The vignette was developed through PLA activities conducted with 3 groups of men and 3 groups of women from different residence areas, each group comprising 8–12 participants. Participants were selected from a sampling frame of men and women aged 15–60 who had at least 1 child. This selection was random, with the exception of a few female HIV-positive individuals (‘seeds’) who were purposively selected from the sampling frame by the principal investigator using the community HIV sero-surveillance data. Female groups included 1–5 HIV-positive ‘seeds’ (see Buzsa et al. for details of the seeded focus group method [35 (link)]). Fieldworkers were unaware of the HIV status of all individuals on the recruitment lists and those participating in the activities. Each PLA was facilitated in Kiswahili (commonly spoken national language) by an experienced fieldworker of the same sex as participants. A second fieldworker took notes on the content of discussions, details of the role-play storyline and behaviours of characters, as well as general observations of the group dynamic. The majority of sessions were attended by the principal investigator. Activities were audio-recorded following informed consent from participants.
PLA activities included brainstorming and ranking of barriers, role-playing and group discussion (Table1 ). Before the role-plays, fieldworkers facilitated a discussion to identify the central characters that would be involved in a woman’s pregnancy and delivery. Thereafter, the participants were instructed to invent a storyline of a (fictitious) woman who discovers she is HIV-positive at ANC, thinking of the issues that a real woman in their village would face and the decisions she would make when trying to use PMTCT services. Participants then acted the play to the facilitator and observers. De-briefing sessions with fieldworkers were conducted following each PLA activity, informing an initial analysis of emerging themes which was used together with PLA notes by the project investigator to draft the vignette.
To compose the vignette storyline, unifying and contrasting elements of the role-plays were identified. Discussions following the role-plays, during which facilitators discussed how realistic the storylines were, were then analysed to confirm unifying elements, or resolve differences between the stories. Themes emerging from other activities, particularly barriers deemed most important in the ranking exercise, were also considered. The final vignette also needed to be viable given the character’s profile, for example, to represent the issues that the character would face considering their residence, marital status or family circumstances. The aim was to present a story that was familiar to most participants (touching on personal experiences, or experiences of acquaintances in their community), but that also achieved the objective of making women feel comfortable to admit to any difficulties they faced (so, for example, a more extreme case of a woman failing to access several of the services was chosen). Overly emotional circumstances or events (e.g. teenage pregnancy or death of a baby) which might derail the interview were avoided.
Once developed, the vignette and associated questions were incorporated into an interview discussion guide, along with open-ended questions about the personal experiences of the respondent during pregnancy, delivery and infant feeding. As conceived in the original study design, fieldworkers then received an additional day of training on the concept and use of the vignette, including examples of other studies employing this technique [24 (link)], and on confidentiality (particularly if participants disclosed their HIV status during the interviews). This additional training session was intended to give fieldworkers the chance to familiarise themselves with and discuss the vignette developed from the PLAs, and to ensure the associated methods were fresh in fieldworkers’ minds prior to commencing the interviews. Fieldworkers were asked to review the vignette, and comment on how well it reflected the role-plays and major themes identified from the PLAs (no amendments were suggested). They were instructed to probe for whether responses to the vignette (what participants thought the character in the story would do) reflected real life in their community. After training, fieldworkers practised the questionnaire among themselves and with volunteer participants.
PLA activities included brainstorming and ranking of barriers, role-playing and group discussion (Table
To compose the vignette storyline, unifying and contrasting elements of the role-plays were identified. Discussions following the role-plays, during which facilitators discussed how realistic the storylines were, were then analysed to confirm unifying elements, or resolve differences between the stories. Themes emerging from other activities, particularly barriers deemed most important in the ranking exercise, were also considered. The final vignette also needed to be viable given the character’s profile, for example, to represent the issues that the character would face considering their residence, marital status or family circumstances. The aim was to present a story that was familiar to most participants (touching on personal experiences, or experiences of acquaintances in their community), but that also achieved the objective of making women feel comfortable to admit to any difficulties they faced (so, for example, a more extreme case of a woman failing to access several of the services was chosen). Overly emotional circumstances or events (e.g. teenage pregnancy or death of a baby) which might derail the interview were avoided.
Once developed, the vignette and associated questions were incorporated into an interview discussion guide, along with open-ended questions about the personal experiences of the respondent during pregnancy, delivery and infant feeding. As conceived in the original study design, fieldworkers then received an additional day of training on the concept and use of the vignette, including examples of other studies employing this technique [24 (link)], and on confidentiality (particularly if participants disclosed their HIV status during the interviews). This additional training session was intended to give fieldworkers the chance to familiarise themselves with and discuss the vignette developed from the PLAs, and to ensure the associated methods were fresh in fieldworkers’ minds prior to commencing the interviews. Fieldworkers were asked to review the vignette, and comment on how well it reflected the role-plays and major themes identified from the PLAs (no amendments were suggested). They were instructed to probe for whether responses to the vignette (what participants thought the character in the story would do) reflected real life in their community. After training, fieldworkers practised the questionnaire among themselves and with volunteer participants.
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