Lessons Learned Using Quantitative and Qualitative Methods to Conduct International Research: Assessment of Beliefs, Behavior, and Environmental Exposure among Ethiopian Women

Background:

Collaborations between academic institutions in the low-income (LICs) and high-income countries (HICs) are being encouraged to leverage resources, foster professional growth and develop collaborative solutions for current and emerging local health problems (George & Meadow-Oliver, 2013). There have also been increased discussions about the role that non-governmental organizations (NGOs) can play in research and ways in which NGO participation can be enhanced. In the wake of unprecedented interest in global engagement, collaboration and research within the field of nursing there is a need to disseminate lessons learned from global research experiences and to define best practices.

Purpose:  

To describe lessons learned while building collaborative relationships among academic institutions and NGOs to conduct an exploratory study on the beliefs, behavior, and environmental exposure among Ethiopian Women, in relation to household air pollution from cooking fires and second hand tobacco smoke in Aleto Wondo, Ethiopia.

Methods:

To build the foundations for this research an exploratory trip was conducted one year in advance to solidify partnerships and enhance our contextual understanding. Prior to applying for funding and IRB approval, we established a Memorandum of Agreement (MOA) with our local academic partner institution in Ethiopia (Hawassa University), who represented regional institutional review board (IRB) jurisdiction for the proposed study area. In addition, MOAs were established with our local implementing NGOs operating within the local communities. To enhance our cultural contextual understanding of local knowledge in relation to our phenomena of interest and to further demonstrate our altruistic intentions, we offered a research-training seminar for Hawassa University and Addis Ababa University nursing students. After solidifying commitments among senior authors (academic advisors) from University of California, San Francisco (UCSF), School of Nursing and the University of California, Berkeley, (UCB) School of Public Health, an interdisciplinary IRB submission and multiple grant proposals were developed. IRB approval was received from both the University of California and Hawassa University. Funding for data collection processes was received from the Alpha Eta and Gamma Alpha Chapters of Sigma Theta Tau International and the UCB - Center for Occupational and Environmental Health - Student Research Award Llewellyn Award. Both quantitative and qualitative methods were used to explore the beliefs, behavior, and environmental exposure among Ethiopian Women, in relation to household air pollution from cooking fires and second hand tobacco smoke.  A staged data collection plan was used. The process included conducting 30 qualitative open-ended interviews, 4 qualitative focus groups, and 350 quantitative household surveys, in the Aleto Wondo region in Ethiopia. In addition, quantitative measurement of household air pollution from cooking fire smoke was collected in 25 households.

Results:  

Key lessons learned emerged during both the foundational and implementation stages of the research process. Discussion points with examples from the field will include: 1) overcoming logistical challenges in the field; 2) confronting translation issues; 3) recruiting and consenting participants; 4) contextualizing participation incentives; and 5) valuing local knowledge during the research process. 

Lessons learned from collaboration with local academic partners:  Specific lessons learned that emerged from working with local and academic partners will be discussed with examples from the field including: 1) the value of an altruistic mindset; 2) ‘testing the water’ with local partners; 3) complexities of international and local IRB processes; and 3) identification and capitalizing on capacity building opportunities. 

Lessons learned from collaboration with local NGOs:  Specific lessons learned from collaboration with a local NGO with examples from the field focused will be discussed in relation to four processes: 1) contextualization of research methods; 2) building relationships; 3) expansion of skill sets, both of the researcher and the local research partners; and 4) setting research precedents in local communities. 

Addressing unique global research methodology related issues:  Finally a discussion of four specific challenges and lessons learned in relation to implementing qualitative and quantitative methods in international settings will be presented including: 1) cross-cultural tool adaptation; 2) recruitment and consent considerations; 3) contextualization of demographic data; and 4) overcoming communication and linguistic challenges.

Conclusions:

Research endeavors between LICs and HICs can be greatly enhanced by working collaboratively with both academic partners and local NGOs. There is however a need for thoughtful reflection on the roles that each entity will assume, as well as the measures that will be taken to foster equitable and mutually rewarding collaborations that support both the partners interests and most importantly the communities that we serve.