Hi R. Hulen,

A few years ago I did surveys in rural Niger, West Africa on women's
satisfaction with health care services (and also on adherence to medical advice
and sources of social and financial support).

I used a variety of qualitative and quantitative techniques to elicit
information. I wrote a survey in English and translated it into the local
language. The questions were geared towards the various spheres in which the
local health department had stated quality goals. It asked for responses of the
type "very much, somewhat, average, not much, very little" to which I assigned
values of 1-5 for my own use. I personally interviewed each woman and marked
down her answers.

Another technique I used comes from the field of participatory evaluation (some
expertise in this at the University of Sussex in England). I did it with
individuals but it could also be done with groups. The basic idea is to discuss
something abstract like help or safety or cleanliness, and ask the participants
to make an analogy with something concrete. For example, I had a box of 20
sorghum seeds. I first asked the subject to generate a list of the people who
helped her when her child was ill (husband, mother-in-law, sister, neighbor,
doctor, traveling pill salesman, etc. were typical replies). Then I said, okay,
this box of sorghum seeds represents how helpful these people were to you in
total. I want you to divide the seeds up, some for each person, but not
necesarily equally. I want you to assign more seeds to whoever helps you more,
and fewer to whoever helps you less.

Another way might be to ask them to rate the overall quality of care from
different providers or at different clinics. You could set the value of X
Clinic to 10 seeds (or pebbles, or pennies, or whatever) and ask them to tell
you what value they would assign to Y Clinic and Z Clinic by comparison. Make
sure to take notes on why they give higher or lower ratings. This can be
especially valuable with a group where they need to argue with each other to
arrive at consensus on what value to assign. By what is said in the arguments,
and what people seem to find convincing, you can get a lot of information.

Yet another way of finding out how people think about health care is to ask them
to help you sketch a map of all the places that health care or health promotion
activities happen for them. You could just do that and take notes on the
discussion. Or you could add another layer and have them assign value with
piles of seeds, etc. to the different places. This would give the same
information as in the paragraph above, but with another layer of richness
because of all the conversation around building the map (where should/should not
be included, and why).

With all these methods, people may have a tendency to try to be polite and say
everyone's doing a good job. Two things can help with this. One is to assure
people of confidentiality, and make the investigators/sureyors people who are
not also delivering the care being studied. Another is to use a preliminary
study to find what end of the scale most responses will be and try on the larger
scale study to give more options on that end (e.g. okay, good, very good,
excellent, outstanding, amazing). The numerical analogy activities after some
opportunity for free generation of categories are also helpful in finding out
what issues are important to the clients.

Good luck!

Alix

alix@...
Alexandra Barstow, Resident
University of Vermont Family Practice Residency
Milton, VT

On 24 Feb 2003 20:00 EST you wrote:

>
> Hi!
> I am with a group of senior nursing students connected to the La Buena Salud
> Wellness project in Idaho, which attempts to bring wellness services to
> Hispanic Migrant Farmworkers. We are looking for ways to evaluate client
> satisfaction satisfaction with the student's services. One of the
> difficulties encountered is that many clients are not literate in their
> primary language or english so written surveys are out. Any ideas? Is anyone
> using something that is working? We appreciate any leads you can give us!
> R. Hulen, RN
>
>
>
>
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