Prepare To Mobilize
What does my information mean? Looking for underlying themes.
After you have gathered information about the people with whom you will be working and the conditions under which they live, it is important to analyze this information for evidence of underlying themes which may affect the impact of the health program—to look for the meaning behind the data you have so painstakingly gathered. This process is necessary to ensure that the approach you and your team develop addresses some or all of the major underlying causes of the health issue. For example, much of the data you collect will necessarily be in the form of symptoms, but in designing your mobilization effort you will want to be sure to address the themes or causes behind the symptoms. Many community mobilizers working in the field do this intuitively and there is relatively little documentation on how they do it.
There are several tools and techniques that can assist you as you look at underlying themes. As is the case with all tools, some work better than others in certain cultural settings. One simple method to use with your team to analyze your data is to repeatedly ask “Why?” until you get to some of the real underlying issues. For example, you could pose the question: “Why are maternal mortality ratios higher in communities in the south region of the country than in the north?” to your team and ask each member to write down his/her response. Then ask them to consider their responses and again ask why and write down another response, and so on until you have done this four or five times. All members of the team can then share their responses with the group and discuss what they are learning.
There are no magic formulas to apply during this analysis of underlying themes, and you may miss important ones. In the spirit of “learning by doing,” your team’s first analysis of key themes serves as a point of departure, but you should revisit these factors and adjust your approach as you learn more about the community.
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VIETNAM: Asking Why
During group discussions arranged by commune leaders early in the program, a program manager asked villagers to make a list of their problems and ended up with a 'shopping list' of requests, e.g. "we need water pumps", "a new school building", "what really would help us is electricity, improved roads, and a bridge" and "seeds and tools", etc. Program managers took the opportunity of their request for seeds and tools to ask them 'why' this particular intervention was important to them? The response initially was 'because this will increase our agricultural production." Again, the question 'why?' was asked of community member, and the response was, "so that we will have more seeds to plant for next season." With continual probing using the question 'why?' eventually program managers were able to get to the bottom of why food was important - the response was eventually stated 'in order to keep our families and children healthy." The important topic of malnutrition was then focused on with communities and a decision was reached that by working together, this problem could be addressed if community members were interested. |
Positive deviance
In exploring the health issue it can also be very helpful to identify and study the people who should be affected by the issue but apparently are not; that is, people living in the same area and/or under the same conditions who have the same risk of being affected by the issue but who are healthy and doing well in spite of the presence of risk factors (such as the “positive deviants” in the Vietnam case study in the box). In other words, you should not confine your information gathering to learning only about what doesn’t work in the community but also about what does. For more information about research tools and techniques for gathering information, see the tools section.
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VIETNAM: Positive Deviance
Despite the high prevalence of malnutrition in the Thanh Hoa province, Save the Children observed that a narrow majority (55%) of children were actually normally nourished according to UNICEF's criterion. Moreover, some of these were from poor families. The PANP "positive deviance" inquiry focused on these resilient children. Strategically, a positive deviance inquiry asks the questions: How do poor families have well nourished children when their neighbors, with access to the same resources, do not? That is, what is their "deviant behavior"6? Positive deviants, a poor family with a well-nourished child, attract attention because they contradict the general pattern. (To be a "positive" deviant refers to a social, rather than numerical, value). The positive deviance inquiry is well suited to communities where a problem is common, recognized, important, demonstrable, and remediable through behavior already modeled by some individuals within the community. The process galvanizes households at risk in poor communities to quickly identify and adopt affordable, lasting solutions to vexing problems from their own impoverished neighbors' experience. |
Gathering Information About The Health Issue
Gathering Information About The Community
Sources of Information
Initiating contact with the community
       
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