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Background
Qualitative Research to Improve Maternal Survival
 
CHANGE's Package of Tools for Behavior Change Interventions to Improve Maternal Survival recommends an approach that is focused, flexible, feasible, forward thinking and fast. This approach is based on experience with field partners developing and adapting these tools.
 
Focused
 
Skilled childbirth attendance is considered to be the single most critical intervention to reduce maternal deaths. The results of almost 15 years of qualitative research experience in countries where maternal mortality remains high have yielded consistent information on "universal barriers" to seeking skilled care – recognition of danger signs, cost, distance and transport. New research is needed to learn program options beyond the universal barriers. To reduce maternal deaths, focus on what is essential to know in order to change skilled careseeking behaviors, not what is merely interesting to know about a wider range of maternal health issues. Focus on identifying the local contextual factors for information to tailor the approach and content.
 
Feasible
 
"Scale-down" qualitative research to rapidly scale-up maternal survival programs. It is necessary to rapidly scale-up programs to improve maternal survival. The comprehensive qualitative research that was an essential element of early programs clearly defined the major barriers to use of care and the behavioral influences on a wide range of maternal health topics. This research can be used "as-is" to provide a foundation for the design of the broad components of safe motherhood programs.
 
Forward-thinking
 
Don't "reinvent the wheel." Once the "universal factors" are validated in a particular program setting, "scaling down" for details about local behavioral parameters will provide the additional guidance that can make strategies, messages and materials "resonate" among families and communities. Too often, overwhelming amounts of qualitative information are collected, making meaningful analysis and effective application of the information difficult and time-consuming. This detracts from the time available to implement. Using new methods and approaches – such as concept testing, projective techniques, doer/non-doer enables researchers to add new dimensions to the factors influencing use of skilled childbirth care.
 
Flexible
 
The essence of qualitative research is flexibility. Research teams should be prepared to rapidly adapt research plans and instruments as new information becomes available. Otherwise, several of the advantages of qualitative research - to identify emerging trends, to uncover unanticipated dimensions and shift emphasis to pursue unexpected findings - may be compromised.

A "rolling analysis," (daily on-site analysis of data by the local team) is a method used increasingly to help build flexibility into qualitative research. Once clear trends are documented, those research questions can be quickly eliminated, allowing new questions to be added to follow-up unexpected leads. For example, a number of complication narratives conducted in Kenya unexpectedly found that many women with obstetric emergencies "detoured" to visit indigenous religious groups for prayer healing. The original research plan was modified to include this new group in future interviews.

 
Fast
 
Complication narratives can accelerate the qualitative research required to design focused, behavior change interventions. Adapting existing generic tools and models to conduct and analyze narrative results allows more time and emphasis to be spent on developing strategic interventions and program implementation.
     
 
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