International Public Health Research Involving Interpreters: a Case Study from Bangladesh

Background: Cross-cultural and international research are important components of public health research, but the challenges of language barriers and working with interpreters are often overlooked, particularly in the case of qualitative research. Methods: A case-study approach was used to explore experiences of working with an interpreter in Bangladesh as part of a research project investigating women's experiences of emergency obstetric care. The case study: Data from the researcher's field notes provided evidence of experiences in working with an interpreter and show how the model of interviewing was adapted over time to give a more active role to the interpreter. The advantages of a more active role were increased rapport and "flow" in interviews. The disadvantages included reduced control from the researcher's perspective. Some tensions between the researcher and interpreter remained hard to overcome, irrespective of the model used. Independent transcription and translation of the interviews also raised questions around accuracy in translation. Conclusion: The issues examined in this case study have broader implications for public health research. Further work is needed in three areas: 1) developing effective relationships with interpreters; 2) the impact of the interpreter on the research process; and 3) the accuracy of the translation and level of analysis needed in any specific public health research. Finally, this paper highlights the importance to authors of reflecting on the potential impact of translation and interpretation on the research process when disseminating their research

Developing a tool to measure health worker motivation in district hospitals in Kenya

BACKGROUND: We wanted to try to account for worker motivation as a key factor that might affect the success of an intervention to improve implementation of health worker practices in eight district hospitals in Kenya. In the absence of available tools, we therefore aimed to develop a tool that could enable a rapid measurement of motivation at baseline and at subsequent points during the 18-month intervention study. METHODS: After a literature review, a self-administered questionnaire was developed to assess the outcomes and determinants of motivation of Kenyan government hospital staff. The initial questionnaire included 23 questions (from seven underlying constructs) related to motivational outcomes that were then used to construct a simpler tool to measure motivation. Parallel qualitative work was undertaken to assess the relevance of the questions chosen and the face validity of the tool. RESULTS: Six hundred eighty-four health workers completed the questionnaires at baseline. Reliability analysis and factor analysis were used to produce the simplified motivational index, which consisted of 10 equally-weighted items from three underlying factors. Scores on the 10-item index were closely correlated with scores for the 23-item index, indicating that in future rapid assessments might be based on the 10 questions alone. The 10-item motivation index was also able to identify statistically significant differences in mean health worker motivation scores between the study hospitals (p<0.001). The parallel qualitative work in general supported these conclusions and contributed to our understanding of the three identified components of motivation. CONCLUSION: The 10-item score developed may be useful to monitor changes in motivation over time within our study or be used for more extensive rapid assessments of health worker motivation in Kenya

How service‐users with intellectual disabilities understand challenging behaviour and approaches to managing it

Background This study explored understandings that service‐users with intellectual disabilities and challenging behaviour held around their behaviour, what shaped these understandings, and the relationship between how behaviours are managed and well‐being. Methods Eight participants (three female, five male) partook in individual semi‐structured qualitative interviews. Interviews were transcribed and analysed using interpretative phenomenological analysis. Results Three master themes emerged from this analysis: (a) challenging behaviour can be explained via an internal or external frame of reference, with each framework having different implications for how participants attempted to manage behaviour. (b) Positive relationships provide a long‐term buffer to challenging behaviour, with positive relationships with family, staff and peers operating through different mechanisms to achieve this. (c) A greater ability to exert power and control in day‐to‐day life was perceived to reduce challenging behaviour in the long term. Conclusions Implications for practice are discussed

Parents choosing to combine special and inclusive early years settings: the best of both worlds?

This paper focuses on parents' perspectives of combining special and mainstream services for their children in the early years, offering insights into: how parents came to make this choice for their children's education; what parents expected from the combined provision and how their expectations were being met in practice. The data presented formed part of a small-scale, UK-based study that investigated local discourses and practices operating for young children within a global context of commitment to inclusion. Despite moves towards inclusive early years education in the UK, many parents of young children identified as having special educational needs opt for a combination of both inclusive and special early years settings. A survey sent to early years providers, voluntary groups and parents in three local education authorities (LEAs) in southern England, revealed that the practice of combining placements was widespread. Follow-up interviews with parents of five children revealed rich detail about the processes of choice making and parents' expectations and experiences of combined provision. The research findings have clear implications for the development of inclusive education and its appeal to parents, who may need convincing that it can offer sufficient specialist expertise and resources