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6. Investigating hygiene practices

Three-pile sorting
Pocket chart
Semi-structured (informal) interviews
Focus group discussion
Appraisal of the methods and tools

The following methods and tools have been field tested for investigating specific clusters of hygiene practices. Each one can be adapted or modified for specific settings whenever necessary. You may also want to include additional methods and tools from your particular training and experience, provided that they fulfil the selection criteria outlined in Chapter 5 (see Diagram 3).

Three-pile sorting

This method derives from the Promotion of the Role of Women in Water and Environmental Sanitation Services (PROWWESS) participatory approach (Srinivasan, 1990). Participants are given a set of drawings showing situations related to defecation, protection of water sources, water use and personal hygiene, food hygiene, corralling of domestic animals, and so on. Participants are then asked to discuss each drawing as a group and to arrive at a consensus as to whether it is good, bad, or in-between, and to explain why. Three-pile sorting operates in the same way as gender roles/tasks analysis, the only difference being that the three piles consist of good, bad, and in-between, instead of man, woman, and both.

Purpose

• To break down barriers and establish good communication. For this reason, it is a good tool to use at the beginning of fieldwork.

• To introduce sensitive/personal topics for discussion such as latrine use and personal cleanliness at the early stages of enquiry.

Materials

A set of twelve to sixteen cards (pictures mounted on thick paper or card board) showing activities related to sanitation and water-related hygiene should be used. The drawings can be drawn by local artists or adapted from health-related illustrated handbooks. It is important that the cards show local settings and practices. Each of the situations depicted should include at least one activity and/or feature that relates to one or more of the five clusters of hygiene practices (see, for instance, Plate 2).

The exact content of the drawings will depend on the hygiene practices you have decided to focus on, and on the materials available. Situations that are not hygiene-related but may be of crucial interest to the smooth running of your project, such as issues of user participation or operation and maintenance, may also be included. Label each card with a number so that you can refer to the number when writing down people's comments.

Procedure

The following guidelines may be helpful to the facilitator:

• Introduce yourself and indicate why the meeting is taking place. Speak clearly, using the local language.

• Ask participants whether the pictures show familiar scenes and whether the practices shown are good or had, and why.

• If it is useful (e.g., to enable participants to talk more freely, or to find opinions of different sections of the study population) divide participants into smaller groups, for example, according to gender or age.

• Hand out the cards and ask participants to pass them around, taking time to look at them closely, then discuss each card.

• Listen and learn.

• Ask the group to decide which category each card fits into: good, bad, or in-between. Remind them that they can use the in-between option if the pictures are unclear, or if the group has not agreed whether the practice is good or bad.

• Take notes on what people say (including the final decision, and how many people attended), but do not interfere with the discussion.

Plate 2. Pictures used for three pile sorting in India (1996)

Management, Review, and Use of Information

• Write up your notes. Describe the participants/samples and summarize what each group said about the cards (see Box 19 for an example of sample description). List the main points made and issues raised in the discussion, areas of disagreement, and any unexpected that were suggested.

This information will indicate what participants believe is good bad hygiene practice, and what they decide is in-between, but it does not prove anything. It can be a starting point for more investigation using other methods such as observation, interviewing, and focus group discussion of the main issues of disagreement.

• List the pictures by number and collate each group's comments with each picture.

• Review the comments made by each group and identify common views and beliefs, as well as unexpected issues raised which may be unrelated to hygiene practices. For example, the picture on Plate 3 (the same picture translated to relate to two different ethnic and cultural groups) generated animated discussions of family planning with particular reference to the responsibilities of the man (see Box 20). Define specific questions for further investigation.

• Prepare reduced copies of each picture used to put in your study report along with summaries of the comments made. These may be placed in an annex/appendix to the main body of your report for reference in order to save space and to facilitate easy reading (see Plate 3 and Box 20).

Plate 3. One of the Three Pile Sorting Cards Used in Tanzania (1994)

Figure 1

Figure 2

FIGURE 6. Pictures Used in a Pocket Chart to Investigate Water Uses According to Source, Showing the Number of Votes (Kenya, 1993)

Pocket chart

This tool derives from PROWWESS, and can be used in many different ways depending on the topic of investigation and the type of information required.

Purpose

• To investigate which water source is used for what purpose, or who uses which defecation site and to find out the reasons why. For example, in one study, the pocket chart was used for collecting and tabulating data on water sources in relation to water uses. In another study it was used for investigating choice of defecation sites (courtyard, traditional latrine, SANPLAT latrine, VIP latrine, bush) according to different members of a household - child, woman, man, senior man, senior woman (See Figure 6).

BOX 21. Extracts from Pocket Chart Discussion Notes

From a Village in Western Kenya

Materials

A wide variety of materials may be used for making the pocket chart. The main components include a set of pictures for each variable (e.g., depicting a water source or a water use); material on which these pictures are placed (a wall, a piece of canvas or other strong material, or the ground); pieces of paper/card. pebbles or beads for 'voting," indicating variables selected; pockets or other receptacles in which the Voting cards or pebbles or beads are put.

Procedure

• Introduce yourself your team, and explain the purpose of the meeting clearly in the local language.

• Introduce the pocket chart by showing it to the participants and describe the materials of which it is made.

• Ask the participants to pass the pictures around and to discuss what is depicted. I Listen and learn.

• Arrive at a consensus with the participants on what each picture depicts. You must make sure that any ambiguity in the participants' minds about what each picture depicts is fully discussed and clarified so that it is clear to each participant what the variables are.

• Ask participants whether they would like to add any other variables that may have been left out. If the answer is yes, find a picture or symbol to depict each additional variable (if the study team includes an artist. this may be prepared on the spot and passed around to the participants for their approval.

• Start with blank pockets, and explain the voting procedure.

• Conduct a demonstration - mock voting in the open.

• Distribute voting cards - assign a different colour for each gender and/or age group, if necessary.

• Cover the pockets. and turn the pocket chart around so that people can vote privately by secret balloting, and start the voting process using one variable at a time.

• Reveal the results to the participants before proceeding to the next variable.

• Record the number of votes in each pocket.

• Review/discuss the results with the participants.

Management, Review, and Use of Information

• Write up your notes from the discussion that took place during the use of the pocket chart.

• Keep the tabulated voting results and prepare a chart showing the pictures or description of them in words and the number of votes as shown in Figure 6 (see Box 21 for an example of pocket chart discussion notes).

Semi-structured (informal) interviews

The semi-structured interviewing method is also part of the standard anthropological investigative approach.

Purpose

• To investigate general as well as specific issues by asking questions informally but systematically.

• To find out which hygiene practices are considered ideal or acceptable, and why.

Tool

A written interview schedule should be prepared for the interviewer to study beforehand. This involves specific training of the study team to enable them to learn or improve their interviewing techniques, discussions of possible lines of questioning, modifications of the question lines, translation of agreed questions into the local language(s), and back-translating from the local language into English in order to check that the intended meaning is conveyed. A semi-structured interview schedule (see the Worksheet 2 for an example) is often used prior to the conduct of interviews rather than during the actual interviews.

Procedure

• Study your semi-structured interview schedule well in advance to familiarize yourself with the scope of the questions and the question lines selected. You can make your own brief set of notes to remind you of the question lines developed and the topics covered. Rehearse your question lines in the presence of others in your team and ask them to give you their constructive criticism (see Chapter 3).

• If possible, have another member of your study team accompany you to the interviewee'.s home and sit through the interview as a note-taker.

• Introduce yourself. the note-taker. and any other members of the study team present (e.g., the observer); establish good rapport with the interviewee and his/her family (see the introduction to Chapter 3).

• Listen carefully and use common sense, however well you may have memorized or studied the interview schedule beforehand. For example do not ask the respondent whether her children are old enough to use a latrine if she has already told you that she has no children.

• Avoid asking leading questions.

• Use prompts and probes sensitively.

• Draw the interview to a close by thanking your interviewee and any others who have assisted you.

Management, Review, and Use of Information

At the end of each day of interviewing, try to find time to write up the interview notes as a team. I he notes jotted down during the interview might be very brief, but now these need to be expanded and annotated. You can expand the notes by adding in detail what YOU did not have time to write down but now recall, and you can annotate by writing your own ideas - relevant questions, importance of findings, themes, and so on - on the notes. It can be useful to have wide margins for your notes, or to write on one side of the page only, using the opposite page for comments and additional information.

Information obtained by interviews is usually analyzed by systems of categorizing, indexing, and filing to facilitate its management and analysis. For example, a separate file or index can be kept for each cluster or sub-cluster of hygiene practices. or for each category of information about the local context. Special computer software packages are now available for use in textual data analysis, however, a simple word-processing package, if available, can also make the job of filing and indexing qualitative information easier and taster. See Box 22 for an example of how interview observation data can be recorded, before they are reviewed by the study team.

Worksheet 2. An Example of a Semi-Structured Interview Guide

Name:

Village/Town/City/Camp/Zone/Section:

1. Greetings (for example, "Good morning/afternoon; How are you and how are the children? Other members of the family? etc.)

*2. How many children do you have?

3. Are the children able to use the latrine on their own?

4. If not, where do they defecate?

5. How do you dispose of the faeces?

6. Who else uses the latrine?

7. Do you use the latrine?

8. If not, why not?

9. Do you think young children's faeces are harmful in any way?

10. Why?

11. Have the children had diarrhoea in the last two or three days?

12. What caused it?

13. How did you treat it?

14. Who else has suffered from diarrhoea in the last two or three days?

15. How was it treated?

16. Where do you get your water from?

17. How much? How often?

18. What is it used for?

19. Do you bear water before drinking or other use

(a) by filtering
(b) by allowing it to settle
(c) by pouring ash in and allowing it to settle
(d) by boiling
(e) by other means?

20. Do you pay for water? How much?

21. When do you wash your hands with soap/ash/other local soap alternative?

22. Why? If not, why not?

*This may be a sensitive question in marry cultures although we did not find any problem posing it after the preceding question (expressing interest in the children's well-being). An alternative may be, "tell me about our children."

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