phd plan of analysis seminar_apurva_pandya 29feb2012

Plan of Analysis SeminarPlan of Analysis Seminar

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HIV Counseling Practices: HIV Counseling Practices: Experiences and Perspectives of Counselors Working with Experiences and Perspectives of Counselors Working with

Targeted Interventions in GujaratTargeted Interventions in Gujarat

Apurva Pandya , MA Shagufa Kapadia, PhDApurva Pandya , MA Shagufa Kapadia, PhDResearcher Professor and Research GuideResearcher Professor and Research Guide

Department of Human Development and Family StudiesFaculty of Family and Community Sciences,

M S University of Baroda, Vadodara29 February 2012

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HIV/AIDS Context

33.2 Million people are living with HIV

Everyday 6800 people get HIV infection.

Negative impact on life (low life expectancy, increase orphans, economic crisis, stigma and discrimination).

Global Context

National Context

Local ContextTotal 1,81,785 people are living with HIV (June,2007).

Concentrated epidemic

Oldest Targeted Interventions in the countyModerate HIV prevalence

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Global and National Response To HIV/AIDS

HIV Prevention Approaches

Medical ApproachSocial ApproachBehavioral ApproachDevelopmental Approach

Reduced in HIV Prevalence across the globe….

Experience of HIV prevention and controlMaintained moderate HIV prevalenceScarcity of researches on counseling within Targeted Interventions

HIV prevalence and experience of implementation HIV prevalence and experience of implementation of targeted interventions (program maturity) of targeted interventions (program maturity)

create a right context to explore create a right context to explore

counseling practices, counselors experiences and counseling practices, counselors experiences and

perspectives on HIV prevention counseling.perspectives on HIV prevention counseling.

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HIV/AIDS Context And

Relevance of Present Research

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How do counselors practice HIV counseling services How do counselors practice HIV counseling services within targeted intervention? within targeted intervention?

How do counselors use or develop counseling skills How do counselors use or develop counseling skills and techniques? and techniques?

How do counselors deal with challenges in everyday How do counselors deal with challenges in everyday counseling practice?counseling practice?

What are counselors’ perspectives on current HIV What are counselors’ perspectives on current HIV counseling practice and their capacity building? counseling practice and their capacity building?

Does the experience of HIV counseling enable Does the experience of HIV counseling enable development of a personal counseling approach? development of a personal counseling approach? How? How? 88

Research Questions

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Research ObjectivesResearch Objectives

Examine counselors’ personal and professional Examine counselors’ personal and professional experiences of providing HIV counseling services. experiences of providing HIV counseling services.

Understand their Understand their perspectives on current perspectives on current practices and capacity practices and capacity building.building.

Evolve indigenous practices and a culturally Evolve indigenous practices and a culturally appropriate working model for HIV counseling.appropriate working model for HIV counseling.

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Research DesignResearch Methodology: Research Methodology: Grounded Theory (GT). Grounded Theory (GT).

It helps in discovery of new information (Glaser and Strauss 1967).

Develop theoretical formulations (Byrne 2001) , and

Establish framework for future exploration (Strauss & Corbin, 1990).

In-depth interview protocol and naturalistic observation protocol 9

Counselors working with Targeted Interventions in the state of Gujarat and their clients

Total 14 counselors working with Targeted Interventions were interviewedTotal 4 counselors’ sessions including two follow up sessions were observed

Theoretical Sampling

Universe:

Data Collection Tools:

Sample Size:

Sampling Technique:

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Text Narrative Visual

Counseling documents

For example, daily diary, registers

In-depth Interview of Counselors

Participants Observation of

Counseling sessions

PhotographsObservational Field

Notes

Types of Research Data

Brief Interview of Clients

Data Collection Through Various MethodsTo Gain Demographic Information, Understand Knowledge and Beliefs of Counselors─HIV/AIDS, Targeted Interventions, Risk populations, and Counseling, Existing HIV counseling practices

To Understand Counseling Effectiveness, Clients’ Feedback and Perceptions of Counseling

To Understand Recording and documentation of counseling process

To Understand Counseling Context and Organizational Environment

To Understand Process of Counseling

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Phase I

Research Design and Research Questions

Phase II

Data Collection & Primary Data Analysis

Phase III

Validation Phase IV

Constant Comparison

Phase V

Theoretical Conceptualization Phase VI

Organization of data and Interpretation

From Broader Questions ToNarrow and Specific Questions

Follow up Data CollectionRecoded the data, Validated Coding,

Establish Reliability

Reviewed cases and Used Constant Comparisons Method(Manual and Computerized Coding, Recoding by Two external Persons)

Establish Validity

Generated Theoretical Concepts

Discovery of Theory

Methodological Saturation

Theoretical Saturation

Process of Data Collection and Analysis

Interviews, Reviews and Observations

Developed categories, coding


Integrate and Interpret Concepts, Member check, External Audit

Establish Authenticity and Generalizability

Targeted Interventions across 6 Regional Deputy Director (RDD) regions Targeted Interventions across 6 Regional Deputy Director (RDD) regions in the statein the state

Listed MSM TI, FSW TI, Core Composite (MSM/FSW) TI and IDU TI from Listed MSM TI, FSW TI, Core Composite (MSM/FSW) TI and IDU TI from each regioneach region

Shortlisted qualified, trained counselors having at-least two years of Shortlisted qualified, trained counselors having at-least two years of experienceexperience

Recruited qualified, trained and experienced counselors as well as Recruited qualified, trained and experienced counselors as well as Auxiliary Nurse Midwife (ANM) and community counselorsAuxiliary Nurse Midwife (ANM) and community counselors

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Shortlisted best practicing counselors from each typologyShortlisted best practicing counselors from each typology

Recruited counselors for participant observationRecruited counselors for participant observation1111

Sampling method for In-depth InterviewsSampling method for In-depth Interviews

Sampling method Participant Observation of Counseling SessionsSampling method Participant Observation of Counseling Sessions

Demographic Profile Of RespondentsDemographic Profile Of RespondentsTypology of Targeted Interventions

Gender Education Experience in TI Training

M F Upto 12th

Graduation

MSW MA 2years >2 years 2 times >2 times

IDU 1 1 1 1

MSM 5 2 1 2 2 3 1 4

FSW 1 4 1 4 1 4 2 3

CC 2 1 1 1 1 1 2 3

11Total 8 6 2 2 7 3 5 9 4 10

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Analytical Issues And Its ManagementSr. No.

Analytical Issues Management

1 Threat to Theoretical Validity Remained open and receptive to respondents responsesRemained Open to contradictory evidence

2 Threat to Interpretive ValidityResearchers’ bias to interpret data

Researcher remained aware about perspectives and beliefs the research brings to the research project. Recoding of the data by external personExternal Audit of the result and discussion will be carried out

3 Threat to Descriptive Validity Audio -taping interviews and detailed, concrete, and chronological field notes during the interview processMember check method was used to ensure description validity. Technical literature review will be done once coding is completed

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Sr. No.

Analytical Issues Management

4 Threat to Generlizaiblity of the result

Methodological triangulation was used and theory triangulation will be applied Development of resource materials on HIV counseling theory, theoretical strategiesDevelopment of training module

5 Reliability of the research findings(Ability to replicate study to similar situations)

Although the uniqueness of this particular study mitigates against exact replication, it would be possible to conduct a similar study using a different site thereby adding to the body of literature on counseling practices with most-at-risk population.

Analytical Issues And Its Management

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Levels Coding Process1 Initial coding

Word by wordLine by lineIncident to incidentConstant ComparisonIn vivo code: participants special term

Naming each word, line or segment of data Define actions on which they restIdentify tacit assumptions (underlying assumptions)Compare data with data Identify gaps in the dataNote: Remain open to all possible theoretical direction

2 Focused CodingThese codes are more directive, selective and conceptual

Synthesized and explained larger segment of the data,Compared people’s experiences, actions, and interpretations

3 Axial Coding (Link between category and subcategory)relates categories to subcategories

Developed link between Initial and Focused Coding,Reassemble them in new ways

4 Theoretical Codingcoding that follows the codes selected during initial coding

Specified the relationship between emerging codes and themes

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Process Of Coding

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Example of Manual Coding

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Example of Computerized Coding

Sr. No. Initial Coding Verbatim

1 Provide informations on STIs/HIV

“When one has unsafe sexual practices with multiple partners, s/he has many chances to transmit STI from his/her sexual partners and at the end sexual s/het transmits STIs to his/her marital partner and other sexual partners.”

2 Provide prevention messages

“Different kinds of STIs. Some are very painful while some are not. All STIs can be treated and cured if you take immediate medical treatment. We can have STIs anytime; therefore we need to get regular medical check-up, blood test and if we have STI, we must take immediate treatment.”

3 Provide information to take action in order to reduce STI/HIV risk behaviour (advice)

“Since you are involved in risk behaviors, you need to go for HIV test, and STI screening. It’s free for you. What do you think? Should you go or not?”

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Example Of Initial Coding

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Example Of Focused CodingSr. No. Focused Coding Verbatim

1 Need based general information sharing

“We cannot know whether HIV virus based on face or body. Even after HIV infection, individuals remain healthy for many years. Only way to know about HIV status in our body is blood test for HIV. HIV test is very important for two reasons: 1) To know whether we have HIV 2) If we do not have HIV, take appropriate measures to prevent us from HIV infection.”

2 Need based prevention information sharing

“When you use condoms, it prevents you from getting STIs including HIV, prevent unwanted pregnancies of your partner, and increase pleasure.”

3 Providing Need based instructions regarding HIV/AIDS/STIs


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Example Of Axial CodingSr. No. Axial Coding Verbatim

1 Opportunistic Information Sharing


2 Opportunistic Instructions


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Example of Theoretical CodingSr. No. Theoretical Coding Verbatim

1 Opportunistic specific knowledge enhancing information Sharing


2 Opportunistic decision sharing


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Coding Progression

Providing informations to take actions

Initial Coding Focused Coding Axial Coding Theoretical Coding

Providing general information about HIV

Providing information to reduce risks

Need based information sharing

Opportunistic information sharing

Opportunistic Specific Knowledge Enhancing Information Sharing

Providing Need based instructions regarding HIV/AIDS/STIs

Opportunistic Instructions

Opportunistic decision sharing

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I Indigenous Counseling Skills &Techniques

Giving Example

Opportunistic Knowledge Enhancing Information Sharing

Opportunistic Decision Making

Explanation

Demonstration

Story Telling Telling a story of a person who had similar problem and counseling helped

Communication & Games

Giving example of a person who changed his/her behavior

Explain HIV/AIDS/STIs

Take decision on behalf of clients and share with clients

Share Information that enhances knowledge on HIV/AIDS/STIs when necessary

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Indigenous Counseling Process

Building Relationship

Understanding Problems

Discuss Alternatives

Prepare Action Plan

Follow Up

Self Introduction, Organizational Introduction, Counselor’s Role

Assess Risks, Take Personal & Sexual History

Provide Risk Reduction Strategies

Plan follow up meeting to assess development

Develop plan to execute appropriate risk reduction strategies

Rapport Formation

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Counselors’ Reflections On Capacity Building

Experiential Learning

Emphasis on Practice

Opportunity to Share Experience

Analysis of Counseling Data

Role Plays of Difficult Sessions

Case History & Case Study

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Indigenous Counseling Practice

Counselors’ Characteristics

Counseling Set up and Organization Environment

Indigenous Counseling Practice

Indigenous Skills and Techniques

Training and Experience

Interpret dataInterpret data

Linking data with Training Counselors Received and Linking data with Training Counselors Received and TheoriesTheories

Conceptualize indigenous HIV Counseling Model or a Conceptualize indigenous HIV Counseling Model or a theorytheory

Discuss the DataDiscuss the Data

Get External AuditGet External Audit26

Future Work

Approach Analysis & Discussion

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THANK YOU VERY MUCH FOR LISTENING

TO THE SEMINAR !!

I welcomeyour comments and suggestions!