Equity and health policy in Africa: Using concept mapping in Moore (Burkina Faso)

<p>Abstract</p> <p>Background</p> <p>This methodological article is based on a health policy research project conducted in Burkina Faso (West Africa). Concept mapping (CM) was used as a research method to understand the local views of equity among stakeholders, who were concerned by the health policy under consideration. While this technique has been used in North America and elsewhere, to our knowledge it has not yet been applied in Africa in any vernacular language. Its application raises many issues and certain methodological limitations. Our objective in this article is to present its use in this particular context, and to share a number of methodological observations on the subject.</p> <p>Methods</p> <p>Two CMs were done among two different groups of local stakeholders following four steps: generating ideas, structuring the ideas, computing maps using multidimensional scaling and cluster analysis methods, and interpreting maps. Fifteen nurses were invited to take part in the study, all of whom had undergone training on health policies. Of these, nine nurses (60%) ultimately attended the two-day meeting, conducted in French. Of 45 members of village health committees who attended training on health policies, only eight were literate in the local language (Moore). Seven of these (88%) came to the meeting.</p> <p>Results</p> <p>The local perception of equity seems close to the egalitarian model. The actors are not ready to compromise social stability and peace for the benefit of the worst-off. The discussion on the methodological limitations of CM raises the limitations of asking a single question in Moore and the challenge of translating a concept as complex as equity. While the translation of equity into Moore undoubtedly oriented the discussions toward social relations, we believe that, in the context of this study, the open-ended question concerning social justice has a threefold relevance. At the same time, those limitations were transformed into strengths. We understand that it was essential to resort to the focus group approach to explore deeply a complex subject such as equity, which became, after the two CMs, one of the important topics of the research.</p> <p>Conclusion</p> <p>Using this technique in a new context was not the easiest thing to do. Nevertheless, contrary to what local organizers thought when we explained to them this "crazy" idea of applying the technique in Moore with peasants, we believe we have shown that it was feasible, even with persons not literate in French.</p

Cadres social, linguistique et climatique d’une enquête alimentaire à Dakar: Adaptation d’une chercheuse à son terrain

International audienceThe Social, Linguistic and Climatic Frameworks of a Dietary Survey in Dakar - Adaptation of a Researcher in her Field. In Africa concerning food, large quantitative surveys dominate and take precedence over the use of qualitative methodologies, only slightly developed until now. Yet the complexity of food and diet encourages the production of ethnographic studies to understand all dimensions involved. The approach taken in the framework of my thesis is both qualitative and quantitative. How can a Western female researcher, and French in particular, manage the contextual constraints of working in Dakar, an African city open to the world and symbolically charged by colonial history? Field work access is negotiated specifically by adopting the rules of greetings and self-presentation. Complicity in the kitchen creates the “in-common” and the presence of the translator makes for triangular discussions. Time management – that passes and goes on – taking into account local constraints, is necessary for the proper conduct of the survey.En Afrique, en matière d’alimentation, les grandes enquêtes quantitatives sont majoritaires et prennent le pas sur l’utilisation des méthodologies qualitatives, encore peu développées à ce jour. Pourtant la complexité de l’objet alimentation (Crenn C et Delavigne AE, 2010 ; Hayn, 2009 ; Hubert, 1991) incite à la réalisation d’études ethnographiques afin d’en saisir toutes les dimensions. La démarche adoptée dans le cadre de ma thèse est à la fois qualitative et quantitative. Comment une chercheuse occidentale, et française en particulier, apprivoise-t-elle les contraintes liées au contexte dakarois : ville africaine tournée vers le monde et chargé symboliquement par l’histoire coloniale ? L’accès au terrain se négocie notamment par l’adoption des règles de salutations et de présentation de soi. La complicité autour de la cuisine permet de créer de l’« en-commun » et la présence du traducteur facilite les discussions triangulaires. La gestion du temps – qui passe et qu’il fait – en tenant compte des contraintes locales est nécessaire au bon déroulement de l’enquête