En la feria educativa

As earlier mentioned, the second phase of field work was mostly aimed at increasing the trustworthiness of the evidence collected through the first round of data collection. During this stage, multiple sessions of ethnographic observations and feedback meetings with all informants were used to reduce potential biases in the interpretation of findings, by attempting to reach a deeper understanding of, and fidelity to, the reality explored, by cross-checking information retrieved in the first phase of field work with all case-study participants, and by further paying attention to the clarification of emerged concepts, their connections and interactions (Lincoln & Guba, 1985; Dye et al. 2000; Punch, 1998).

Both inquires were structured around the preliminary findings obtained for each key sentence included in the topic guide used in the first phase.

Field observations and feedback sessions were only recorded manually in a diary; notes were later transcribed and managed together with the data obtained in the first phase of field work as explanatory and descriptive comments and examples in support of the available data, as well as remarking notes to give emphasis on confirmatory evidence, to lessen the likelihood of contradictory findings and to modify or delete erroneous interpretations.

2.4.4.1. Ethnographic observations

A period of one month was spent for ethnographic fieldwork. Ethnography, when associated with the analysis of an intervention, has been found to be a valuable immersive approach in revealing insights that may be hard for implementers and recipients of that interventions to articulate due to the familiarity with their daily practice, and in showing how these activities are unfold in their social and wider contexts (Spradley, 1980; Evans & Lambert, 2008; Creswell, 2014). This approach holds great potential for getting firsthand data from an external observer and an holistic comprehension of how individuals experience a phenomenon, but also for looking at how and why context, human factors and situational interactions are played out over time in their complexity (Spradley, 1980). When associated with other methods of data

collection, such as focus groups and interviews, field observations provide a strong technique for triangulating emerging findings (Merriam, 2014).

In this phase of data collection, the fieldworker was principally observing, seldom asked questions to the actors involved, aiming only at clarifying their practices, and bringing light to the logic, concerns, classifications, processes and meanings that emerged in the field (Spradley, 1980; Evans et al., 2008; Creswell, 2014).

Field observations were run in 4 FHTs, and lasted one week each. The duration of ethnographic work was bounded by resource constrains, while the selection of FHTs was guided by convenience choices. First, FHTs had to be complete at the time of observation, so all health workers and professionals had to be present in their FHUs. Second, FHTs had to be based in fully functioning health units, that is in an environment and infrastructure that was not under construction or reconstruction. Lastly, were considered for observations only FHTs that were more keen to accept an external researcher.

Observations of CHWs and their teams were structured around the direct scrutiny and check of preliminary findings obtained from data collected in the first round of field work for each of the key theme investigated.

To this purpose, the main perspective of inquiry adopted was that of CHWs, rather than health professionals or community members. Observations included their physical settings (outside and inside health units), their role and the one of other actors involved (including team members and community members), their planned and unplanned activities and interactions (as part of a team, and as individual health workers), their conversations and content, the meaning they attribute to factors, persons and events, might this be transparent, non verbal or symbolic, and their attitudes (Merriam, 2014). During field sessions, the researcher followed each team from the beginning to the end of the working day, in the attempt to observe as much as possible patterns of events and variations. Being semi-structured and set into a dynamic context, observations included a variety of situations and actors that were difficult to get anticipated, but who became relevant for grasping an overall picture of CHWs practice.

The researcher played the role of an observer, while being a participant, since the research activities were known to the group observed, but interactions allowed to

establish a close connection and an insider’s identity, without, however, turning to be an active member of the group (Adler, 1998; Merriam, 2014).

2.4.4.2. Informants’ feedback sessions

The last step of field work was represented by informant feedback sessions, where preliminary findings were reported to case-study participants (CHWs, nurses and doctors of the control and intervention group) in order to check their accuracy and the interpretation of the researcher, so to improve the credibility, validity and transferability of their content.

Feedback sessions are a participatory technique, also known as member checking or respondent validation, widely acknowledged across the literature as a method for decreasing the misinterpretation of results and researcher’s bias (Creswell, 2014; Lincoln et al., 1985; Dye et al. 2000; Punch, 1998; Tanggaard, 2007; Morse et al., 2002). This approach enables participants to gain control over the authenticity and truth of the representation provided by the researcher on their interviews and focus group discussions, as well as to provide critical analysis and comments (Creswell, 2007).

A total of three feedback sessions were held with all informants. Attendance to the events was high, since all CHWs, and 80% of health professionals who took part in the first round of data collection participated. One sessions was dedicated to CHWs belonging to the control group, another with CHWs who received the intervention, a third one with nurses and doctors. These meetings took place together with the official closure of the overall trial, which, on ethical grounds, granted to all participants of the project a reward, namely the full delivery of the training and the action-guide to CHWs and health professionals of the control group, while a shorter session to refresh some contents and themes for those who formerly received the intervention.

During each session, preliminary results were presented to its relevant audience with a power point presentation in bullet points, a short narrative and key quotations for each theme of inquiry. After the presentation, participants were invited to provide their feedback and comments, in order to identify over or under emphasized points, vague descriptions, errors, biases and wrong assumptions in the data. Manual notes were taken during the sessions by the researcher, who later transcribed them and incorporate

them under each relevant section for the usage previously described. Group discussions lasted 1 to 2 hours approximately, and were facilitated by the researcher.