|Community Assessment of Natural Food Sources of Vitamin A, Guidelines for an Ethnographic Protocol (International Nutrition Foundation for Developing Countries - INFDC, 1997, 141 pages)|
The following definitions are presented as relatively theory-free vocabulary for talking and writing about information-gathering and operations in intervention projects. The definitions refer to the language used in this manual. Other academic disciplines and international programs, have somewhat different styles of vocabulary and terminology. In some cases, medical people and social scientists use similar words, but with somewhat different meanings. The definitions in this manual are, in most cases, those in common use in applied health programs.
Attribute (synonymous with characteristic). Any observable or imagined quality of a person or thing that is referred to for evaluating or categorizing that person or thing. For example, color, taste, physical shape or size, costliness, goodness, healthiness, sacredness, etc. In all cultures people categorize foods by referring to attributes such as tastiness, best way to prepare, filling, costliness, nutritiousness, strengthening, and many other qualities.
Basic (Generic) questions. A set of questions about main features or qualities that are important starting points for almost any intervention project. Such questions are fundamental to operational planning and are much the same regardless of the type of population or type of intended intervention. For example, "What is the size and location of the intended target population?" Answers to this question are essential to any project, regardless of the specific nature of the expected intervention.
Bitot's spots. These white, foamy or cheesy patches form on the conjunctive, the white area surrounding the cornea. Bitot's spots are of en accompanied by nightblindness.
Carotene. A category of yellow-red pigments (lipochromes) found in many animals and plants (notably carrots), that are important because they are precursors (building materials) for vitamin A.
Community. Any more-or-less distinct geographic locality, such as a rural town or village; in urban areas it may be a ward or neighborhood, usually with a name. In a more abstract sense, people may speak of an entire City, or the nation, as a community.
The concept of community is primarily useful for designating a population to be studied, or population to be served in a particular program or project. The term community does not imply anything about solidarity, cohesion, or degree of structured-ness. Some communities are ridden with factionalism and strife; some suburban communities have almost no organization or social cohesion.
In some cases, the word community is used to refer to the catchment area of a particular health or service facility. In such cases the geographically designated community may have practically no other claim to "communityness" other than the designation as a service area.
Community-based. Activities and organizational features (e.g., offices, outreach work) located in the midst of the target or client population, in contrast to being based in some central governmental location, in a hospital, or other facility that is geographically and socially distant from the people who are being served.
Community health workers; community-based workers. Any members of a health program or intervention program whose work is primarily carried Out in the geographical location of the client population. This contrasts with hospital-based or office-based personnel.
Community-level. see Community-based, above.
Community participation. In an intervention program, this includes persons from the client or target population in at least some of the stages of situation assessment, planning, and selecting interventions, and carrying out of the actual intervention activities. Such involvement from the client population may be compensated (salaries, honoraria) or it can be based on volunteered services. The participation may involve local advisory committees, volunteer or paid peer counselors, volunteer or paid information collectors, including survey interviewers, as well as a variety of informal forms of involvement in program activities.
Concept (or construct). Any entity (usually a word or phrase), that is a key element in statements about information-gathering and that serves as an orientation point or an element of explanation in data-gathering or analysis. (Community, culture, outreach, addiction, decision-making, and sharing are all concepts.)
Conjunctivitis. Inflammation of the mucous membrane that lines the inner surface of the eyelids. Due to infection.
Corneal ulceration. Ulcers appear on the cornea. Treatment should be sought immediately because the child is in danger of losing complete vision in the eye where the ulceration is manifested.
Corneal xerosis. This refers to the drying of the cornea, the transparent part of the eye in front of the pupil. Corneal xerosis is a sign of severe xerophthalmia indicating that the vision is severely threatened. With proper treatment in the form of mega-dose vitamin A capsules, a child can recover completely from nigh/blindness or Bitot's spots, while a child with corneal xerosis may or may not regain complete vision.
Culture (see also Food culture). The systematic patterns of explicit and implicit concepts (ideas) about behavior and behavior settings (environments), learned and used by individuals and groups in understanding and adapting to their life situations.
We have gradually realized that it is useful to define culture as that which is in the heads of individualsideas, concepts, recipes for behavior, values, attitudes, and expectations. Culture is most visible in the languagethe words and expressions that people use in talking and thinking about various domains of information.
Culture pattern. Any system of ideas concerning usual expectations for behavior, actions, types of persons, definitions of situations, ways to do things, and the equipment (technology) used in a particular topic or focus. Examples are the culture patterns of daily meals, categorizing of foods into food groups, and the various ideas of appropriate and inappropriate foods for pregnant and lactating women.
Data (singular: datum). A plural word referring to any information from empirical observation, whether qualitative or quantitative in form. In quantified studies such as surveys, the raw data are in the form of answers to specific questions, that are then aggregated or grouped to present frequency distributions and other forms of summary data.
In qualitative research based on open-ended interviews and general observations, the field notes and interview notes are the raw data. Sometimes groups of open-ended interviews are subjected to content analysis, from which one can obtain frequencies of repeated themes, and other quantified data.
Domain. Any topical area of information or phenomenon, whether broad or narrow, that contains a systematic array of units or elements. For example, the domains of plants, animals, crops, healthy foods, and treatments of illness.
Emic. Referring to information and observations constructed to reflect as far as possible the client (target) population's own vocabulary, conceptual categories, language of expression, and cultural belief system. The word contrasts with etic, that refers to information collected in terms of the conceptual system and categories, of the health professionals or other outsiders. To collect emic data, it is usually necessary to use the local language or dialect and gather information in a very open-ended, nondirective way.
Example. When you use the pile sort technique and ask informants to "group the food items in any groups you wish to...any way that you happen to think of," the resulting groups are emic categories.
Empirical. Referring to, or based on, observations (data-gathering) of real world phenomena (as contrasted with abstract modelling or armchair speculation).
Etic. Research observations and data constructed in the researcher's system of categories and definitions. For example, if we collect data using a scientific definition of xerophthalmia, these data would be considered etic.
Focused ethnographic study (FES). The use of a clearly specified set of structured ethnographic information-gathering techniques in a relatively short-term study of a health issue or topic, usually for a specific applied purpose.
Food culture. The entire system of beliefs and practices concerning food production, acquisition, distribution, and consumption, characteristic of a particular group or community.
Household. Any co-residential, domestic group that shares common cooking and eating facilities and other social and economic arrangements. Households are often useful units in terms of which samples are selected for study by both qualitative and quantitative methods. In most cases a household is made up of all the residents of a house, apartment, or other such residence. In some cases it is useful to consider brothels as households, if the women live in the same building, share the same food, and cooperate in the maintenance of the living area.
Hypothesis. A hunch or idea, especially concerning relationships between concepts or variables. That is, any hunch about the types of people, relationships among the different actors and actresses, or the way things are done in the target community. Such hypotheses then serve as guidelines for the design of information-gathering. Hypotheses may be deduced from theoretical systems, or they may arise inductively from specific empirical observations. They may also arise, seemingly spontaneously, from your thought processes.
Illness. The physical and psychological discomforts and ailments as seen from the perspective of the person suffering these conditions. Thus, illness is used as an emic term, to contrast with the etic term, disease.
Inductive research. A data-gathering approach in which the researchers gradually discover categories, variables, and generalizations as they emerge from the data. This methodological approach contrasts with deductive research in which the categories and variables are structured in advance from a theoretical system. In general, qualitative research such as the data-gathering presented in this manual, tends to be more inductive than is common in quantitative research.
Informant. A person who gives information about any topic we are interested in learning about. The informant may give us the information m response to a structured or unstructured interview, or simply in informal conversation. If we have several contacts with the informant and develop a social relationship of information exchange, we refer to that person as a key-informant.
Iteration, iterative (action or tactic In getting information). The process of circling back, to repeat some research operations, such as going back to a key-informant to ask more questions on a particular subject; going back to your set of key questions to revise them based on new information; or returning to revise your map of the community, after you learn more information. This is a basic principle in qualitative research.
Keratomalacia. At this stage of xerophthalmia the cornea appears to actually melt away. Even if the child's sight cannot be saved, remember that corneal ulceration and keratomalacia are signs of severe vitamin A deficiency which is life-threatening. Therapy to save the child's life should be sought immediately.
Key-informant. An informant with whom you have repeated conversations and interviews and with whom you develop a more or less cordial relationship of information exchange. Some fieldworkers call these persons key actors/actresses, or community consultants, because they are persons who have a lot of information and are able to tell the information to you fairly systematically. In situation assessment, key-informants are essential for providing in-depth details about the target community and people.
Macrolevel (in an intervention). Pertaining to activities and influences coming from the level of the city, region, or nation. (Contrast with mesolevel or microlevel.)
Example: An intervention to change the municipal law enforcement (e.g., to permit unrestricted distribution of condoms in the city) is a macrolevel intervention.
Measurement. Any act of empirical observation, with or without physical instruments, that makes publicly clear (and potentially replicable) through some set of rules or definitions, the mapping or translation of the observed things, events, persons, and the relationships among them, into data units (symbols), either textual or numerical. Such mapping or translation results in patterns of correspondence between the things, events, relationships observed, and the symbols that represent them as data.
Example 1: (using instrument) We use a sphygmomanometer placed on a person's arm to measure blood pressure. The instrument is defined in such a way that the height of the column of mercury is read as a unit of pressure.
Example 2: (contents of interview question) We might define, in a given survey in a population, that the religion of the respondent will be the answer that she or he gives to the question, "What is your religion?"
Median (median value). The midpoint in a distribution of numbers, at which then are an equal number of cases above (more than) and below (less than) the median value. In the following list of children by age, the age of the median child is sixteen years:
Ages of the children:
4 6 8 9 10 11 16 17 17 18 18 19 19
Mesolevel (in an intervention). Pertaining to activities and influences at the level of the community or subcommunity that is the specific target population.
Microlevel (in an intervention). Pertaining to the individuals in the target or client populationtheir behaviors, knowledge, attitudes, skills, and other qualities. For example, knowledge-attitude-behavior surveys aim to find out information about the microlevel of intervention. Interventions that try to persuade persons to change their behaviors are microlevel tactics.
Model. Any physical forms, whether in writing (e.g., tables, charts, flow diagrams), mathematical symbols, diagrams, or three-dimensional structures, that are used as a simplified analogy for some aspect of phenomena about which we are gathering information.
Examples of models include diagrams, maps, model cars, airplanes, houses, or other structures. Some nutrition researchers use plastic models of foods as examples or memory aids when interviewing people about their food intakes.
Nightblindness. A physical condition in which a person cannot adapt to dim light or to a darkened room or setting. If a child can crawl or walk, the mother may notice that the child suffering from nigh/blindness becomes inactive at dusk or night time.
Participant observation. Direct participation by a data-gatherer in the daily living and day-to-day activities of a community or intervention location, so as to make possible the systematic description of activities through notes from direct observation, plus additional data from verbal statements of people involved in those same events and activities.
Probe; probing. Follow-up questions or comments used by an interviewer to go deeper or to get more detail about something an informant says. Here are some examples of effective probes:
"That's very interesting; can you tell me more about it?"
"Could you give me a case of a family who regularly uses those plants in their diet?"
"Any other examples?"
"Could you tell me exactly what happened when llira had nigh/blindness and what she did?"
"Could you go over that again, maybe using her exact words as you remember them?"
Qualitative data. Information based on empirical observations that is collected and presented in non-numerical form. This includes text materials as well as pictures, maps, diagrams, and other patterned information.
Quantitative data. Information based on empirical observations presented in the form of numbers, regardless of the level or precision of measurement.
Respondent. A person who answers a set of questions in an interview or questionnaire. The responses given by the individual are considered to pertain to that person alone and not to a wider population whom the individual purports to represent. One who answers an interview in this assessment procedure, for example.
Retinol. The physiologically active, principal component of vitamin A. Animal foods (meats, eggs, milk) contain retinal. Plants do not contain retinol, but they have carotene, which is transformed into retinol in our bodies.
Staple food. Food that is consumed on a regular, often daily, basis by most of the population and which usually provides a major portion of their calorie intake. For example, millet is the staple food of numerous countries in Sahelian West Africa, maize is the staple in many South American communities, and rice constitutes the staple in many Asian countries. For purposes of this manual, some items of lesser caloric value may also be considered staples if consumed on a near-daily basis. Such items include oils, chills, and onions.
Subculture (pertaining to any identifiable group). Same definition as culture, but applied to a particular category or subgroup of people who are part of a larger culture or society.
Example: The differences in cultural patterns between high caste families and low caste families in an Indian village can be usefully considered as subcultures (subcultural differences).
Subgroup. A smaller segment of the main group.
Symptom (of an illness). Same as sign with the additional implication that this sign is a causally related member of a cluster or pattern of signs that characterizes a particular illness.
Target population (same as client population). The population or group that is expected to be the recipients of an intervention program. In a program aimed at changing injection drug use behaviors, the injection drug users (and probably their sex partners) are the target population.
Note: In many intervention programs there will be multiple client, or target, populations. Usually different client populations will require different strategies or intervention.
Theory. Any system of concepts and propositions about concepts, intended to generalize about, or explain observable actions, behaviors, and other phenomena in some real-world domain. For example, we have long spoken of the germ theory of disease. When (later) viruses were discovered, we could speak of the germ and virus theory of disease.
It is a widely held common sense notion that all people have their theories of human behavior to account for particular forms of behaviors. Also, all people have theories of the causes of disease. Practically all such theories are composed of statements (generalizations) in the form of "If ___________ ,______________then." "If my child is exposed to chilling wind or water, she or he is likely to get a respiratory illness."
Triangulation. The process of using data from two or more different sources to verify or estimate a particular datum (piece of information). The term is from surveying and ocean navigation, in which the observer sights on two different points at some distance and then uses the triangle (observer-point 1-point 2) to calculate location or distance.
In qualitative research and situation assessment, triangulation takes the form of verifying points of information by comparing the statements of independent key-informants, comparing statements of informants with one's own direct observations, or other combinations of independent data sources.
Validity. The extent to which a particular method of measurement (observation) actually represents that which it claims to measure. For example, peoples' reported income on their tax forms may not be a valid measure of their economic status (because they do not give the true amounts). The issue of validity is especially complex in most variables that deal with human behavior.
Variable. Any concept about which we gather information, that is thought to be composed of measurable phenomena that can assume more than one value, state, or degree in empirical observations. Income level, socioeconomic status, level of education, etc. are all variables. Concepts or phenomena that only have one single form or value in a population or site (e.g., everyone in the community speaks Spanish) are said to be constants.
Vitamin A-rich. Animal food sources or food sources of plant origin containing a high content or vitamin A. Animal sources contain active preformed vitamin A called retinol. Some animal sources that are rich in vitamin A are liver, fish liver or fish liver oil, egg yolk, butter, and cheese. Food sources of plant origin contain provitamin A or carotene. Foods rich in carotene are: dark green leafy vegetables (DGLVs), such as cassava leaves, spinach, amaranth, red sorrel and baobab leaves; yellow and orange fruits and vegetables, such as mangos, papayas, red sweet potato, pumpkin, carrots; and red palm oil which is widely consumed in parts of Africa.
Xerophthalmia. This term, which in Greek means dry eyes, is used to describe all ocular signs of vitamin A deficiency. Xerophthalmia, or nutritional blindness, is an eye disease that is most prevalent among preschool children ages six months to six years, but can also be found among pregnant women and adolescents. Xerophthalmia, caused by insufficient intake of vitamin A-rich food, can be compounded by various childhood diseases including measles, diarrhea, and respiratory infections. Xerophthalmia occurs at a late stage of the deficiency and indicates that the child is at-risk for blindness or death.