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6. Research modules

This section consists of a set of research procedures or modules carried out with mother-respondents that are designed to yield answers to many of the primary and secondary questions. The same mother-respondents are interviewed for each module.

The modules for structured interviews are as follows:

Module 1 (M 1 ) Pile Sort
Module 2 (M2) Food Attributes and Differences
Module 2a (M2a) Optional Directed Free List with Attributes
Module 3 (M3) Rating Food Qualities
Module 4 (M4) Household Food Acquisition
Module 5 (MS) 24-Hour Recalls and Food Frequency
Module 6 (M6) Hypothetical Health Case Scenarios

Preliminary Work to the Structured Interviews with Mother-Respondents

The structured interviews include a series of six modules which involve various procedures geared to get information on local concepts surrounding food items, food consumption patterns, and perceptions related to the stages of xerophthalmia. The way in which these exercises are carried out and the direction that the structured interviews take is partially based on the information gathered during Part 1 of the data-gathering process.

Before carrying out the research modules in this section, the research team needs to review the list of twenty-five to thirty key foods (IV-C) that will be the focus of the procedures. This list is used in Modules 15. The other major preparation is to develop a system and select the sample of mothers who will be the respondents for the structured interview modules. Before beginning the structured interviews, it is also important for the research team to create a system to manage the data generated.

Modules 1, 2, and 3 describe cognitive mapping procedures that are intended to provide an ethnographic picture of cultural beliefs concerning staple and vitamin A-rich food items.

Modules 4 and 5 are used to obtain data on food practices, specifically, food availability, food costs, food acquisition, and consumption practices.

Module 6 is aimed at understanding community beliefs and practices in relation to vitamin A deficiency.

As a cognitive mapping procedure, Module 6 helps to establish the explanatory model of vitamin A deficiency. It is also designed to amplify the picture of cultural perspectives on vitamin A deficiency, adding the dimension of where households seek help for these problems and what guides them in choosing healthcare.

All of the research procedures administered to respondents should first be pilot-tested with key-informants in the presence of the research manager. The field team should be aware that some modules appear to repeat similar questions. The mother-respondents should know the importance of each step in the modules and how they are different.

Introduction to Pile Sort and Food Attribute Modules

The goal of the pile sort and food attribute modules is to understand how people in the community think about, or what meanings are attached to, food items in the key food list. In a systematic way, the project team can learn what features community members associate with individual food items and how these items fit into the larger food system. While the food attribute module gets local concepts and qualities related to each food item, the pile sort module gathers information on how community members group food items according to local attributes. You may find that the attribute module is useful in identifying a range of local concepts, therefore allowing the team to become familiar with general food perceptions, while the pile sorting module guides respondents to separate foods by the more salient attributes.

In many cases the team may want to carry out these two complimentary modules together during a single session. During the testing of the manual, some researchers found that the attribute module was easier to carry out and served as a way to familiarize mother respondents with the list of key foods, and prepared them for the pile sort exercise.

It is important to keep in mind that one pile sort task should be administered during this initial visit with respondents and a second pile sort task will be carried out four or five weeks later at the end of the research period. The reason for conducting two pile sorts is because often during the first session you will find that women group foods according to those eaten or prepared together. The second time the task is administered the team should remind the respondents how they initially grouped the key foods and suggest that this time around they group foods in a different fashion (see Module 1).

When conducting these modules it is important that the research manager and assistants keep the purpose of the modules in mind, making adjustments and modifications in the research approach to conform to the local situation. Remember that the collection of data should be an inductive process and that you are building your approach based on results from the ongoing collection of information. Therefore, the research team analyzes the data on a continual basis, refining the research strategy as information is collected and a greater understanding of the local food system is established.

M1. Pile Sort

Purpose

The purpose of this module is to better understand people's perceptions regarding relationships between staple food and vitamin A-rich food and how they relate to eating patterns. In a nondirected pile sort, when you ask individuals to group the items in any way that makes sense, it is assumed that the sort process reflects people's ideas about similarities and differences. That is, the person doing the sorting is thinking "These belong together because...." Through this module, you can collect systematic information about people's idea systems that will enable you to identify classifications and dimensions or the food items included on the key food list. In particular you are interested in identifying attributes and qualities related to vitamin A-rich food items. You will be looking for clues about food, such as food restrictions among certain age groups, food taboos, food considered healthy, etc. Pile sorting gets information on the systematic sorting of foods, identifying local practices and concepts that broaden the researchers' understanding of the basic meal plan.

In this module you ask respondents to sort foods into groups of items that belong together and you will then inquire about the basis for their choices. For example, you may find that women group together green leafy vegetables and mangoes because they are both considered cold foods.

Since you may find that the first pile sorting frequently uncovers information on recipes, food preparation, or typical local food combinations the module should be administered on two separate occasions. Although the information on local menus can be extremely valuable, you will also want to gather data on the way in which respondents group foods according to attributes. It is therefore recommended that the first pile sorting task be carried out during the first session with the respondent and the second pile sort be conducted at a later time. For example, if the sessions are staggered over a four to five week period, the team may want to conduct the second series of pile sorting tasks during the last session when the case scenarios are administered.

Although you will conduct pile sorts with all mother-respondents in your sample, you may also want to carry out the module with a variety of other people including fathers and other caretakers, such as grandmothers and older siblings.

Another possibility is to involve students and perhaps teachers in the research, if the local primary or secondary school is in session.

Preparation of Materials

You will use the twenty-five to thirty key staple and vitamin A-rich foods selected through the administration of the free list and the criteria given in the introductory module section. Each food is assigned a number from one to twenty-five or thirty, depending on the total number of foods. The procedure for administering the task can be slightly different with literate and nonliterate respondents. The data are collected through a card sort module with both groups. The key foods selected can be drawn for the nonliterate group on the cards or written for literate participants. Depending upon the community with which you are working, you may use the drawings for both groups. People in general are more willing to respond to questions about food when they can actually see the food or a drawing of the food being discussed. Using drawings will reduce the possibility of confusing food items and ensure that you are talking about the same foods.

To prepare the materials for pile sorting make one card for each of your key foods. Draw the food item on one side of the card and place its corresponding number on the reverse side. (The purpose of the number is to assist the interviewer in recording. The same number is used throughout the modules.) Alternatively, write the name of the food item in addition to drawing a picture of the food. You may want to find a local artist to draw the foods as realistically and simply as possible, using colors appropriate to the area. If there are items that come from the same food source on the list of key foods be sure to make separate drawings for each item. For example, if both cassava root and cassava leaves have been identified as key items on the list of twenty five to thirty foods, it will be necessary to make separate drawings for the root and the cassava leaf.

The research team in India who tested this procedure successfully used nonperishable items (dahl, rice, dried greens, etc.) in small plastic bags for the pile sort module, rather than drawings.

Each sorting module should take about thirty minutes.

Administering the Pile Sort

i. Explain to the respondent the purpose of the pile sort. Tell the respondent that you are interested in learning how he or she would place the foods together, according to similarities and differences in the foods. You may find that the respondent is more receptive to the sorting if you describe the module as a game. You may begin by saying, "I'd like you to put these foods into groups or piles that belong together".
ii. To ensure that the respondent is familiar with the foods and recognizes the pictures and to give her/ him an idea of the range of foods, begin by asking the respondent to go through the cards, reading the names aloud, or, read each food item to the respondent. You may say, "Here are some of the foods which I'd like to know more about. Let's go through them each individually and you read their names aloud." Or, "Just to make sure that you are familiar with all of the foods, I'm going to go through the foods and read them aloud."
iii. Next place the cards, one by one, on a flat surface with enough space to hold all of the cards so that the food names or drawings are easily visible.
iv. Ask the respondent to group the foods in whatever way she/he wants. Assure her/him that there are no wrong or right answers. Allow the respondent to take as much time as necessary.

If the respondent is hesitant or has problems understanding the module, demonstrate how you would go through the module. Choose an item or subgroup that is familiar to the local population and go through the module. For example, you may select animals that are common in the region and go through the module grouping the animals according to similarities or differences.

You may say, "I would place cows, sheep, and goats together because their meat is consumed by the people here. I would place camels and donkeys together because they are used for transportation purposes."

Another possibility that has worked extremely well at the field level is to use laundry or cooking utensils to demonstrate how the module should be carried out with nonfood items.

You could ask the respondent how she sorts clothes when preparing to do the laundry. For example, you may say, "In my household, I would put shirts and pants together because these are the clothes worn by my husband and sons. Pagnes (women's wraps) and blouses would be placed together because they are worn by the women of the household. Boo-boos (an outfit worn by men and women in countries in West Africa) are sorted separately because they are more delicate and are only worn on special occasions.

If the respondent gets stuck in the middle of the module, try to encourage completion of the task.

You may say, "Now you have grouped milk, eggs, and meat together in one pile and oranges, pumpkins, and mangoes in another pile. Where are you going to place these remaining foods? How do you think they fit with the other foods?"

Some researchers testing the module found that to ask whether the remaining foods have "friends," facilitates the process. Another possibility is to ask the respondent about the "personality" of the food item(s) and to suggest that the respondent group the foods accordingly.

v. Once the module has been completed, go through each pile and ask the respondent to explain why the foods have been placed into these particular groups. Remember that you are searching for categories and dimensions. Ask probing questions to get answers as complete and as specific as possible. If you find that the same attribute is used to describe different food groupings, probe to gain an understanding as to why these foods were grouped separately.
vi. On the recording Form 4.1, write down the name of the respondent and record the numbers for each group of cards. After the card numbers, note a descriptive phrase or phrases that summarize the respondent's statement about the group.

For example, the recording form may look like this:

FORM 4.1 Pile Sort Table for Individuals (M 1 )

Procedures for Analyzing the Data

i. At the top of Form 4.2, enter all of those qualities or characteristics that the team has identified as important (e.g., children's foods, hot or cold foods, etc.), including those characteristics which were mentioned frequently by respondents during the pile sorting task. On the same form include the twenty five to thirty food items, so they correspond to the index numbers in the left column on Form 4.2.
ii. Using Form 4.1, tabulate the responses on Form 4.2 by placing a mark in each appropriate box. For example the food item, carrot was characterized by the first respondent as an expensive food. Locate the food item, carrot, in the first column and the term expensive in the top row. Find the box where the column and row intersect on Form 4.2 and place a mark in this box.
iii. Go through each respondent's form and record the answers from all of the pile sorts on Form 4.2. Calculate the totals in each box.

Conducting the Pile Sort a Second Time

i. Administering this module a second time, towards the end of the study and after you have conducted the cognitive mapping procedures, may elicit some interesting responses. You may say: "Remember the module that we went through compiling the food items according to either similarities or differences? I found your responses to be very interesting the first time around and wonder if there is any other way these foods can be sorted. Could you group the foods again this time arranging the foods a different way?" (Since you should have the results from the first pile sort on the recording form you may want to remind the respondent how she sorted the foods during the initial session).
ii. Go through the module again. If you find that it is difficult for her/him to go through the module a second time, give the respondent suggestions. You may find it useful to make reference to attributes mentioned over the course of the research process. At the same time try to avoid imposing your ideas on his or her decision-making process.
iii. Once the informant has completed the pile sorting task, ask again about the basis for the second sorting. Remember that you are trying to extract local terms. You may find it necessary to try several different ways of probing to get the reasons for the informants' answers.
iv. Record the numbers on Form 4.1, as you did during the first pile sort module. Be as specific as possible in recording. Transfer the information to Form 4.2 and combine the responses with the previous calculations.

M:2. Food Attributes and Differences

Purpose

The purpose of this module is to identify in greater detail the attributes and qualities that people in the community apply to food. The goal is to elicit concepts and perceptions associated with individual food items, which will enable the researcher to establish food patterns and develop a broader picture of the local food system. Depending upon the order in which you decide to carry out the pile sort and attribute module, you may have already collected some information about food attributes during the pile sort. This module allows the researcher to elicit responses from the respondents about each food item on the list of twenty-five to thirty foods.

FORM 4.2 Summary of Responses to the Pile Sort (M1)

1. Food Attributes

Preparation of Materials

i. Form 5.1 is a check list to use during this module.
ii. At the top of the form write the interviewee's name and number.
iii. Write in the list of key foods. Be sure to fill out the forms before you begin the module. If you have access to a photocopy machine, you will want to make copies of a master form already filled out with the list of key foods.
iv. This module should take thirty to forty-five minutes.

Administering the Task

i. Introduce this module by suggesting that you would like to learn more about some of the foods which are eaten in the area.
ii. Starting with the first item on the list, you may say, "I have heard a lot about the foods in the area but would like to learn more. As you can see, here is a drawing of kuka (Hausa baobab leaves) on the card. What can you tell me about kuka? What kind of (or type of) food is this? What aspects of this food would you like to share with me?"

Or, "Why do you buy this food? When you purchase this food, what do you think of? Is there anything else?"

Another possible way to elicit information may be to ask, "How would you describe the personality of this food?"
iii. If the respondent is reluctant to respond, give guidance by stating examples of how the food could be described or viewed. At the same time, avoid influencing or feeding answers to the respondent. You could also use examples from other domains. For example, mention a common animal and describe some of its characteristics.

You may say, "Let's take cows, for example. I would describe cows as strong, big, powerful.... How would you describe them?"

iv. When the respondent has exhausted the list of descriptions that belong to the first food item and the attributes have been recorded on Form 5.1, move on to the next item and ask her/him to go through the same process. You will probably find that the respondents become comfortable responding to the questions once they have mentioned the attributes for a couple of foods on the list. If necessary, you may have to probe the informant reminding her/him of some of the attributes which had already been mentioned in association with this food item. Proceed through all of the food items one by one.

Procedures for Analyzing the Data

i. If the information was not already recorded while the module was being conducted, fill out the food name and the attributes listed during the modules on Form 5.1.
ii. Transfer the responses on Form 5.1 to Form 5.2. A separate Form 5.2 should be used for each food item. Continue by calculating the number of times the attribute was mentioned for each food item by the different informants and include that figure under Number.
iii. Examine the Percent columns on the forms and calculate the number of times respondents mentioned each attribute by dividing the total number of responses by the number of responses for that particular item. Write in the percent of the responses. Go through the entire list of attributes and calculate all of the percentages.

Continued

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