Reflection on research constraints and limitations

Critical interpretation of research results needs to take into account the limitations of the study and how those limitations were managed. Here this falls into three categories: i) sampling methods, ii) data collection methods and iii) interactions with participants.

Limitations of sampling methods

Some limitations occurred in relation to the sampling methods used. In the study related to human exposure to tsetse (Chapter 4) children were excluded, who are, by my observation, involved in daily water collection, thereby exposing them to tsetse. Furthermore, in the randomisation process for selection of participants to carry a GPS tracker, individuals carrying out occupational activities at the rivers banks, such as sand collectors may have been missed. A larger sample could potentially have captured more occupational risk groups.

The sampling for action research (Chapter 5) was initially done by the village chief who informed women about the first meeting, and later by the participants themselves, who invited other women. This sampling strategy was prone to some selection bias in favour of participation of individuals who were already exposed to HAT through their own experience, either as patients or care-givers of sick family members. Personally affected by these experiences, these participants were likely to be more motivated to participate in the tsetse control operations. This may have resulted in expression of overly positive views

126 and higher acceptance of tsetse control technology and of the operation itself. It may also have reduced the likelihood of any negative perceptions about the intervention. To minimize this bias I attempted to: i) enquire and use more probing questions with participants on any observed behaviour or when they expressed how other community members may think or feel, ii) perform an external evaluation of the condition of targets to check if any vandalism occurred in the process32_{, and iii) interview village chiefs at} the end of the action research to ensure that we had some external views on the processes. Through this additional collection of information, I checked for any overly positive framing of research results. However, more interviews with those members of community not engaged in the intervention, would have provided a better representation of a wider range of opinions.

Limitations in data collection

In the assessment of the impact of women-led intervention on tsetse density, no baseline assessment on tsetse density was carried out before women deployed targets. This decision was taken to ensure participants did not have prior knowledge of the control tools. While this ensured that the community was ‘naïve’ it prevented measurement of the apparent density of the tsetse population before the deployment of targets. The relative density of tsetse was assessed within and outside the intervention area to verify perception of women on effectiveness of intervention. The trend was in accordance with expectation with tsetse numbers being lower in areas where targets were deployed. Nonetheless, it is conceivable that the difference existed before targets were deployed.

Some limitations also occurred in collection of qualitative data. Elders’ memories may have been affected due to age, so recall bias may have occurred when discussing their memories. Only elders who had the ability to articulate their thoughts were interviewed which means that less articulate individuals who may have nonetheless had relevant different thoughts and memories were not included in the study.

The use of technical equipment for collecting data could have resulted in bias. For example, a number of limitations are recognised in the use of GPS trackers for monitoring daily human movements. Despite participants being instructed to carry on with their usual daily routine, the novelty of being in possession of a GPS trackers is likely to have influenced or changed their behaviour. Some participants openly shared that carrying the GPS tracker strongly influenced their movements—these were then excluded from the study. One female and two male participants were excluded because they were either a) moving with the tracking device to record boundaries of their land, or b) walked to the meet friends to show them the

32 _{If targets were vandalized by members of the community this would indicate that acceptance of the women-led} programme, including tsetse control tools, is low.

127 devices. However, it is possible that some participants did not openly admit to altering their normal behaviour and so may have influenced the study results. Furthermore sand extraction is a common activity among women and in some of the villages about half of the women reported being engaged in this activity. Sand extraction activity however was not recorded in my sample. Participants also expected that GPS loggers would be collected at sunset and this may have influenced (or curtailed) longer-distance movements.

The occasional use of video camera during action research may have brought additional enthusiasm among participants. This could have caused overly motivated behaviour and more enthusiastic expression of opinions. A careful assessment of the impact of this technology on potential bias was done beforehand. All villages involved in action research do not have regular supply of electricity. In one of the villages, however, the village chief installed a generator and satellite TV for villagers to view the football World Cup. At the local markets, televisions are common for communal viewing of the news, football matches and films. Hence participants are not unexposed to media and technology, which are part of their daily lives. Careful planning was done before any video recording: recording was conducted by a single female Ugandan journalist, who joined the group discussions and only occasionally switched on the camera and no scenes were repeated specifically for video recording. Furthermore, most of the deployment and maintenance of targets was carried out by women in the absence of the research team or the journalist, therefore these results could not have been biased.

During the role play, participants acting roles of decision-makers that are not known to them from their daily life, such as ‘minister’, ‘donor’, ‘WHO representative’ roles may lack complete understanding of the exact nature of these positions and people. All efforts were made to explain related details. Also, being involved in a tsetse control intervention prior to the role play and focusing on discussions related to sleeping sickness control may have created bias towards over-presenting priorities related to this disease and this bias may have played out in the role plays.

Interactions with participants

The critical self-evaluation of myself in the role of a researcher and the impact of this role on the research process and its outcomes, is referred to in the social sciences as ‘reflexivity’ [208, 224]. Such reflection allows one to identify the potential for personal characteristics to have influenced data collection, analysis or interpretation. Flanangan [225] proposes that both processes, enquiry related to the research and self- enquiry, can only be analysed and described separately.

128 Before boarding on a PhD I obtained a degree in medical anthropology (MPhil), during which I conducted a study of health-seeking behaviour of HAT patients in West Nile. My own experience witnessing HAT patients and interviewing their care-takers three years before the start of this research left a strong emotional impact and ultimately spurred me to conduct this research. Some authors refer to this as ‘studying the familiar’ [224] and in the context of this research I felt better able to engage with participants and understand their struggles and challenges related to HAT. For instance, I understood participants’ expressions of difficulty related to the distances and problems of accessing HAT treatment facilities because I had previously observed how hard it was for family members to travel with patients in late stage HAT with a bicycle as the only means of transport.

My personal background, particularly my upbringing in a rural area in a socialist state contributed strongly to my value systems which are centred on community cohesion and voluntarism. These have served to shape my enduring belief that community collaborative action is feasible and beneficial. This belief was perhaps translated into practice through action research, and my interactions with the study participants. Action research, however, allows for both: action and research to occur simultaneously as a transformative process with the boundaries between researcher and participants becoming blurred. Being aware of these dynamics also helped me to develop a reflective approach to my research. For instance, I engaged with the community aiming to record their views but not proceed with an intervention if they did not express a wish to do so. Prolonged engagement with participants, triangulation of research methods and debriefing sessions with the research team also helped to keep on my own influence on the research process [224].

During the action research, and despite the research team maintaining a neutral stance and letting participants make their own decisions, the presence of the research team is likely to have affected group dynamics. As Rifkin suggests [226], the process of participation inevitably involves power dynamics and to address clearly who has power and who does not is an important reflection. Provision of targets by the research team as the only way for participants to access these tools inevitably placed the research team in a position of power. The community, however, will not be completely autonomous in delivery of tsetse control and will depend on external suppliers of tiny targets in the future. These dynamics therefore were realistic and allowed me to assess how the community negotiates its way through such power dynamics. It became obvious through the role play for instance, that the community, regardless of its involvement with tsetse control programme facilitated by my research team, still promoted testing and treatment of HAT as their first priority. This indicates that power dynamics, between community and programmes, implementing disease control are likely to exist, but that the party holding power will be challenged and

129 have to adapt during the process of interaction with the host community.

The community’s perception of me as a white foreign woman is important to consider. The behavioural norms and relationships that community members often develop with other foreigners, such as missionaries or NGO workers (before my arrival), could also have caused some reluctance on their part to express their views openly and critically. I was based in West Nile for over four years (between 2011 and 2015) and intensive interaction with the villagers throughout this period created many opportunities for informal observations which helped me to gain a certain level of understanding of the cultural norms and ways of communication. I obtained a basic knowledge (some greetings and expressions of politeness) of the Lugbara language to facilitate my interaction with participants, which helped to break inter-personal barriers.

The decision-makers interviewed were aware of my links with the Liverpool School of Tropical Medicine (LSTM) and the schools’ work in tsetse control in West Nile. My research with local communities and women was also known to most of them. This may have caused them to express uncritical and positive attitudes towards community and women- focused tsetse control interventions. Senior levels of decision- makers were also likely to be influenced by their political role and therefore conscious when expressing their opinions to agree with institutional and political views of their organizations. An entirely neutral interviewer could perhaps have collected opinions that were nearer the truth.

Lastly, I was employed by LSTM as research assistant concurrently as I conducted my PhD research. In capacity of research assistant I was responsible for organization of sensitization campaigns to inform local communities in the trial area about the purpose and functionality of the targets. I was also in charge of liaisons with the district authorities to keep them updated on the progress of the Gates’ funded project. My working obligations however were completely independent to my research objectives. Where my study villages overlapped with the Gates’ project data collection was completed prior to any sensitization activities took place. I am therefore confident that this ‘double role’ as a researcher and research assistant did not influence the data collection process.