Reflections on the Broad Brush Survey (BBS) research methodology

Reflections on the Broad Brush Survey (BBS) research methodology; a
rapid, qualitative, mixed-method set of research activities used to inform
a community based randomised controlled trial HTPN 071 (PopART).
V1,2,
G3,
K3 ,
H1,4 ,
N3,
P3,
B1,
S5,
1Zambia
AIDS-related Tuberculosis Project (ZAMBART), Lusaka, Zambia; 2Department of Global Health and
Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine; 3Desmond
Tutu TB Centre, Department of Paediatrics and Child Health, University of Stellenbosch; 4Department of Clinical
Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine; 5Imperial
College London; 6Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health,
London School of Hygiene and Tropical Medicine; 7MRC/UVRI Uganda Research Unit on AIDS
J4,
Bond
Hoddinott
Abrahams
Ayles
Beyers
Bock
Chiti
Fidler
Hargreaves
6
3
1
1
2,7
1
Hayes R , Mantantana J , Musheke M , Ndubani R , Seeley J , Simuyaba M , Simwinga M1,2, Viljoen L3
Contact: GBond@zambart.org.zm; +260 211 254 710
BACKGROUND
BBS FINDINGS
 BBS (Broad Brush Surveys) are a set of mixed-methods qualitative research
activities adapted to rapidly identify key community features and community
perceptions and experiences to inform community randomised trials.
The Broad-Brush Surveys were
efficient at gathering data to
inform three broad themes:
(1) Data to describe research
communities in terms of key
similarities and differences
compared with other research
communities (meta-indicators)
(2) Data explaining community
members’ understandings,
experiences and attitudes toward
HIV
(3) Data informing anticipated
barriers and catalysts for
implementing the intervention
under evaluation as well as the
research evaluation.
See FIGURE 1. BBS Findings
 The BBS process and outputs described here were undertaken in 21 communities
(12 in Zambia and 9 in South Africa) prior to the implementation of a community
randomised, controlled trial, HPTN 071 (PopART).
 HPTN 071 (PopART) evaluates the impact of a multi-component HIV prevention
intervention, including universal HIV testing and treatment, on HIV incidence
measured at community level.
SEQUENCE OF RESEARCH ACTIVITIES
Observations: MMC Services, STI services, ART clinic, VCT, ANC, Entry/Exit Points,
Churches, Weekend/night observations, Significant events, HIV 'hot spots'
CHALLENGES AND LESSONS LEARNED FROM
BBS METHODOLOGY
Challenge
Lesson learned
•
Recruitment challenges (eligibility criteria,
expectations of incentives, research
mistrust and fatigue) and low participant
turnout
•
Participants reluctant to participate because
of suspicions of the type of information
sought
•
•
Managing large qualitative datasets in a
short time
•
•
Indexing of activities through photos
Brief summaries of research activities
immediately after each event used for rapid
analysis
•
Site entry into communities
•
Adapting BBS sequence of research
activities (South Africa)
Leaning on previous relationship with
communities (Zambia)
•
12 Days
•
•
DATA COLLECTION SUMMARY
 Activities completed in South Africa and Zambia (number of group discussions,
number of interviews with key informants, number of observation activities)
Number of
Group
Discussions
(n)
Activity
Zambia
South Africa
Total
Group
Discussion:
Participants
Group
Discussion:
Participants
(n = x women)
Key
Informants
Key
Informants
•
Flexibility in applying research methods:
when, where, how many, mixed groups
Improvised on-the-spot group discussions
with available community members
Work with local research assistants to gain
community confidence(Zambia)
Additional explanations of research aims
•
Local community tensions (political
tensions/expectations)
•
Negotiation with various gatekeepers and
neutrality
•
Number of activities per discussion seen as
time-consuming and leading to fatigue
•
•
Adapting discussion guide
Limiting number of activities, selecting most
relevant per activity or per group
Observations
(n = x women)
82
875
538
65
29
140
48
232
155
30
22
63
130
1107
693
95
51
203
Improvised
research setting:
Group discussion
in community
household
RESEARCH ACTIVITIES
Improvised
research setting:
On-the-spot group
discussion in
public space
 Different activities as part of observations and discussions
1
2
3
OUTPUTS
 Site specific reports (summative matrix reports, short community reports,
detailed narrative reports)
 Technical report
 Presentations (internal presentations; community dissemination; posters and oral
presentations)
5
4
CONCLUSION
6


9

7
8
1. Market observations 2. Wealth, poverty and risk ranking (character card) activity 3. HIV
prevention: Concept mapping 4. ‘What kind of place is this?’ 5. Community mapping
6. Character cards 7. HIV-timeline 8. Transect Spiral Walk 9. Transect Spiral Walk
For more information,
visit www.HPTN.org
or follow us:
Facebook: HIVptn
Twitter: @HIVptn
BBS has been successfully adapted to be embedded in community randomised
controlled trial design and practice.
BBS proved effective, efficient and robust in producing rapid and comparative
social research findings on HIV experiences and the socio-economic and
structural realities of a large number of community sites relevant to trial
implementation and future social research within the trial.
Initial feedback has highlighted key catalysts and barriers that have a bearing on
successful implementation of the trial to key implementers and local stakeholders
and recommendations has been made.
ACKNOWLEDGEMENTS
HPTN 071 is sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) under Cooperative Agreements UM1-AI068619, UM1-AI068617, and UM1-AI068613, with funding
from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). Additional funding is provided by the International Initiative for Impact Evaluation (3ie) with support from the Bill &
Melinda Gates Foundation, as well as by NIAID, the National Institute on Drug Abuse (NIDA) and the National Institute of Mental Health (NIMH), all part of NIH. The content is solely the
responsibility of the authors and does not necessarily represent the official views of the NIAID, NIMH, NIDA, PEPFAR, 3ie, or the Bill & Melinda Gates Foundation.
The authors thank all the research participants and their families, the research communities and their religious, traditional, secular, and civil leadership structures, and volunteers in the
community advisory board structures.
20th
Presented at the
International AIDS Conference
Melbourne, Australia
July, 24 2014
Poster Number: THPE 214