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Experiences of using life histories with health workers in post-conflict and crisis settings: methodological reflections.

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Witter, Sophie, Namakula, Justine, Alonso-Garbayo, Alvaro, Wurie, Haja, Theobald, Sally ORCID: https://orcid.org/0000-0002-9053-211X, Mashange, Wilson, Ros, Bandeth, Buzuzi, Stephen, Mangwi, Richard and Martineau, Tim ORCID: https://orcid.org/0000-0003-4833-3149 (2017) 'Experiences of using life histories with health workers in post-conflict and crisis settings: methodological reflections.'. Health Policy and Planning, Vol 32, Issue 4, pp. 595-601.

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Abstract

Introduction
Life history is a research tool which has been used primarily in sociology and anthropology to document experiences of marginalized individuals and communities. It has been less explored in relation to health system research. In this paper, we examine our experience of using life histories to explore health system trajectories coming out of conflict through the eyes of health workers.

Methods
Life histories were used in four inter-related projects looking at health worker incentives, the impact of Ebola on health workers, deployment policies, and gender and leadership in the health sector. In total 244 health workers of various cadres were interviewed in Uganda, Sierra Leone, Zimbabwe and Cambodia. The life histories were one element within mixed methods research.

Results
We examine the challenges faced and how these were managed. They arose in relation to gaining access, data gathering, and analysing and presenting findings from life histories. Access challenges included lack of familiarity with the method, reluctance to expose very personal information and sentiments, lack of trust in confidentiality, particularly given the traumatized contexts, and, in some cases, cynicism about research and its potential to improve working lives. In relation to data gathering, there was variable willingness to draw lifelines, and some reluctance to broach sensitive topics, particularly in contexts where policy-related issues and legitimacy are commonly still contested. Presentation of lifeline data without compromising confidentiality is also an ethical challenge.

Conclusion
We discuss how these challenges were (to a large extent) surmounted and conclude that life histories with health staff can be a very powerful tool, particularly in contexts where routine data sources are absent or weak, and where health workers constitute a marginalized community (as is often the case for mid-level cadres, those serving in remote areas, and staff who have lived through conflict and crisis).

Item Type: Article
Subjects: W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84 Health services. Delivery of health care
WA Public Health > WA 20.5 Research (General)
WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Problems of Special Population Groups > WA 305 Mental health of special population groups
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1093/heapol/czw166
SWORD Depositor: JISC Pubrouter
Depositing User: JISC Pubrouter
Date Deposited: 01 Feb 2017 15:18
Last Modified: 13 Sep 2019 10:12
URI: https://archive.lstmed.ac.uk/id/eprint/6744

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