AIDS. Risk behaviour studies that apply HBM have been largely quantitative and use of qualitative methodology is rare. The marriage of qualitative and quantitative methods has never been easy. The challenge is in triangulating the methods. Method triangulation has been largely used to combine insights from the qualitative and quantitative methods but not to link both the methods. In this paper we suggest a linked trajectory of method triangulation (LTMT). The linked trajectory aims to first gather individual level information through in-depth interviews and then to present the information as vignettes in focus group discussions. We thus validate information obtained from in-depth interviews and gather emic concepts that arise from the interaction. We thus capture both the interpretation and the interaction angles of the qualitative method. Further, using the qualitative information gained, a survey is designed. In doing so, the survey questions are grounded and contextualized. We employed this linked trajectory of method triangulation in a study on the risk assessment of HIV/AIDS among migrant and mobile men. Fieldwork was carried out in Goa, India. Data come from two waves of studies, first an explorative qualitative study (2003), second a larger study (2004-2005), including in-depth interviews (25), focus group discussions (21) and a survey (n=1259). By employing the qualitative to quantitative LTMT we can not only contextualize the existing concepts of the HBM, but also validate new concepts and identify new risk groups.

Bleiker, Roland and Amy Kay (2007) Representing HIV/AIDS in Africa: Pluralist Photography and Local Empowerment. International Studies Quarterly 51(1): 139-163. Article Abstract

This essay explores the nature and political consequences of representing HIV/AIDS in Africa, where the disease has taken its greatest toll. We examine how different methods of photography embody different ideologies through which we give meaning to political phenomena. We distinguish three photographic methods of representing HIV/AIDS: naturalist, humanist, and pluralist. Naturalist approaches portray photographs as neutral and value free. Humanist photography, by contrast, hinges on the assumption that images of suffering can invoke compassion in viewers, and that this compassion can become a catalyst for positive change. By examining a widely circulated iconic photograph of a Ugandan woman and her child affected by AIDS-related illnesses, we show that such representations can nevertheless feed into stereotypical portrayals of African people as nameless and passive victims, removed from the everyday realities of the western world. We contrast these practices with pluralist photography. To do so we examine a project in Addis Ababa, which used a methodology that placed cameras into the hands of children affected by HIV/AIDS, giving them the opportunity to actively represent what it means to live with the disease. The result is a form of dialog that opens up spaces for individuals and communities to work more effectively in overcoming problematic stigmas and finding ways of stemming the spread of the disease.

Chow, M. Y. K., S. Quine, and M. Li (2010) The Benefits of Using a Mixed Methods Approach - Quantitative with Qualitative - to Identify Client Satisfaction and Unmet Needs in an HIV Healthcare Centre. AIDS Care 22(4): 491-498. Article Abstract

Research into patient satisfaction with HIV ambulatory healthcare facilities is limited due to confidentiality restraints, the short history of the condition and the stigma attached. Furthermore, most satisfaction studies of this client group have not used mixed methods (quantitative with qualitative) despite its increasing use since the 1990s in healthcare research. This cross-sectional study demonstrates how a mixed methods approach is beneficial in assessing HIV client satisfaction and in identifying unmet needs in HIV healthcare. Conducted at the largest ambulatory HIV healthcare centre in Australia, this study consisted of two phases conducted sequentially: Phase One, a quantitative self-administered questionnaire survey, provided an overall statistical picture of satisfaction levels. This was followed by Phase Two, qualitative semi-structured face-to-face interviews, which enabled in-depth investigation of the reasons for satisfaction/dissatisfaction. Phase One had 166 respondents, giving a high response rate of 71%, while Phase Two had 22 participants. The study demonstrates the three advantages of using a mixed methods approach. Firstly, it increased the comprehensiveness of overall findings, by showing how qualitative data (Phase Two) provided explanations for statistical data (Phase One). Secondly, it expanded the dimensions of the research topic, as Phase Two enabled investigation of the determinants of satisfaction/dissatisfaction more broadly after assessing the client satisfaction levels in Phase One. Thirdly, it increased the methodological rigour as findings in both phases could be checked for consistency. Thus using a mixed methods approach can greatly enhance our understanding of client satisfaction in HIV/AIDS research.

DeJong, Jocelyn, Ziyad Mahfoud, Danielle Khoury, Farah Barbir, and Rema Adel Afifi (2009) Ethical Considerations in HIV/AIDS Biobehavioral Surveys That Use Respondent-Driven Sampling: Illustrations From Lebanon. American Journal of Public Health 99(9): 1562-1567. Article Abstract

Respondent-driven sampling is especially useful for reaching hidden populations and is increasingly used internationally in public health research, particularly on HIV. Respondent-driven sampling involves peer recruitment and has a dual-incentive structure: both recruiters and their peer recruits are paid. Recent literature focusing on the ethical dimensions of this method in the US context has identified integral safeguards that protect against ethical violations. We analyzed a study of 3 groups in Lebanon who are at risk for HIV (injection drug users, men who have sex with men, female sex workers) and the ethical issues that arose. More explicit attention should be given to ethical issues involved in research implementing respondent-driven sampling of at-risk populations in developing countries, where ethical review mechanisms may be weak Respondent-driven sampling is especially useful for reaching hidden populations and is increasingly used internationally in public health research, particularly on HIV. Respondent-driven sampling involves peer recruitment and has a dual-incentive structure: both recruiters and their peer recruits are paid. Recent literature focusing on the ethical dimensions of this method in the US context has identified integral safeguards that protect against ethical violations. We analyzed a study of 3 groups in Lebanon who are at risk for HIV (injection drug users, men who have sex with men, female sex workers) and the ethical issues that arose. More explicit attention should be given to ethical issues involved in research implementing respondent-driven sampling of at-risk populations in developing countries, where ethical review mechanisms may be weak.

Evans, Catrin and Helen Lambert (2008) Implementing Community Interventions for HIV Prevention: Insights from Project Ethnography. Social Science & Medicine 66(2): 467-478. Article Abstract

Global policy on HIV prevention among marginalised populations recommends a community-based approach with participation and mobilisation as central features. The overall aim is to empower individuals and groups to reduce their vulnerability to HIV. Community empowerment initiatives have had mixed results, however, in spite of utilising very similar peer-education based intervention strategies. This is particularly true of community-based interventions in sex work settings. Drawing upon an ethnographic study conducted in the early years of a well-known sex worker initiative—the Sonagachi STD/HIV Intervention Project (SHIP) in Kolkata, India—this paper argues that ethnographic research can illuminate the complex and inter-dependent dynamics of context, practice, agency and power that are specific to a project and shape the course of intervention implementation in ways that may be ‘hidden’ in conventional techniques of project reporting. Two detailed excerpts of what we refer to as ‘private contexts of practice’ are presented—focusing upon the complex processes underlying community mobilisation and peer education. We show that the gathering of ethnographic forms of evidence in conjunction with more conventional evaluation measures has two distinct benefits. First, an ethnographic approach is able to capture the play of power through observation of real-time events that involve multiple actors with widely different perspectives, as compared with retrospective accounts from carefully selected project representatives (the usual practice in project evaluations). Second, observation of actual intervention practices can reveal insights that may be hard for project staff to articulate or difficult to pinpoint, and can highlight important points of divergence and convergence from intervention theory or planning documents.

Fassin, Didier Frédéric Le Marcis and Todd Lethata (2008) Life & Times of Magda A: Telling a Story of Violence in South Africa [with Comments]. Current Anthropology 49(2): 225-246. Article Abstract

How to write about violence? Most recent anthropological works have dealt with this question in terms of either political economy, narratives, or performance. Using J. M. Coetzee's "Life & Times of Michael K" as a pre-text, an ethnological inquiry into violence is proposed through the biography of a young South African woman. The reconstitution of her life story through informal interactions and in-depth interviews embedded in long-term research in her home community attempts to inscribe her life in its times, in other words, to articulate an experience of extreme poverty and sexual abuse and later of living with HIV and becoming involved in AIDS activism with the historical condition of apartheid and its aftermath. Taking seriously the young woman's perspective on her biography implies both epistemological and ethical issues. As it unfolds through her narrative, relocated in its social context, her story can be read as the progressive appropriation of an imposed fate, the slow shift from subordination to subjectification and, finally, a form of political education to violence.

Johnston, Lisa Grazina, Sara Whitehead, Milena Simic-Lawson, and Carl Kendall (2010) Formative Research to Optimize Respondent-Driven Sampling Surveys Among Hard-to-Reach Populations in HIV Behavioral and Biological Surveillance: Lessons Learned from Four Case Studies. AIDS Care 22(6): 784-792. Article Abstract

Respondent-driven sampling (RDS) is widely adopted as a method to assess HIV and other sexually transmitted infection prevalence and risk factors among hard-to-reach populations. Failures to properly implement RDS in several settings could potentially have been avoided, had formative research been conducted. However, to date there is no published literature addressing the use of formative research in preparing for RDS studies. This paper uses examples from Banja Luka, Bosnia and Herzegovina; Bangkok, Thailand; Podgorica, Montenegro; and St Vincent's and Grenadine Islands, Eastern Caribbean; among populations of men who have sex with men, female sex workers, and injecting drug users to describe how formative research was used to plan, implement, and predict outcomes of RDS surveys and to provide a template of RDS-specific questions for conducting formative research in preparation for RDS surveys. We outline case studies to illustrate how formative research may help researchers to determine whether RDS methodology is appropriate for a particular population and sociocultural context, and to decide on implementation details that lead to successful study outcomes.

Lockhart, Chris (2008) The Life and Death of a Street Boy in East Africa: Everyday Violence in the Time of AIDS. Medical Anthropology Quarterly 22(1): 94-115. Article Abstract

This article focuses on the life history of a single street boy in northwestern Tanzania, whom I name Juma. I suggest that Juma's experiences and the life trajectory of himself and of significant individuals around him (particularly his mother) were structured by everyday violence. I describe everyday violence in terms of a conjuncture between macrostructural forces in East Africa (including a history of failed development schemes and the contemporary political economy of neoliberalism) and the lived experience of individuals as they negotiate local, contextual factors (including land-tenure practices, the power dynamics between immediate and extended kin, life on the streets, and constructions of gender and sexuality). I suggest that AIDS and its many impacts on Juma's life course can only be understood in a broader context of everyday violence. From this basis, I draw several general conclusions regarding AIDS prevention and intervention strategies.

Lorway, Robert Sushena Reza-Paul and Akram Pasha (2009) On Becoming a Male Sex Worker in Mysore: Sexual Subjectivity, "Empowerment," and Community-Based HIV Prevention Research. Medical Anthropology Quarterly 23(2): 142-160. Article Abstract

Growing public health attention has been placed on the HIV vulnerability of males who sell sex to males in India. However, there is little research that outlines the trajectories through which males come to be involved in practicing sex work in India. Locating "male sex work" within a vibrant social, political, and erotic landscape, this article explores the intertwining of "sexual subjectivity" and "sex work." The authors refer to 70 sexual life histories generated from research conducted in Mysore to unsettle dominant public health notions that regard male sex work as rooted solely in poverty or as a decontexualized "behavioral risk factor." Such perspectives are countered by demonstrating how male sex work in Mysore encompasses a complex interplay between self-realization, sexual desire, social interaction, and public health discourse. Local conceptualizations of selfhood are discussed to suggest the limitations of prevailing empowerment discourses that advance Western notions of individuality.

Mavhu, Webster, Lisa Langhaug, Bothwell Manyonga, Robert Power, and Frances Cowan (2008) What is ‘Sex’ Exactly? Using Cognitive Interviewing to Improve the Validity of Sexual Behavior Reporting Among Young People in Rural Zimbabwe. Culture, Health & Sexuality 10(6): 563-572. Article Abstract

Self-reporting of sensitive data is often unreliable, particularly when questions are asked about culturally or socially censured behaviours. This study aimed to improve the validity of questionnaire responses through cognitive interviewing of young people in Zimbabwe to better understand their underlying thought processes when responding to sexual behaviour questions. A questionnaire was developed in English and translated into Shona. Three rounds of cognitive interviewing were conducted with 65 young people. Data were coded and analysed using principles of grounded theory. Young women emphasised that they would not admit to having participated in sexual activities if questions were phrased in such a way that they could be seen as having initiated them. They suggested that in order to legitimise women's participation, the wording of their sexual questions should use the passive tense. The Shona term for 'vaginal sex' is used to refer to both consensual and non-consensual sex. In Shona, there is no formal term for anal sex and phrasing this activity in a way that was both acceptable and understood proved particularly challenging. Cognitive interviewing is useful in exploring the underlying thought processes and the cultural context behind question responses. Examining the cultural and societal norms within a study population is key to obtaining valid responses.

Seeley, Janet Samuel Biraro, Leigh Anne Shafer, Pamela Nasirumbi, Susan Foster, Jimmy Whitworth, Heiner Grosskurth (2008) Using In-Depth Qualitative Data to Enhance our Understanding of Quantitative Results Regarding the Impact of HIV and AIDS on Households in Rural Uganda. Social Science & Medicine 67(9): 1434-1446. Article Abstract

Two significant challenges face researchers tracking HIV-related socio-economic and demographic change over time in large cohort studies. Firstly, data collected in cohort studies established to describe the dynamics of HIV infection may contain no systematic data on household consumption expenditures which is an established measure of current and long-run household welfare. The second challenge is the choice of the unit of analysis in order to recognise and record impact; this is because most cohorts use the household as that unit. This means that the influence of factors outside that unit cannot easily be tracked. In this paper we show how a detailed understanding of the impact of HIV and AIDS on wider families and social networks, obtained through in-depth longitudinal research with a small number of households, can shed light on the findings from quantitative analysis from a larger cohort in the same population in rural Uganda. The findings of large-scale survey data from more than 2000 households over a 12-year period showed a lack of a strong association between poverty, HIV status and/or death of the household head. In-depth ethnographic research with 26 households in 1991/2 and a restudy of the same households in 2006/7 provide insights into the reasons for this finding: the choice of socio-economic indicators and support from other family and community members play a part in affecting survey findings on the impact of HIV at household level. One other factor is important in explaining the findings. HIV-infected family members from outside the household may drain resources from the household, so looking at the impact of HIV and AIDS on people's wider families provides pointers to why those who have not had an AIDS-related death in their own household may have failed to prosper. Our qualitative findings show that AIDS may well throw households into disarray and poverty, but more often reduces development and hinders families from getting out of poverty. Used strategically, small longitudinal studies can provide important information with which to explain patterns observed in large-scale quantitative datasets.

Theobald, Sally and Bertha Nhlema-Simwaka (2008) The Research, Policy and Practice Interface: Reflections on Using Applied Social Research to Promote Equity in Health in Malawi. Social Science & Medicine 67(5): 760-770. Article Abstract

The case for research to promote equity in health in resource poor contexts such as Malawi is compelling. In Malawi, nearly half of all the people with tuberculosis cannot afford to access free tuberculosis services. In this scenario, there is a clear need to understand the multiple barriers poor women and men face in accessing services and pilot interventions to address these in a way that engages policy makers, practitioners and communities. This paper provides a critical reflection on our experience as applied social researchers working at the REACH (Research for Equity and Community Health) Trust in Malawi. Our work largely uses qualitative research methodologies as a tool for applied social research to explore the equity dimensions of health services in the country. We argue that a key strength of qualitative research methods and analysis is the ability to bring the perceptions and experiences of marginalised groups to policy makers and practitioners. The focus of this paper is two-fold. The first focus lies in synthesising the opportunities and challenges we have encountered in promoting the use of applied social research, and in particular qualitative research methods, on TB and HIV in Malawi. The second focus is on documenting and reflecting on our experiences of using applied social research to promote gender equity in TB/HIV policy and practice in Malawi. In this paper, we reflect on the strategic frameworks we have used in the Malawian context to try and bring the voices of poor women and men to policy makers and practitioners and hence intensify the research to policy and practice interface.

Thomas, Felicity (2007) Eliciting Emotions in HIV/AIDS Research: A Diary-Based Approach. Area 39(1): 74–82. Article Abstract

Little attention has been given to understanding the emotional well-being of people living with HIV/AIDS in developing countries, despite the fact that emotions may impact on people's sense of purpose and value, and ultimately their ability and resolve to hold livelihood and familial responsibilities together. Drawing upon research undertaken in the Caprivi Region of Namibia, this paper examines the use of solicited text and photo diaries in enabling insight into the emotional impacts of HIV/AIDS. The advantages and constraints of diary methods are examined, focusing on informant-directed research and the ethical considerations surrounding their use.

Wainberg, Milton L., M. Alfredo González, Karen McKinnon, Katherine S. Elkington, Diana Pinto, Claudio Gruber Mann, Paulo E. Mattos (2007) Targeted Ethnography as a Critical Step to Inform Cultural Adaptations of HIV Prevention Interventions for Adults with Severe Mental Illness. Social Science & Medicine 65(2): 296-308. Article Abstract

As in other countries worldwide, adults with severe mental illness (SMI) in Brazil are disproportionately infected with HIV relative to the general population. Brazilian psychiatric facilities lack tested HIV prevention interventions. To adapt existing interventions, developed only in the US, we conducted targeted ethnography with adults with SMI and staff from two psychiatric institutions in Brazil. We sought to characterize individual, institutional, and interpersonal factors that may affect HIV risk behavior in this population. We conducted 350 hours of ethnographic field observations in two mental health service settings in Rio de Janeiro, and 9 focus groups (n=72) and 16 key-informant interviews with patients and staff in these settings. Data comprised field notes and audiotapes of all exchanges, which were transcribed, coded, and systematically analyzed. The ethnography identified and/or characterized the institutional culture: (1) patients’ risk behaviors; (2) the institutional setting; (3) intervention content; and (4) intervention format and delivery strategies. Targeted ethnography also illuminated broader contextual issues for development and implementation of HIV prevention interventions for adults with SMI in Brazil, including an institutional culture that did not systematically address patients’ sexual behavior, sexual health, or HIV sexual risk, yet strongly impacted the structure of patients’ sexual networks. Further, ethnography identified the Brazilian concept of “social responsibility” as important to prevention work with psychiatric patients. Targeted ethnography with adults with SMI and institutional staff provided information critical to the adaptation of tested US HIV prevention interventions for Brazilians with SMI.

Wood, Kate and Helen Lambert (2008) Coded Talk, Scripted Omissions: The Micropolitics of AIDS Talk in an Affected Community in South Africa. Medical Anthropology Quarterly 22(3): 213-233. Article Abstract

In this ethnographic article, we explore the character of local discourse about AIDS in an affected township community in South Africa, describing the "indirection" that characterized communication about suspected cases of AIDS. Through a case study of one affected family, the article first explores the diverse ways in which people came to "know" that specific cases of illness were AIDS related, and how this "knowledge" was communicated. We consider why communication was indirect and coded, arguing that this reflected not a "denial" of its presence in this community but, rather, a complex group of overlapping concerns far from unique to AIDS: first, a normative injunction on naming potentially fatal conditions; second, an interest in pursuing different therapeutic options and the need to maintain hope of recovery; and third, a wish to avoid the "disrespect" entailed in referring directly to the nature of the problem in a context where, discursively, stigma was still present. The coded and indirect character of HIV/AIDS-related talk underlines the importance of ethnographic inquiry in understanding community responses to this epidemic, demonstrating that the subtleties entailed by verbal silence and elision should not be interpreted naively as collective "denial" but rather be grounded within existing patterns of responses to dangerous sickness.

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