Quantitative Physiological Measurements Summary

● Content analysis

● Consistency Checks (includes informal inter-consensus and informal cultural consensus)

● Informal Person-Centered Cultural Consonance

● Reliability Checks

● Photographic, Video, and Voice Recordings

● Field School Approach

● Qualitative Research Combined

● Limitations (includes case-control samples, standardization, and applications)

● Significance

1.2.3.2 Quantitative Physiological Measurements Summary

My frameworks for selecting qualitative and quantitative methods could not have been more opposite. I had an abundance of qualitative methods to choose from, extensive training and the flexibility to test them out in the field to see if they solicited useful and relevant information. Some worked better than others in a particular research setting and I purposefully selected methods which best elicited specific information. Choosing and implementing quantitative methods on physiological measurements was a different story.

I had a very limited set of methods to choose from based on the specific geographic, cultural, topical and infrastructural constraints of my research setting. I had much less training, experience and flexibility in biological data collection. I could not easily

“experiment” in the field due to ethical and financial restrictions, nor was I willing to subject my long-term key informants to a confusing battery of pokes and prods during cherished ritual healing encounters “just to see” (none of which—I had to state for IRB purposes—had any medicinal value and which could, in fact, cause physical or

psychological harm).

Even if I succeeded in collecting enough data (which was unlikely because I could not control any of the factors in the research setting: e.g., consistency of the participants, time of day, duration of medical event and ritual procedures), it was nearly impossible to

keep samples viable in the remote field settings where my research occurred (e.g., no access to refrigeration, consistent electricity or even regular postal services). In order to find evidence that Asante indigenous ritual healing ceremonies influence physiological processes, I needed to take measurements before, during, and after these ceremonies.

Furthermore, due to ethics, informed consent, IRB regulations, and common decency, whatever methods I chose would need to be translated into Twi, as a large percentage of my informants did not speak English. This made things complicated because there were no Twi equivalents for many of the medical, technical, and psychological concepts that I needed convey. Miscommunication risks grew exponentially the more complicated the method was. I’ve included many of the Twi language explications I created as I was trying to translate the following methods.

As a result of all of these factors, my quantitative methods were drastically limited by: a) what was an effective measurement of physiological change, b) what could be translated into the Twi language without major miscommunication, and c) what could be accurately implemented in my remote field setting.

I provide a detailed explication of the following methods I attempted in the field and what worked, what didn’t and why. In Appendix: Chapter 1: 1.3 Quantitative Methods there is a detailed description of each of the following topics and quantitative methods I used in this research.¹⁸

● Perceptual Measures of Stress (includes Perceived Stress Scale (PSS), State-Trait Anxiety Inventory (STAI), STAI-6, and State-Trait Inventory for Cognitive and Somatic Activity (STICSA))

18 I also describe some of the research limitations I encountered in Appendix: Chapter 1: 1.3.1 Quantitative Research Limitations and Significance.

● Twi Translations of PPS STAI-6

● Rapid Assessment Perceptual Interviews

● Physiological Measurements of Stress (includes stress hormones and the stress response)

● Stress Hormones (includes salivary cortisol measurements, catecholamines, feedback regulation of the HPA axis, measurements of Vagal tone, Galvanic Skin Response (GSR) or skin conductance methods)

● Biospecimens (includes blood, urine, sweat, cheek, and hair samples)

● Physiological Stress Response Measurements (includes heart rate, pulse, blood pressure, respiration rates, and blood oxygen saturation levels)

● Data Collection Process

● Group Entrainment

● Binaural Beats (includes alpha, beta, theta, and delta states and potassium and sodium levels and ratios)

● Limitations

● Significance

In the end, I collected physiological measurements (e.g., heart rate, pulse, blood pressure, blood oxygenation levels, and subjective feedback) of over 95 different

individuals in two types of samples. The first was collecting physiological measurements at shrines over the course of a year in order to obtain a comparative baseline for Asante physiological patterns before, during and after indigenous ritual ceremonies. The second sample type was measuring the same people at the same shrine over the course of a year.

This helped me understand the different physiological responses between long-time ritual attendees or shrine workers and new patients. It also helped me track the variation in responses from ritual to ritual to understand the pattern of general trends over time (e.g., changes in individual patients over the course of one ritual ceremony and over the course of many different ritual ceremonies).¹⁹ All in all, the combined qualitative and

19 This was accomplished using two battery-operated devices: a blood pressure monitor (the cuff went around the participant’s left bicep) and a pulse oximeter (that clipped lightly onto the participant’s right index finger). I placed both devices on at the same time and their combined time of measurement lasted from one to three minutes depending on whether there were any errors. I recorded all measurements in a notebook without any identifying features that could trace back to particular individuals.

quantitative mixed methods used for this research provided a rich context for discussing biocultural interactions in Asante medical encounters.