A review and assessment

Table 10: Overview of user-oriented methods used in country studies

a. Interviews with key informants

Initial interviews with a selective group of key informants, in order to gain insight into local conditions, were conducted in Uganda both at the national and regional level. At the national level, interviews were held with representatives of the Ministry of Health, the Ministry of Local Government, the Uganda Essential Drugs Management Programme, the AIDS Control Programme and the Uganda Red Cross. Local key informants in the community were members of the Local Resistance Council, the District Medical Officer and hospital/provider facility administrators. Some interviewees also raised objections to the research design. Some informants, for example, questioned the - in their view - limited scope of the study (only into injection practices) and the sampling frame, which excluded families who did not have children under the age of five.

The qualitative, intensive character of an interview with key informants adds to the understanding of the motivations for injection use, and of the context in which such use takes place. Therefore, this technique seems to fit the descriptive and exploratory nature of this research perfectly well.

b. Household questionnaire design and flow of questions

The questionnaires used in Uganda and Indonesia are presented in Appendices 4.A and 4.B respectively. They show some marked differences. In Indonesia, the focus of the questionnaire was on the treatment of ill people in the households. Individuals who were healthy but had received an injection (for example, for vaccination) were subsequently left out of the research. This type of questioning yielded a large amount of data on illnesses of individuals and their treatment.

The Ugandan questionnaire did not start from illness incidence, but from actual injection use. The questionnaire began by asking: "Who was the last person to get an injection and when was this injection received?" Here, the focus was the injection use and the symptoms for which the injection had been sought. Also, the Ugandan questionnaire focused specifically on informal injection use, equipment at home etc.

Differences in focus and questionnaire design of course limit the comparability of the results. This could have been avoided by a comparison of the questionnaires during the Second Workshop, and by agreement on the best design to be followed.

c. Focus group discussions

Six focus group discussions were conducted in three villages in Lebak, Indonesia. In Lombok these sessions were not conducted due to language constraints. The participants were chosen from subjects in the household survey who were willing to participate voluntarily, and who are able to talk easily in Bahasa Indonesian or the local language, Sundanese. Each group consisted of 6 to 12 participants, all of them women with children under five. During the focus group meetings, three major topics were discussed: the presence of illnesses in the region; the conditions which require, in the view of the participants, an injection as treatment and the treatment of the four tracer conditions identified by the Indonesian team. In Uganda, no focus group discussions were organized.

Focus group discussions conducted in Indonesia yielded insight into the local ideas about illnesses and their treatment. Preferences for injection therapy could thus be understood in their proper context. This method seems useful for researchers who want to gain a quick understanding of local ideas and who desire more insight into the context of injection use in their setting.