Volume 16, No. 2, Art. 3 – May 2015
Research Note: The Methodological Implications of Relying Upon Fieldworkers for Qualitative Health Psychology Research
Abstract: The fact that a researcher forms a critical component of the world that he or she is studying is no more evident than during the gathering and analysis of data that underpins his or her qualitative research study. Having selected a Straussian grounded theory of the meanings of voluntary medical adult male circumcision (VMAMC) for HIV prevention in South Africa as a research topic, I found that my personal characteristics (being a young, white, English-speaking female researcher) had a profound impact on my ability to recruit and interview participants for this study. Thus, I had to rely on fieldworkers to act on my behalf in this capacity. However, this had a number of methodological implications for my study and as such, this article addresses these to remind qualitative researchers that practical solutions to overcoming research process obstacles can have methodological implications that need to be considered and addressed to ensure rigor within qualitative health psychology research.
Key words: data collection; fieldworkers; grounded theory methodology; researcher characteristics; voluntary medical adult male circumcision; South Africa
Table of Contents
2. The Participants
3. The Fieldworkers
4. Implications of Relying Upon Fieldworkers
Given my personal and academic interests, as well as the fact that a review of existing literature and research showed that there was little to no insight into the HIV prophylactic voluntary medical adult male circumcision (VMAMC) meaning-making by key individual agents (adult men) in South Africa, this research topic was worthy of investigation. As such, I aimed to provide a Straussian grounded theory analysis of repeat semi-structured interview data to account for the factors involved in individual meaning-making of VMAMC as a means of HIV prevention. The study showed that meanings of this public health intervention may impact whether or not the public will utilise it as a HIV prevention strategy in South Africa. Thus, the resulting grounded theory may be imperative in considering the viability and success of the national upscaling of VMAMC as part of the Department of Health's HIV prevention strategy. While the findings of the study are worthwhile, given the nature of this study I found (as a young, white, English-speaking, female researcher) that recruiting participants and gathering interview data was a particularly arduous task. 
During the proposal writing phase of this study I came to understand that traditional male circumcision has existed for centuries and is practiced by various people as a rite of passage, as a symbolic inscription of religious commitment, and as a collective health measure for preventing a host of diseases and infections that afflict males (BHATTACHARJEE, 2008; EL-HOUT & KHAULI, 2007; SHELDON et al., 2012). However, I did not fully anticipate the degree to which the removal of the foreskin, as both a rite at the level of the individual body and the socio-cultural context as well as a HIV prevention intervention, would extend beyond its biomedical, psychosocial, and anthropological understandings of the male body to limit my active participation as the researcher. 
For example, only one male (out of the 60 adult males who I personally invited to participate in this study) accepted this invitation and agreed to be interviewed by me. Those who declined the invitation to participate in this study (or agreed to participate provided they could be interviewed by one of the male fieldworkers) indicated that it was culturally and/or morally "inappropriate" for them to discuss any matters regarding circumcision with a woman (particularly one from a different race and cultural group). As such, I had to rely on fieldworkers to gather data for my doctoral study. The fieldworkers were far more successful in recruiting and interviewing participants with approximately one in every 15 adult males approached agreeing to participate in this study. 
2. The Participants
I sought to recruit participants from adult male participants who lived or worked in Alexandra Informal Settlement in Johannesburg, South Africa. Through the assistance of the fieldworkers and snowball sampling procedures, the final sample consisted of 30 participants (aged 18-64) from various educational, religious and cultural backgrounds, however; the sample consisted primarily of black males (with three white participants). These participants represent key beneficiaries and stakeholders of VMAMC since they may be impacted by the possible upscaling of this intervention in an effort to reduce HIV infection rates in South Africa. 
Alexandra, the oldest informal settlement in Gauteng Province (established in 1905), has an estimated population of some 390,000 individuals (SHAPURJEE & CHARLTON, 2013). Gauteng Province has a HIV prevalence of 10% and this is the same as the national HIV prevalence for South Africa (UNAIDS/WHO, 2013). Alexandra has encountered challenges such as high unemployment, rampant crime, infrastructure backlogs and limited job opportunities, all of which have proven to be factors relating to high risk of HIV infection (LE MARCIS & EBRAHIM-VALLY, 2005). 
Earlier studies of young men in Alexandra have also demonstrated that significant numbers seem to, simultaneously, accept and reject hegemonic norms of masculinity by negotiating and embracing unconventional perspectives of masculine gender identities (LANGA, 2008). Thus, this target population seems to represent the core of African, urban masculinity, making it one of interest in exploring the factors that influence meaning-making regarding VMAMC as a means of HIV prevention. These factors were considered to make Alexandra a convenient and appropriate site that met the sampling needs of this study. 
However, as noted previously, the participants resisted my involvement with data collection. This is particularly noteworthy as I adopted a Straussian grounded theory approach to the research process whereby grounded theories are developed and constructed "through past and present involvement with people, perspectives, and research practices" (CHARMAZ, 2006, p.10). Given that acts and discussions of circumcision are traditionally the domains of males, I had to employ two fieldworkers to assist me in recruiting and interviewing participants for this study. 
3. The Fieldworkers
A general rule for creating sound quality data when conducting interviews is that particular characteristics should be to be considered when choosing an interviewing fieldworker (WIMPENNY & GASS, 2000). In this case, factors including age, race, culture, gender, and multi-lingual proficiency were key criteria that had to be fulfilled, considering the sensitive nature of the research topic. Thus, the fieldworkers who I relied on to assist with the research process were young (age 21-23), black, multilingual males who were registered at a local university. These fieldworkers were registered for Bachelor of Health Sciences degrees where a course in psychology (at various years of study) had been completed. They proved to have the basic skills and abilities required to assist me with my study. After I trained them in participant recruitment and conducting one-on-one semi-structured interviews, the fieldworkers visited Alexandra and invited adult men who approached or exited a demarcated area where individuals can access public transportation services to participate in this study. They informed these men as to the nature of the study and what their participation would entail. Interested participants exchanged their details with the fieldworkers so that they could be contacted to arrange an interview. 
Fieldworkers conducted interviews with these participants on an individual basis, which were audio-recorded, at a time and place that was private, safe, and considered suitable to both the fieldworker and participant. Thereafter, they transcribed the interviews verbatim and provided me with electronic versions of the audio-recordings and transcripts upon completion. 
4. Implications of Relying Upon Fieldworkers
In order to generate quality interview data, it was necessary to ensure that the fieldworkers were competent in this method of data collection. The fieldworkers received training regarding the ways in which to make initial contact with potential participants (so as to maximise cooperation and legitimise the value of participating in this study). I offered each fieldworker training on how to effectively conduct a semi-structured interview as well as how to effectively keep writing notes during the interview (FRANCIS & HEMSON, 2009). Thus, a great deal of time had to be dedicated to the training of these data collectors so as to ensure that there was a degree of uniformity to the data, which is typically compromised by interviewer and coding errors. This meant that I had to generate a document that outlined the formatting and recording instructions to be followed and used this in the training of the fieldworkers. 
However, I found that the fieldworkers sometimes changed the phrasing of a question on the interview schedule, which distorted the meaning of the intended question. Fortunately though, given the number of questions asked in the interviews, the fieldworkers were often able to clarify the meaning of such questions and obtain accurate information from the participant. Another challenge was related to the use of probing questions during the interviews. There were a few cases (in reading the data transcripts) when a participant's response was not entirely clear to me, which could have been clarified if a probing item had been asked by the fieldworker. However, in such instances, I was able to meet with the interviewer to discuss such issues. It was found that my limited understanding of traditional male circumcision was at the root cause of certain responses requiring clarification, which the fieldworker was often able to provide during these meetings. 
Furthermore, I relied on follow-up interviews, which were constructed on the bases of the analysis of data gathered in the previous interview. At this point, I was able to provide the fieldworkers with a platform to probe the participants for clarity on information offered in those previous interviews (to address any potential gaps in the developing theory) as well as to share the emerging themes with the participants so as to obtain verification, correction and/or comment on the analyses undertaken. However, participants could not always be contacted to arrange follow-up interviews or they were unable (or unwilling) to participate in further interviews. 
There was also an economic implication to this process since I paid the fieldworkers from my personal funds at the university recommended rates per hour. Given that there was over 50 hours of interview data (plus time spent transcribing these interviews), this was a costly exercise and one that not all emerging academics are able to afford. Although Anselm STRAUSS and Juliet CORBIN (1998) suggest that the researcher can be discerning in what sections of the interview are transcribed, I felt it necessary to have each interview transcribed in its entirety. This was because of the limited active engagement that I was able to enjoy during the data collection process (HARRY, STURGES & KLINGNER, 2005). Considering that I was not able to even meet most of the participants, I had to ensure that there was as much accuracy as possible in the recording of participant responses. As such, I spent innumerable hours reading the transcribed data while listening to the audio-recordings of the interviews. 
A core ethical concern was related to maintaining anonymity and confidentiality of the participant's personal details as well as the interview data. I addressed the matters related to conducting ethical research with the fieldworkers and required that they sign a confidentiality clause indicating that they will not disclose the identity of participants (as well as the content of interviews with these participants) with any third party. However, I have no guarantees that the fieldworkers will adhere to this standard of ethical research practices. 
Overall, while I was satisfied with the quality of work produced by the fieldworkers, this process involved intense supervision to ensure that there was quality control and editing regarding the transcribing of the interviews. Additionally, as far as possible, I had to supervise the control of sampling in an effort to ensure that the participants did in fact meet the sampling criteria for this study. This meant that the fieldworkers and I met regularly to discuss any concerns relating to the collection of data whereby further training could be provided to improve response rates, quality of interviewing and the class of interview data. 
Bearing these limitations in mind, there are some methodological benefits to not acting as the primary interviewer in this study. The fieldworkers shared a number of characteristics similar to the participants—they were the same race, and sometimes from the same traditional background, as the majority of the participants from the general public; there was also shared language between a number of these participants, and they shared a similar educational experience with some of participants. Thus, they were able to quickly establish a rapport with the majority of the participants, a critical element to acquiring data regarding such a personal, sensitive, and provocative research topic. 
Furthermore, by giving the fieldworkers a semi-structured interview schedule, they were able to have a format from which to conduct the interview but was sufficiently flexible to allow the participant to volunteer information that I might not have thought of to mention during the interview considering my dissimilar personal background to the participants and the matter of traditional male circumcision or VMAMC. This also meant that I was able to obtain data that was relatively free from my strictly personal line of enquiry. 
Additionally, given my personal, educational, and professional interest with HIV prevention and sexual behaviour research, I found that I was able to have some of the participant-objectivity rarely afforded to qualitative researchers. I was thus, unable to form an observationally-based personal opinion of the participants (except for the one participant who permitted me to interview him) and the analysis that followed the gathering of data was then largely free from potential personal biases that I otherwise might have developed. 
There seems to be an increased focus on qualitative health psychology research in South Africa. This sort of research carries with it a set of challenges and benefits that are unique to those in quantitative studies. Most notably, the role and impact of the researcher and their relationship with participants and data (depending on the research topic) can have a number of consequences to the successful recruitment of participants and the interviewing thereof. Fieldworkers are particularly useful in overcoming such challenges, however; the methodological implications to their involvement in qualitative studies requires consideration to ensure that the findings of such studies are sound and uphold the canons of empirical qualitative research. 
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Lynlee Howard-Payne is a lecturer in the Department of Psychology, School of Human and Community Development at the University of the Witwatersrand, South Africa. She holds a PhD in psychology from the University of the Witwatersrand and specialises in qualitative health research and critical public health psychology. She has recently published work on grounded theory methodology, public health in South Africa, and voluntary medical adult male circumcision.
Department of Psychology
School of Human and Community Development
University of the Witwatersrand
Private Bag 3, WITS, 2050
Tel.: +27 11 7174522
Howard-Payne, Lynlee (2015). Research Note: The Methodological Implications of Relying Upon Fieldworkers for Qualitative Health
Psychology Research [19 paragraphs]. Forum Qualitative Sozialforschung / Forum: Qualitative Social Research, 16(2), Art. 3,