Sensitizing the study team

To sensitize means "to make sensitive" and is a term widely used in participatory research as well as in anthropological circles where the ability to recognize local/lay knowledge is highly appreciated. The term is less known in circles that uphold the premise that knowledge comes from the academic and/or technical "expert" and should be transmitted to the "ignorant lay or local person.

Investigating hygiene practices systematically is not something that comes naturally to the average water supply and sanitation project worker, particularly if his/her training background and/or experience does not include qualitative investigations. For example, the average water or sanitary technician concentrates on pumps and pipes and does not see the need to find out what the users of those pumps and pipes are doing; what they have to say, and why.

It is important for each member of the study team to be trained to be inquisitive and not assume that she/he knows what is going on in the locality. It is very important to adopt a learner's attitude, however difficult that might first appear to someone whose job it has been to teach the people.

Encourage the study team to discuss the following ways of establishing rapport with the study population, and to identify the most relevant points for their own setting. People will react towards members of the study team according to their gender, ethnicity, age, style of dress and speech, and how they present themselves. Individually and as a team, investigators should aim to minimize status differences so that people can feel comfortable with them. This will bring about cooperation and minimize the "observer effect." where people act or say things that are not usual because of the presence of strangers. It will also help to minimize possible bias as a result of the observer effect.

Suggested ways of establishing rapport include:

· Appearance. This is very important. For example, when working in a rural community, try to identify with local people and minimize the gaps that exist by wearing simple clothes and using simple language. The reverse may be necessary when talking to professionals or top level personnel, you would dress to suit the occasion, but without drawing unnecessary attention to yourself.

· Greeting. This is more effective in the local language, especially when in rural settings. If you are not a speaker of the native language, it is helpful to learn at least a few basic words to demonstrate your interest.

· Introduction. Introduce yourself and ask the person you are addressing to introduce herself or himself, in a locally acceptable manner. This is particularly important in the case of interviews. In group discussions, each participant should be invited to introduce themselves. This will help to assure study participants that investigators are genuinely interested in learning about them.

· Terms of address. When asking questions, use the respondent's name, with the appropriate title, whenever applicable. This helps information gathering (particularly interviews) to remain informal or conversational rather than formal or interrogative. The person being asked questions should not feel that they are on trial or being given a test about what they know.

· Establish confidence by stressing to the study participants that you are interested in her/his/their opinions, knowledge and beliefs. In the context of individual interviews or group discussions, make it clear that your intention is to learn and not to judge.

· Establish confidentiality by assuring the study participants that your conversations or interviews will not be repeated to others and that when you write a report, they will not be identified by name.

Once established, good rapport with the study population can be maintained by observing certain universal rules of courtesy which include the following:

· Privacy. Investigators should be very careful about intruding in people's privacy. Private and sensitive questions such as asking to see people's latrines can cause embarrassment; so might asking about income.

However, this can be minimized if the study team ensures that the participants are well-informed about the investigators' motives and interests. If people understand why you are asking them such questions, they are more likely to cooperate with you.

· Timing. Visits to people's homes and the timing of group discussion meetings should take into account local patterns of activities. For example, investigators should avoid arriving for interviews at meal times. Make sure that you consult people before setting the dates and time for group meetings. You will need to be flexible enough to allow for possible rescheduling of activities during local holy days, market days, and other less predictable events such as, for instance, funerals.

· Feedback. Presenting the findings to the study population(s) informs those who participated in your study, and provides them with the opportunity to comment on your conclusions, to confirm your analysis, to correct any misconceptions, and perhaps also to provide additional information. Feedback helps people to increase awareness of their own hygiene practices, and to appreciate the reasons for your project's interventions. Seeing that you have taken the trouble to let your informants see the results of their cooperation, using flip-charts or summary sheets. may help them to remain interested and cooperative during the study period and beyond.