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DATA ANALYSIS FORM 13.4
Creating an Ethnomedical Model of Illnesses (sample)

Unit 14. Focus Group: Ethnoanatomy and Ethnophysiology of Women

Purpose

The purpose of this unit is to understand how women relate their health problems to their understandings of how women's bodies work. It can also be used to resolve contradictions that have arisen in earlier units. This might also be a good way to determine if stigma is associated with certain illnesses and, if so, how this is managed. Specifically, this unit addresses the ethnoanatomy and ethnophysiology of women. These terms encompass how women conceptualize their bodies, what constitute the different parts of the female body, how women's bodies function, how the various body mechanisms interact, and the effect of illness on the body.

Data Collection

1. Develop a discussion guide based on previous units. Similar to the ethnographic field guide, this guide is not meant to be a list of questions to be rigidly followed, but should identify the topics to be covered in the discussions. You may want to develop a scenario based on previous interviews (but be sure no one could identify a specific person) to start the discussion. Form 14.1 can be modified for data collection.

2. Select 6 to 10 participants. The participants should be similar in background and age. They should feel comfortable and confident enough to speak in a group. You may wish to conduct two to three sessions with different groups of women. For example, one group might consist of local healers, another group of educated young married women, and another group of older married women. Do not include "experts" in the same group as "non-experts," as they may dominate the group discussion.

3. The focus group should be conducted in a place where there will be few interruptions. There should be a facilitator who guides the discussion using a discussion guide. A recorder takes notes, keeping track of who says what (this will help in the transcription of the tape). The recorder should also draw a diagram showing where each person is sitting. Ideally the discussion should be tape recorded. You may wish to have one other person observe the dynamics and interactions during the discussion.

4. Start by explaining the purpose of the discussion and then explain the scenario. A good focus group runs itself after an initial orientation by the facilitator. Encourage participants to speak to each other and not to the facilitator.

5. Record data on Forms 14.2 and 14.3. Note that these forms are to be used by the facilitator to copy what the women have drawn on large sheets of paper.

6. Some Tips: If one person is dominating the group, the facilitator should ask others if they agree or had similar experiences. Natural lulls in the conversation are good opportunities to ask another question or simply repeat what was said earlier. If women shake their heads in agreement or disagreement, encourage them to explain.

Data Analysis

1. Expand the notes from the focus group using the written notes to help identify the voices. If there was an observer, incorporate observations into the text.

2. Code the discussion using the codes developed earlier. You may need to add more codes.

3. Referring to Forms 14.2 and 14.3, use Form 14.4 to draw a consensus picture of the location of several key women's illnesses and different organs. Use a separate form for each illness. You may wish to make a diagram which includes several illnesses on the same sheet to show progressions and relationships.

Interpretation Suggestions

1. Do women use different terms or phrases when discussing illnesses with each other than those used with outsiders?

2. Does the location of an organ relate to a perceived location of specific health problems? How?

3. How do illnesses progress through the body?

4. What is the "ethnophysiology" of the key illnesses? What are the important organs and how do the organs function together? How do illnesses progress? How is a "cure" supposed to work?

5. How does the local ethnophysiology of women's bodies differ from the biomedical model?

FORM 14.1
Focus Group Discussion Guide: Ethnophysiology of Women

Greetings, introductions o participants and moderators, explanations of the focus group session.

1. Have the informants give a list of a woman's internal organs (like a free list) - write them on a piece of paper. Probe to complete the list.

2. Have the women draw an outline of a woman's body on the floor or on a large piece of paper - it would also be possible to provide a ready made outline.

3. Have the informants complete Ethnoanatomy (Form 14.2) activities by placing and drawing the different organs within the outline. This aspect of the exercise includes both location, shape, size, etc. of the different organs. Informants should describe these characteristics from their own EMIC point of view.

4. Elicit the participants notions of Ethnophysiology, by describing the interrelationships between the different organs that they identified in point #3 above. This should be a fairly free set of comments at first. For instance, "How do these organs work? How are they connected to each other?" Make any adjustments/modifications of the diagram as required to match their spoken statements. Make additional copies of the original diagram as needed to indicate different physiological processes.

5. Ask a series of descriptive questions involving the diagram on a topic of particular interest. Most of these questions will take the form, "Show me what happens in a woman's body when...?" Here are some examples:

a. Show me what happens in a woman's body when she eats something? Ask to see all the places the food goes.

b. Show me what happens in a woman's body when she gets pregnant?

c. Show me what happens in a woman's body when she gets (illness name)? You can ask several different questions here to help your informants be more specific - where does X start in the body? Can you point to it with your finger? Where else in the body does it occur? Where does it go next?, etc. (Record on Form 14.3).

d. (Repeat for all the illnesses being considered). With the assistance of the informant, draw the location of the different illnesses on the diagram of a woman. Record findings on Form 14.3.

In the process of doing this exercise, informants will make new connections, associations between organ systems - you may decide whether you want to draw these on or not.

6. It is likely that many important organs may not be mentioned at all by women. After steps 4 to 8 are completed, you may wish to prompt the informants about the location of other types of unmentioned organs. (It has been suggested that people who eat meat are more likely to know about different organs).

7. Throughout the body mapping, make notes on the Process of the data collection. There will surely be disagreements about the types, size, and placement of different organs within the body - this disagreement is data and it should be recorded.

DATA COLLECTION FORM 14.2
Location of Internal Organs (sample)

Short Free List:

What are the different organs in a woman's body?

1. _________________________
2. _________________________
3. _________________________
4. _________________________
5. _________________________
6. _________________________

Where are they located in a woman's body?

(Draw on this figure with the guidance of the informant, who can point to place on figure.)

Where does food go? (Draw)

Where does a baby grow? (Draw)
__________________________________________________

Printed with permission from Nandini Oomman
__________________________________________________
DATA RECORDING FORM 14.3
Location of Illnesses (sample)

Choose one of the health problems mentioned by the women:

Health Problem # _________________ Health Problem Name_________________

Code the following:
Where does it start?
Where does it go?
How does it relate to other organs?
__________________________________________________

Printed with permission from Nandini Oomman (1995)
__________________________________________________

DATA ANALYSIS FORM 14.4
Consensus Picture of Woman's Body: Location of Internal Organs and Important Illnesses (sample)

Unit 15. [Advanced] Successive Pile Sorting: Building a Taxonomy of Illness Terms

Purpose

This exercise will permit further exploration of the domain of women's illnesses. As in Unit 5, the purpose is to examine how illnesses are categorized, but using a different method. In the free pile sort (Unit 5), separate illnesses were grouped together by the informant. The method of successive pile sorting offers more structure to the informant. In this activity, the informant is presented with all illnesses as a group and splits them apart to identify differences.

Data Collection

1. Prepare the Task Materials. Use the same set of illness cards developed for Unit 5. Select no more than 1 5 illnesses (8-10 is recommended).

2. Select informants. Conduct the successive pile-sort with 5 - 10 selected female key informants. These should be women you have been your informants previously.

3. Suggested Wording and Data Recording. Form 15.1 should be used for recording the successive pile sort.

a. Prior to beginning the interview, record the illnesses to be used for the task in the section marked Illness Terms, in order. Use no more than 12 illnesses.

b. Read the illness cards to the informants one by one.

c. Ask the respondent:

"If you had to divide these illnesses into two separate groups, how would you do it?"

Record response on Form 15.1. Write the numbers of illnesses in one pile in the box marked 1A and the numbers of illnesses in the other pile in the box marked 1 B.

d. Come back to the illnesses in the first pile. Ask the respondent;

"How is this group of illnesses different from that (point to other pile) group of illnesses?'

Record the response in box 1A and 1B under term.

e. Now consider the illnesses in box 1A. Ask the respondent

"If you had to divide these illnesses into two separate groups, how would you do it?"

Record answers in boxes 2A and 2B. Then ask how the two groups differ and record terms in the same boxes. Continue this process in the same way, continually splitting the piles into smaller and smaller groups until there is only one illness in each box.

f. You may need to modify Form 15.1 to add more boxes depending on how many illnesses you have included.

Data Analysis

Microcomputer Application

Successive pile sort data can be analyzed using ANTHROPAC (Appendix B-1).

1. Draw lines connecting the boxes according to the informant's responses.

2. In this kind of analysis, the reasons for splitting become of paramount importance.

3. Tabulate the reasons for splitting groups of illnesses (Form 15.2). Identify the 3 to 4 most commonly mentioned reasons for splitting rows 1, 2, and 3.

4. Draw one (or several if necessary) composite picture/model of the taxonomic structure using a clean copy of Form 15.1.

Interpretation Suggestions

1. Compare the composite taxonomic model with MDS of regular pile sort. How do the different groupings differ between the two models?

2. How does the way that informants label different groups (e.g., more serious vs. less serious, women's problems vs. can happen to anyone, etc.) relate to the way you might design an educational intervention?

DATA COLLECTION FORM 15.1
Collection of Successive Pile Sort Data (sample)

Women's Health Problems en's Health Problems

DATA ANALYSIS FORM 15.2
Tabulation of Successive Pile Sort Responses (sample)

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