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4. Conduct unstructured interviews

An unstructured interview is a spontaneous conversation, not a specific set of questions asked in a predetermined order. You have a focus: you want to collect information about different aspects of the belief system. Use the guide that you developed in Step 2. You will get the information you want by asking broad questions during a natural, free-flowing chat. You may discuss a few of the pieces with some participants and different pieces with others.

EXAMPLE: Early in your field work you should have several conversations about different childhood illnesses in the community. The conversation might flow as follows:

Researcher: "What kinds of illnesses do children in this village get?"

Caregiver: "Well, diarrhea is the most common; also cough and cold, measles, fever, typhoid."

Researcher: "Are there any others? Any that are more common during cold or hot weather..."

Caregiver: "Pneumonia and whooping cough. They are both very common during cold weather."

Researcher: "Can you tell me something about measles?"

Caregiver: "During measles, it is good to give cold water because measles is very hot. The child should be kept in the house away from other children."

Researcher: "Why should the child be kept in the house away from other children?"

Caregiver: "Because measles spreads from child to child very easily. Once one child gets measles, all the children in the family get it."

Researcher: "How does measles spread from child to child?"

Caregiver: "I think it must happen through smell and sweat. Maybe it happens when a child touches something a sick child has touched. I'm not sure."

Researcher: "You said that diarrhea is a common disease in children. Is that spread from child to child?"

Caregiver: "Not usually. Only some kinds of diarrhea are."

Researcher: "Which kinds can be spread from child to child?"

Caregiver: "I think peach (bloody diarrhea) must be spread this way because once one child in a family gets it, the others do too."

An unstructured interview can go in any direction. In this example, you could have chosen to try to identify more kinds of childhood illnesses. You could have asked about diseases that occur in very young children. Or you could have expanded upon each illness identified as hot or cold.

There is no one right way to do an unstructured interview. The important thing is to gather and record information about aspects of the belief system. You proceed in any order that is natural. You can always return to a subject that you did not explore at the time it was mentioned. Make notes to remind yourself to go back and ask more about certain topics.

Some general rules for conducting unstructured interviews are:

• Avoid leading questions;
• Probe beyond the expected answer;
• Explore inconsistencies;
• Record participants' own words.

Avoid leading questions

The best way to ask questions is to allow people to answer in their own terms, voicing their own views, values, and experiences. Leading questions are phrased to suggest a particular answer or to imply that one answer is expected or more correct. For example:

• What fears do you have when your baby's diarrhea does not stop?
• What actions do you take to stop his/her diarrhea?
• How good was the treatment your baby got at the health center?

These questions are phrased to elicit answers related to fear, actions, and treatments, respectively. Nonleading questions on the same topics would be asked in this way:

• How do you feel when your baby's diarrhea does not stop?
• What do you do when his/her diarrhea does not stop?
• How do you feel about the treatment your baby got at the health center?

It takes practice to ask nonleading questions. Listen for leading questions when you are training field workers to conduct unstructured interviews. Have them write down their leading questions and rephrase them so that they are nonleading. For example, see Figure 3.3.

Probe beyond the expected answer

To probe means not to stop too soon when discussing an important topic. Ask the same question in a number of different ways to better understand beliefs and assumptions. An advantage of unstructured interviews is the opportunity they provide for rich insight and understanding beyond mere "answers. " The following example from Indonesia illustrates how you might probe the perceived causes of diarrhea:

EXAMPLE: Researcher: "You say that children here often get 'regular diarrhea,' which lasts only a few days, is not accompanied by vomiting, and does not make the child very ill. What causes this 'regular diarrhea'?"

Caregiver: "I don't know, it just comes."

(A skilled interviewer does not stop here, but tries to ask the question in a different way.)

Researcher: "Is regular diarrhea more common during certain times of the year?"

Caregiver: "Yes, during the dry season."

Researcher: "Why do you think 'regular diarrhea' is more common during the dry season?"

Caregiver: "Because the river water is so dirty."

Researcher: "The river water is dirty?"

Caregiver: "Yes the water is very low so you can see all the feces and garbage and dead animals that are in the river."

Researcher: "How is that related to 'regular diarrhea'?"

Caregiver: "Sometimes children drink the river water without boiling it, or the water gets in their mouths when they are swimming."

Researcher: "And how does that lead to diarrhea?"

Caregiver: "The dirty water causes the diarrhea."

Figure 3.3. Asking Nonleading Questions

By probing, the researcher learned that the Caregiver sees a relationship between diarrhea and the oral intake of "dirt." It would be helpful to probe even further to get a deeper understanding of local perceptions of disease causes. This is demonstrated below.

Explore inconsistencies

Sometimes caregivers' statements will appear to contradict their previous statements or explanations. This may simply reflect the fact that all people hold some beliefs that are not completely consistent with their other beliefs It is possible, also, that they misunderstood the question, resulting in an apparent contradiction. Nevertheless, it is important to explore apparent inconsistencies to clarify a misunderstanding or gain new information.

EXAMPLE: In reviewing her notes from an unstructured interview conducted in northern India, a researcher found some inconsistencies about the characteristics of illnesses and treatments. In that culture, illnesses and treatments are believed to have "hot" and "cold" humoral qualities. Hot illnesses are treated with cold remedies. Although the caregiver had described "diarrhea with vomiting" as a cold illness, she treated it with a cold traditional medicine. When later questioned, she explained that the cold medicine had been prepared with boiled water, thereby making it a hot remedy.

By exploring the inconsistency, the researcher learned that cold remedies can become hot remedies if prepared with boiled water. This knowledge was useful in promoting ORS for all types of diarrhea. ORS could be given with clean cool water for hot types of diarrhea and with boiled water for cold types of diarrhea.

Record participants' words

When taking and rewriting notes, reproduce the respondent's own words and phrases as faithfully as possible. Of course, you cannot record everything a person says during the interview. Focus on new words or pieces of information and on subjects that seem unclear or confusing. Very often, the particular words or phases used provide valuable keys to understanding the culture.

EXAMPLE: In continuing the conversation about the causes of regular diarrhea (see above), the researcher learned about a new word and a new concept.

Researcher: "Can you tell me more about how dirty water causes diarrhea?"

Caregiver: "Sometimes people don't boil the water enough. For example, the farmer leaves the water on the fire when he goes to the field, but the fire goes out before the water boils. If the water is not boiled, the kuman (tiny living creatures that can cause disease) don't die."

Researcher: "The kuman?"

Caregiver: "There are kuman inside the stomach when there is diarrhea. The kuman come out with the stool. The child is well when the kuman come out and the diarrhea stops.

Researcher: "Are you saying that kuman cause diarrhea?"

Caregiver: "Yes, kuman sometimes cause diarrhea, but other things can also cause diarrhea."

Researcher: "Do kuman cause any other kind of illnesses?"

Caregiver: "Yes, they can cause skin problems and tuberculosis."

In this example the researcher unexpectedly identified a new word and concept (kuman) that she thought might be important. When reviewing her notes later, the researcher found the exact quotes of the caregiver's words very helpful. For example, the Caregiver noted that if water is not boiled, "Kuman don't die." This suggested that the Caregiver considered kuman to be living things - a point that could be further explored at a later time. The caregiver's statement that kuman are inside the stomach and come out with the stool gave the researcher an idea. She thought it might be useful to discourage the use of antidiarrheals by explaining that antidiarrheals keep the kuman in the stomach. By preventing the kuman from coming out in the stool, antidiarrheals can prevent the child from becoming better.

5. Check Lists

It is not necessary to start from the beginning with every interview. After several discussions about different types of diarrhea or about different actions taken in response to diarrhea, it is often useful to present your "lists" to other key informants, asking for corrections, additions, and more detail.

EXAMPLE: "Other people I talked to told me about several different kinds of diarrhea. My list includes teething diarrhea, heat diarrhea, cough and cold diarrhea, constipation diarrhea, and spirit diarrhea. Do you agree with this list? Could you add to it? Are there any other kinds of diarrhea, perhaps some that are not very common but that sometimes affect young children?"

EXAMPLE: "I have been told that diarrhea can be caused by a child's eating too much food, by mixing sweet foods and sour foods, by excess heat in the body, by sitting in one place too long, and by worms. Do you agree that these are all causes of diarrhea? Are there other things that can cause diarrhea for some children?"

Do not start checking your lists too early. You risk cutting off other information by structuring new answers with a list. You should generally have information from four or five key informants before beginning to check lists.

6. Organize the information

Review and rewrite your field notes as soon as possible after each interview. Do not wait until the end of the day. After several conversations, you may forget who said what. The time you spend reconstructing each interview is as important as the time given to interviewing.

If you follow a certain order when rewriting your notes, it will be easier to summarize and compare the information obtained from all the participants. For example, you might follow the outline of your interview guide, adding information that identifies and gives some background about the key informant. If you are rewriting field notes by hand, it is useful to make a form for each informant that leaves plenty of space to add information collected during follow-up visits. An example of a format for revised field notes used in Baluchistan is reprinted at the end of this section. (Note that all of the spaces were not filled during the first visit or for each informant.) Some of the references listed in Part I give helpful tips on taking and organizing field notes.

7. Summarize belief system "pieces"

The last task is to make a rough chart listing the different pieces of the belief system. The chart summarizes the information from the initial key informant interviews, naming and describing the main features of community beliefs related to diarrhea! diseases:

• Types of childhood illnesses in the community;

• Word or words used to describe diarrhea;

• Different types of diarrhea (if the community identifies different types) and signs and symptoms associated with each;

• Perceived causes of diarrhea;

• Actions taken in response to diarrhea.

In most cultures there are at least a few different locally recognized folk types of diarrhea. If they have different signs and symptoms, causes, and actions associated with them, you may design your summary chart like Summary Chart A in Table 3.1. If you are unsure about whether or how the types are related to causes or actions, you may want to design your summary chart like Summary Chart B in Table 3.2.

Table 3.1. Sample summary chart A*: Folk type of diarrhea

* Data from Baluchistan, Pakistan

Key Points

• Enter the community in a nonthreatening, sensitive manner;

• Identify key informants and sketch a map of the community using participatory research mapping techniques;

• Conduct unstructured interviews using nonleading questions; probe beyond the expected answer and explore apparent inconsistencies; record participants' own words;

• List and organize results of interviews;

• Summarize such pieces of the belief system as general illnesses, words for diarrhea, different types of diarrhea, perceived causes of diarrhea, and actions taken in response to diarrhea! episodes.

Figure 3.4. Revised field notes

Identification
Key Informant:
Interview Date(s):
Tribe/Ethnic Group:
Head of Household:
Other:

Household information and observations

Childhood illnesses and associated signs and symptoms

1.
2.
3.
4.
5.
6.
7.
8.

Words used for conditions or illnesses with "stools that are looser, more watery, or more frequent than usual"

1.
2.
3.
4.

Locally recognized types of diarrhea

1.
• Signs and symptoms
• Perceived causes
• Treatment

2.
• Signs and symptoms
• Perceived causes
• Treatment

3.
• Signs and symptoms
• Perceived causes
• Treatment

4.
• Signs and symptoms
• Perceived causes
• Treatment

Household management of diarrhea

• Signs or symptoms that cause concern
• Signs or symptoms that lead to intervention
• Kinds and amounts of fluids given
• Kinds and amounts of food offered during and after diarrhea
• Signs or symptoms that lead to seeking help

Women's work and child care

• Child care patterns
• Decision-making regarding the care of sick children

Concepts related to diarrhea management

• What happens to food and water when they are taken into the body?
• What goes wrong or happens differently during diarrhea?
• Other

Miscellaneous

Table 3.2. Sample summary chart B

Types of Diarrhea (named by key informants)

Watery Diarrhea ("Pani Dust")
Bloody Diarrhea ("Khooni Dust")
Green Diarrhea ("Hare Dust")
Mucous Diarrhea ("Rhad Dust")
Yellow Diarrhea ("Pile Dust")
Bits and Pieces ("Phate-Phate")

Perceived causes of diarrhea by types of diarrhea

The numbers refer to how many informants named the item as a cause of that specific type of diarrhea.

Appropriate actions during diarrhea episodes: (as named by key informants)

• Herbal treatments (asafoetida, cardomon, aniseed, marorphali, opium)
• Food treatments (lemon, milk, curd, banana, or tea - usually a mixture of two or more items)
• Change in diet (a decrease in "harmful" foods and an increase in "helpful" foods)
• Massage
• Exorcism
• Allopathic drugs

Data were collected by M. Bentley in North India

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