Methods for Phase 3 – Qualitative process evaluation

For the qualitative process evaluation (Phase 3), a total of 40 semi-structured interviews were carried out with a sample of individuals who had been involved in the study in different capacities. 10 health workers, 15 men and 15 women were interviewed.

We asked health workers about their experience of providing the intervention. Their views were sought on the training workshop, intervention format, educational materials to be used with couples, teamwork among colleagues, management support, relationship with the research team and manageability of the workload. We asked what aspects of providing the intervention components they had enjoyed and what was difficult, as well their perception of the reactions of participants in the sessions. We attempted to identify technical or logistical challenges and sought suggestions on how these could have been overcome.

100 Two health workers were interviewed from each participating PHC. In each centre, we

interviewed the study contact person. In some PHCs there were two contact persons, in which case they chose among themselves who would be interviewed.

For the selection of the second member of staff, I proceeded as follows for each PHC. First, I compiled a list of all individuals who had conducted at least two out of the three intervention components. This amounted to approximately 2/3 of the total number of staff working in each the maternity department. Then I went to the PHC unannounced one day, without knowing their rota, and asked who was on duty that day out of the people on my list. I then made small bits of paper with the names of the people who were on duty, put them into an envelope, and pulled one out at random. I then went to speak to this member of staff in private, explained the purpose of the semi-structured interview and how it would be conducted, and asked whether they would be willing to participate. In one case I had a refusal and therefore picked another name. I did not tell any of the person’s colleagues, nor the contact person, that they had been selected, and told the chosen person so. The aim of this precaution was to ensure that this member of staff would feel comfortable to talk freely about their workplace and colleagues, without fear of any repercussions.

It was not practically possible for me, as the analyst, to be blinded to the identity of the health workers who were interviewed, given that I was the person who had the documentation required to carry out the selection and I was the only person available to approach the health workers and obtain their consent. I recognise this as a limitation, given that being able to reassure

interviewees that I didn’t know who was being interviewed might have made them feel freer to criticise the study. However, three researchers from the local research institute Centre Muraz, who had not been involved in the study up to that point, were recruited specifically to carry out the interviews with staff (see Subchapter 5.1.3). Therefore, the people who arranged the meetings and conducted the interviews were not known to interviewees and had not been involved in the study up to that point. This may have minimised bias and encouraged staff to talk more freely.

Interviews with men were also conducted by the three (male) researchers from Centre Muraz, whereas those with women were conducted by Ms Djeneba Ouedraogo (who was also the study field coordinator). Men and women were asked about their experience participating in the intervention. Topics covered included how they/their partner received the invitation to participate, how they were treated at the health centre, whether the format of the components was acceptable to them, and whether the content of the sessions was interesting or useful to them. We attempted to understand in what way participation in the intervention did or did not make sense to them in the light of their own values and their relationship and family dynamics,

101 and whether and in what way it had been beneficial to them. If respondents/their partners had attended none or only some of the components, an effort was made to understand why.

The women and men who were interviewed were all part of the intervention group. Men and women were not each other’s partners, but represented 30 distinct couples. This choice was made in order to capture the broadest possible range of experiences of the intervention. I selected participants randomly in January and February 2016 among the couples in which the woman had already completed the 8-month follow-up interview. Waiting so long introduced the risk that some people might not remember the details of their experience of the intervention. However, this choice was made in order to avoid introducing any bias prior to the completion of the quantitative follow-up. The 15 men were randomly chosen in a pre-defined proportion according to their level of adherence to the intervention and the 15 women were chosen in a similar proportion, based on the number of sessions attended by their male partner. I also attempted to choose participants in equal proportions from the five PHCs.

I made the selection from the list of women who had completed the 8-month follow-up interview, ordered chronologically based on the interview date. I screened each subsequent record, representing a woman/couple, until the required number of women and men had been chosen, based on the desired stratification by adherence level and PHC.

The interview guides are available in Appendix 7, Appendix 8, and Appendix 9.