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Velandia Mora, Manuel Antonio
During the process of bringing the community with information and prevention programs, some people report the presence of STD or HIV infection, signs of what they call "dry" or "agallones" they are "watered by many sides of the body" and that some are presenting "Jurgen" of time, likewise found that in the scientific literature and documents produced by NGOs, these same signs are described as persistent generalized lymphadenopathy, and this is the terminology usually used by those working in these institutions. Both groups refer to the same situation.
Many times l * s health team members fail to interpret what they communicate l * s * s users of their services or be understood by est * s, although in both groups there knowledge that would enable the construction approach and common health text.
Ethnography (Cortés 1,998) etymologically means description (Grafe ) lifestyle of a group of people used to live together ( ethnos). This Ethnos is the unit of analysis for the researcher (ethnographer), Ethnos can be a region, a community, a group within the community, a family, a guild, which constitutes an entity with relationships governed by custom and rights, obligations and reciprocal interactions, or because they share lifestyles and similar situations [3] , such as users of an entity providing services, using condoms, being gay, or living with HIV / AIDS. Ethnography seeks to place the actors in a historical context and is interested in attitudes, relationships that account for the set of values, interactions, interests and intentions.
Ethnography is a strategy that allows a description of social relationships, attitudes, behaviors, practices and knowledge of human groups that make up societies. To a better knowledge of human diversity, enabling the creation provide a database that conceives generalize certain behaviors and social habits, in this case of so-called vulnerable groups. Within each group each member is different and unique and each situation, because their conditions are typical, despite the risks they are exposed are common to all, for example, STDs, AIDS, HIV infection, teenage pregnancy, or poverty.
Ethnography and qualitative research tool used to turn a series of techniques and media. Among their techniques are:
Direct Observation and / or Participant . Is first hand and observe the particular behavior or collective microgrupal specific conditions of time, space and environment. The researcher recorded in a diary the most fundamental aspects observed in the daily behavior patterns, including such basic items as smells, sounds, movements, how they approach the preventive elements or discuss their use. The researcher is embedded in the community analyzed as a member of the same, taking an active part of society.
Conversations, interviews and questionnaires . They are communicative exchanges ranging from the less formal and are a casual chat to structured interviews following a questionnaire seeking to collect a complete and comparable aspects of interest. In interviews can locate specific , in which the investigator excerpted from verbalizing the experiences of his interlocutor specific aspects referred to as the hub of research and generally oriented questions from the overall experience of another through a questionnaire does not necessarily structured, but relativized to a theme (to go from general to specific), the interviews focused reference point to the experience with respect to a particular topic, ie, those conditions or axes as the investigator determines as priorities within the global information, experiences and experiences on the subject has his / * the research subject (ie, go from the particular to general). This information is contained in the working sessions, in a place that is not necessarily the respondent's living space.
Life Stories . Are in-depth interviews reveal how the person is perceived, how it reacts and how it has achieved various changes that have affected his life, which can make a historical reconstruction and identify how it fits your particular process in the social process. This allows us to glimpse the diversity to be found within a community. Unlike interviews, life histories are characterized by contact that the researcher assumes the respondent, as the stories require empathy as an essential element for the collection of information, because the process requires multiple meetings carried out at the place or places at which the interviewee develops their daily lives, because the research done at the same time an observation of that area and how the interview unfolds in it. The knowledge gained is a subjective assessment, which makes a person's location in time, space, relationships and procedures for a given historical moment.
Each investigator determines the method of analysis, ie, the strategies, the type and how you select the items you consider most important. Likewise, the significance that may have these items. Hence the importance of interpretation, which is found not expressed in the first instance, but its deeper meaning.
Focus Groups [4] . Technique that takes advantage of group dynamics and can achieve increased levels of understanding and deepening fundamental issues a topic of study in a small group of participants led by a trained moderator. The main reasons that make it more popular this qualitative ethnographic technique are, among others, the following:
- Interaction group among people who usually promotes richer responses and allows the contribution of new and original ideas.
- Obtaining direct knowledge of the behaviors, attitudes, language and perceptions of the group by observing the debate. This is especially important in the stages of "creative" in the initial development of a program.
- require less time and costs that the implementation of a series of interviews.
specific applications of research in a focus group clearly illustrate the importance of the following factors: Formation of ideas, selection of different designs, either conceptually or as a prototype to reduce the number of concepts to be included in a quantitative test, evaluation of the message concepts, identifying and defining problems, generating hypotheses about the reasons why certain product is chosen, will experience certain behavior, attitude or practice.
Different elements that must be present: Focus groups are used when: The interaction between the participants may encourage more interesting answers or new or original ideas, peer pressure / group will be valuable to promote their ideas and opinions contrary to elucidate , The matter is so delicate that participants give neutral answers or provide certain information, if you need depth of individual responses, the nature of the subject is such that most participants can say everything that is relevant or anything they know in a few minutes. At work on AIDS, sexuality and STIs have seen the need to delve into a number of categories [5] that enable the classification of information obtained and these are:
- myths and taboos regarding sexuality, health and gender relations, gender and emotional
- cultural elements and cultural habits: Regionalization, idiosyncratic and the particular way the individuals look, feel, express and take his own life.
- appropriate knowledge and false beliefs: Recovery and recognition of knowledge and imagination.
- Semantic body, sexuality and health: is the recognition of appropriate language, simple and easy to understand that is consistent with the way how people communicate in their particular semantics.
- particular values \u200b\u200bto life, body and health.
Ethnography allows the identification of a number of elements that allows the creation of communication tools for behavior change [6] such as
- Development messages based on existing information;
- Segmentation of audiences;
- Limited number of messages
- Preparing messages consistent with the target group and their needs;
- Emphasize the positive results of behavioral changes and present incorporation behavior changes as simple and attractive;
- Presentation of behaviors that are realistic and achievable
- transfer of skills to initiate and sustain behavior change;
- Creating supportive social norms ;
- Prepare the user * s * s for relapse of STI and HIV infection.
two concrete examples
Condoms made of synthetic resin
Needs:
1. What is the average penis size in Colombia? There are significant differences regions? It would produce different products that are appropriate to each region.
2. Do potential customers or not to accept a condom made from a material other than latex? What is the attitude toward using a condom made of synthetic resin?
3. Are there differences in the use of latex condoms with Synthetic Resin?
4. How prefer that is packaged condoms synthetic resin?, what would be the ideal way to pack, what color, how should it be called?
How were the responses:
questions A numeral one.
Technique: A sample consists of men who met the following criteria:
· Age: 19 to 40 years.
· Birthplace: Colombia's five geographic regions
· ; accepted to participate in research: implied allow his penis was measured in length and diameter, flaccid and erect. She checked the penis in a flaccid state. Later it was left alone to person: to achieve the excitement was possible to see magazines or videos. Each person stimulating his penis and its erection was complete when requesting the presence of the professional who made the measurement.
was not taken into account sexual orientation or marital status lso informants.
Size Average: 9 + / - 11.6 cm. Extended length: 21.24 cm. Shorter length of 7.6 cm
Average diameter: 53 mm; Major diameter: 59 mm, lower diameter: 47 mm
Comment: Unlike the imaginary socialized men holding the Atlantic and Pacific Coasts have longer penises than other men in the country, the penises were longer on average men in the region of Tolima.
People prefer that condoms are not "too long " as it were " feel bad." How in the different regions of the country of all sizes are "better one" average condom. " " Those who are small at best not use them." If anyone has a very small penis " the latex is also fall." It was decided to make the condom reference "UNIQUE" Length: 17 cm. Diameter: 58mm ± 1mm. The condom reference "UNISEX" Length: 17 cm. Diameter: 61mm ± 1mm.
to the questions of number two.
Technique: Conversations and focus groups
The material they are made "is new." People try to stretch it as their reference after the elongation of the latex. They feel "softer feel ", " thin" and is "very resistant ." They are attracted to is "very colorless " and that placing " not noticed almost " on the skin. The scientific evidence shows that the synthetic resin material that is highly resistant electrostatic pressure, tension and friction. Its thickness is 0.00045mm. Is 10 times thinner than latex. Completely colorless and odorless.
use Front worry "that sounds "Or" to fall "during intercourse. The synthetic resin adheres to the skin. During the penetration no sound other than the same sex as the lubricant acts as "shock" of the noise. Can be used with any type of lubricant.
Question number three.
Techniques: Direct observation, interview on time, discussions and focus groups
were asked to explain those used orally and a latex condom. They did individual and group. Some people were selected in the initial interview agreed to put the condom in front of the investigator. The selection criteria were the same group of number one, all persons were consistent users of latex condoms. They were asked to use condoms references "UNIQUE" and "unisex." With the results of the observation was performed manually using a condom with synthetic resin. The manual appears in each of the condom packaging.
to the questions of number four.
Technical: Focus groups
possible prototypes were created packages, ranging from the traditional model to packaging designs "feminine."
People felt that carrying condoms in his pocket is "somewhat uncomfortable " and furthermore, it "facilitates damaging." The packaging should "be discreet ." It was suggested a package that looks like a "credit card". What color was "discreet "And" like cards. "
The final packaging of the condoms "UNIQUE" and "UNISEX" is a card (see photo).
The names were selected from a pool of suggestions made in the focus groups or during interviews.
Another example of the realization of a qualitative research
How to properly use a protease inhibitor drug [7]
Sample: Men and women who live with HIV or AIDS receive care in programs that provide drugs inhibitors. Health team members working in various private institutions, NGOs and state AIDS programs (physician * s, nurses, workers, psychologists * s, educadoræs, volunteer * s). People were selected from both groups living in Cali and Bogota.
selection indicators: sex, age, time of diagnosis, HIV status, adherence or no treatment.
Needs:
People living with HIV or AIDS need treatment for a number of drugs known as inhibitors. Of these drugs are taken two or three (cocktail). Some must be taken with a full stomach, others with not eating. Medications can have a taste that is not pleasing to everyone and this makes the shot, causing rejection and non-adherence. They wanted to know specifically how to achieve greater adherence to protease inhibitor Ritonavir, trade name Norvir liquid form.
Concerns raised
1. How informed staff member health team to patients living with HIV / AIDS on how to properly use medications inhibitors
2. How patients use medicines.
3. That products change the flavor or prevent drug reflux that occurs in some people after the shot, and even before that.
How were the responses:
questions A numeral one.
Technique: Focus Group
L * s health team members consider the possibility of treatment is "... A lgo hopeful" that has meant "... A lot of expectation and great desire to learn about drugs, the mechanisms how these drugs act and to know what is best suited for each particular case . "In general, the development of therapeutics has motivated them to education, training and updating, but despite having knowledge of scientifically based conflict between the possibility of improving the overall health and what it means for (a) user * having to use drugs for long periods or even having to do without interruption. Someday ell * s * s claim: "... It becomes a chronic management is not fata l disease "another of them consider an additional situation" ... His life becomes ingest drugs, which is also live for that. Is that I say all day are pending drug that is uncomfortable ... ". These private reflections or statements made by (a) user * program can compromise adherence to medication.
The vast majority of professionals are afraid to additional situations that are generated by the expectation or the use of HAART (Highly Active Anti Retroviral Treatment): "... When people start treatment and start having loads undetectable are also generating false expectations that no longer have the problem of infection, they already solved your problem, then one returns to take people to zero and tells them the possibilities of risk and assume that you are healed and then they can go on with life who initially had . "Despite this they are aware of HAART," ... It's a good response, however, is a process that starts from drugs, it is something that is constructed with the patient, must be based on the provision that encourages the process and the ideal is to end in adherence " . Despite their willingness to support, they feel "... Much concern, because according to research all these medications will tend to make resistance.
On information, motivated above, at times tend to saturate with this the * user * s soa exaggerate some aspects, such as fear of not ingested enough fluid , are often motivated to take large amounts of liquid, perhaps thinking "as they will not comply" so, if they take a portion of the proposed amount, however will be fulfilled. Some myths were observed in views of patients, such as: ... hartísima I take water as a liter ( With each dose of ). What happens is that water helps me. I've seen that water helps me, it's easier to take my medications. One more, which referred to the liquid and the side effects said: "... I started a few attacks here (points to the bottom back ), the pain was so hard not resisted or standing or sitting, as the pain was so intense that a doctor gave me an injection and took away the pain, I said to the (...) you must take plenty of water, they told me to be take ten, fifteen, or twenty glasses water, I have that understanding, so I moved on to (...) and I are taking effect. " Another more explicit thus: "... At first I did like twelve glasses, but more is better , or liquid or milk or juice. One patient reported:" ... M doctor told me i had to take twenty-five glasses of water because it was to stop or avoid other calculations effects.
How patients use medicines.
Answers to the questions of number two.
Technique: Focus Group
" I heard that some are caught and taken all the drugs again and not take into account the hours that the doctor gives ", " these schedules are for the patient fuck", but each drug remains active time in the body: " If you do not follow these times, as the virus takes advantage and multiplies, and you can even become resistant to drugs and there they brought us the p ... because one is left with no alternative " " The same thing happens to those who, supposedly to save, they take the medication for a few, or believing that it will be better, they take larger amounts than their doctor has recommended . "
" Getting used to the schedule was not easy ", " I had a PDA I whistled a few minutes before having to take my medication so I could take the time to catch me " . "I was told the health team that I myself did my schedule, they supported me and changed it several times until I was perfect for my life will not change much ."
" Initially I did not I take a drug, I served order them and save a few days, until I was fully aware that if I wanted them to take and would not stop for anything . " "I know some stop taking their medications on weekends or when the viral load is undetectable "
Answers to Question Three numeral.
Technique: Focus Group, which includes tasting of medicinal products and flavors.
" liquid Norvir unlike that which was taken in capsules, should not keep in the fridge, so it no longer has that problem, and that makes it easy for a everything. " " Oh, and the taste is different. It comes with a slight licorice flavor and as a mint and burnt brown sugar (or candy that it is put to the custard, rather) . " " Like all drugs produced in a laboratory because it has a saborcito a chemist, but I tried it I know it's not as strong as some exaggerated."
" Like all medicines, if you want to not have that typical taste, it can achieve ". " One way is by eating something very cold, as this one numbs the tongue and not let you feel the flavor . " I prefer ice cream or juice with crushed ice or blended with ice cream is better, so I do with the leftover juice and stop not waste anything." "Without ice cream can be used to suck a little bit of ice and no more, no taste." "Also good if you take the cold drink, or eat ice cream immediately after the drug, but I prefer the first." "There are other ways to help with the taste, it may be some products that are available in everywhere. The nucite ® (Those who know how to milk, chocolate and nuts), but the nutritionist said that one should not be exceeded in the sweet, so this works well but is best done from time to time. Another thing I also know rich environment is flavored cookie nucite ® for Columbine, a wafer filled with hazelnut cream flavor. "
"Those who tried and say that if you take the medicine and then biting a green apple, Acidito takes the flavor right away." "When the apple has been in the fridge works much better." Bran cookies (which are pure fiber) also reduce the taste and is much better if something rubs them, served a little too nucite ® or smear peanut butter. "
"Some friends who love aguapanela taken shortly after taking the drug and say that this is also good for removing the taste of medicine." "I like the aguapanela ice with a few drops of lemon and it works better. Even also serve the single lemon, acidic fruit juices, like orange juice or lemonade, but better if taken with some sugar. " "And if you get eruptadera one made a little bit of salt in their mouths and go away quickly. When I feel that I return the flavor also use lemon drops and that helps me a lot. "
As can be seen in these two examples, qualitative research is ethnographic observation window on the world as it is, and how people interact freely with him. Through these field works were obtained realistic parameters for the creation of a resin package for condoms more appealing and practical in the eyes of consumers, and a manual for using drugs to improve adherence, and incidentally, improve the quality of life of people living with HIV or AIDS.
observations and conclusions achieved through ethnography are very hard to find in a strict quantitative research, since the variables are subject to the limitations imposed by the person asking the questions, but not by reality itself . Additionally, human contact allows the researcher to work more humane, in other words, more targeted to meet the needs of people who think, feel, laugh, suffer, live and die in a world that numbers and statistics do not reach completely draw conceptual coolness.
Bibliography
[3] Tovar Cortez, Elsa. Approaches to ethnographic research Latin American Journal of Sexology, reprint No. 3, Page 77-78, Colombia 1,998.
[4] Velandia Mora, Manuel Antonio, The Qualitative Research Colegio Mayor de Nuestra Senora del Rosario, Bogotá, 1998
[5] Velandia Mora, Manuel Antonio, educational methodologies: tools for health promotion, in Proceedings of Workshop on attitudes in the service and let's support Foundation / Ministry of Health / Board Coordinator of NGOs working in HIV / AIDS in Bogotá, 1998
[6] Velandia Mora, Manuel Antonio, Effective Communication: An approach that uses model-FHI-USAID AISCAP, Colegio Mayor de Nuestra Señora del Rosario , Bogotá, 1998
Additional information may be requested from the author. 
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