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Prepare and present a concise summary of your work to the CDD advisors. Include a brief description of the pieces of the belief system and the relationships among them. Refer to the summary charts and sheets developed in Steps 3 and 4. This part of the presentation should take no more than 20 to 30 minutes.
Next, present the possible approaches your team developed to promote the AHM practices. Be prepared to explain the existing beliefs and practices that led you to think of the different approaches, and the advantages and disadvantages of each approach as identified by your team.
Take notes on the program or project advisors' comments on and questions about different approaches. They may point out additional advantages or disadvantages. If the advisors suggest different or additional approaches, discuss their advantages and disadvantages as a group. Record any questions that you cannot answer.
the meeting, revise your assessment of possible approaches to
incorporate the program or project advisors' questions and
Make a list of the topics about which you need more information. Include any questions asked by the program or project advisors, those listed in your assessments of possible approaches, and other issues that might help you understand the belief system. For example, you may want to ask about perceptions of how the body works, ideas about "what goes wrong" or "happens differently" in the body when a person is ill, or about actions taken during diarrhea.
Review your lists. Arrange the topics so that they will be easy to follow during a conversation.
Review your field notes to identify beliefs and practices concerning AHM of diarrhea. Identify whether they are likely to be helpful or harmful to promoting AHM;
List and assess possible approaches to promote AHM. Present and discuss them with CDD staff;
Prepare a list of additional questions and information needs.
1. Select key informants for additional questioning
2. Use appropriate methods to obtain additional information
3. Explore possible images and proverbs
4. Revise your assessment of possible approaches to promote AHM
5. Choose the most useful approaches
Persons: You and the field workers
Time: 3-5 days
step, the list of information needs and questions developed in
Step 5 is used to guide the collection of additional information
to help assess the possible approaches to promote AHM. The
objectives of this step are to revise the assessment of possible
approaches to promote AHM, to explore local images and sayings
that might be used with the approach to encourage AHM, and to
choose two or three approaches with the most advantages.
Plan to meet again with at least five key informants. You may return to the same informants you interviewed during previous steps or select additional informants. You may use this opportunity to talk with one or two new people. Perhaps you have recently heard of a person who is particularly knowledgeable about childhood illnesses. If an informant was particularly knowledgeable about traditional medicines, you may want to explore this topic with him/her. If you want a better understanding about thirst, weakness, or other signs and symptoms of diarrhea, it may be useful to talk again with mothers of children with recent illnesses.
You may use the list of information needs and questions developed in Step 5 as an interview guide for semistructured discussions with key informants. Alternatively, you may choose to use any combination of methods, including card sorting, specific case histories, and decision models. Be careful to follow the same guidelines for conducting interviews and taking and rewriting field notes (Step 3) that applied to the previous data collection activities.
Ask the key informants to help you visualize how to portray the metaphors for conveying AHM in local images. For example, if one possible approach deals with "weakness" or "thirst," ask "What does a weak child look like?" or "What does a thirsty child look like?"
Ask about, and look for, local objects or images that might help you explain the importance of fluid replacement, extra feeding during convalescence, or seeking care. Think and ask about how people fetch, store, and use water. Use your imagination. Are there any machines or processes that use water in their operation? You are looking for something familiar that can be used to help explain AHM practices.
Ask if there are any local sayings or proverbs that could be used to emphasize messages about AHM. For example, are there sayings about attending to a problem early before it becomes serious? A proverb about early action could emphasize the importance of giving extra fluids at the onset o f diarrhea or of seeking care at the appearance of certain danger signs. Are there sayings that might emphasize the importance of restoring nutrition by giving a child extra food after diarrhea is over?
As ideas for images and proverbs develop, discuss them with the key informants or small groups of villagers. Once they have a few examples of what you are interested in, local people can often suggest better proverbs or analogies.
EXAMPLE: Small contests or competitions are very popular in the culture of South Sumatra. The researchers therefore decided to conduct a contest to identify local images for explaining AHM during diarrhea.
The objectives of the contest were carefully explained during -village meetings. Many entries were submitted from each village. The best image for explaining the importance of fluid replacement and continued feeding during diarrhea was found to be that of a small kerosene lamp that farmers use when they stay in the fields overnight. An analogy can be drawn between a child with diarrhea and a lamp that develops a leak that cannot be repaired right away. The farmer will need to add more fuel than usual to keep the light strong and burning throughout the night. If only the usual amount is added, the flame will become weak and go out. Similarly, a child with diarrhea loses water and food from the body. He will need more fluids than usual, together with food to keep the body strong. If only the usual amount of fluid is given, the child will become weak and die.
This image was felt to be particularly appropriate because it draws on several existing cultural themes. It addresses concerns about weakness resulting from diarrhea and builds on the belief that weakness results from loss of fluid and food. It illustrates the idea of balancing fluids lost with fluids given. The image applies to all types of diarrhea because all are believed to cause weakness.
EXAMPLE: In the desert of Baluchistan people tend to plant trees and crops in holes to conserve water. Villagers explained that the hole helps collect water and keep it from being wasted; the water goes into the roots and then into the rest of the tree. The study team thought it would be useful to compare the roots of a tree with the veins in a child's body. They developed an analogy to explain how ORS works: just as the hole directs the water into the roots of the tree, the sugar and salt in ORS direct water into the veins of the body.
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