Design and methodology of a mixed methods follow-up study to the 2014 Ghana Demographic and Health Survey

ABSTRACT

Background: The intended meaning behind responses to standard questions posed in large-scale health surveys are not always well understood. Systematic follow-up studies, particularly those which pose a few repeated questions followed by open-ended discussions, are well positioned to gauge stability and consistency of data and to shed light on the intended meaning behind survey responses. Such follow-up studies require extensive coordination and face challenges in protecting respondent confidentiality during the process of recontacting and reinterviewing participants.

Objectives: We describe practical field strategies for undertaking a mixed methods follow-up study during a large-scale health survey.

Methods: The study was designed as a mixed methods follow-up study embedded within the 2014 Ghana Demographic and Health Survey (GDHS). The study was implemented in 13 clusters. Android tablets were used to import reference data from the parent survey and to administer the questionnaire, which asked a mixture of closed- and open-ended questions on reproductive intentions, decision-making, and family planning.

Results: Despite a number of obstacles related to recontacting respondents and concern about respondent fatigue, over 92 percent of the selected sub-sample were successfully recontacted and reinterviewed; all consented to audio recording. A confidential linkage between GDHS data, follow-up tablet data, and audio transcripts was successfully created for the purpose of analysis.

Conclusions: We summarize the challenges in follow-up study design, including ethical considerations, sample size, auditing, filtering, successful use of tablets, and share lessons learned for future such follow-up surveys.

KEYWORDS:

• Mixed methods
• follow-up survey
• family planning
• unmet need
• computer-assisted personal interviewing
• Demographic and Health Surveys

RESPONSIBLE EDITOR Virgilio Mariano Salazar Torres, Karolinska Institutet, Sweden

RESPONSIBLE EDITOR Virgilio Mariano Salazar Torres, Karolinska Institutet, Sweden

Acknowledgments

The authors thank Sunita Kishor, Tom Pullum, Enid Schatz, Jennifer Johnson-Hanks, Madeleine Short Fabic, and Yoonjoung Choi for input on study design; Gulnara Semenov, Mianmian Yu, David Cantor, and Guillermo Rojas for contributions to survey coordination and data processing; Adwoa Adutwum, Afifatu Yussif, Dinah Badmus, Mahmuda Ainoo, Rafatu Ussif, and Sarah Okai who conducted interviews; Clara Burgert for creating the map; and Philomena Efua Nyarko, Peter Peprah, and Abena Asamoabea Osei-Akoto at Ghana Statistical Services who coordinated fieldwork auditing.

Author contributions

SS conceived the study design, directed the project, and drafted the manuscript. SS, RA, MA, and CA led interviewer training. RA, MA, and CA co-directed field implementation. RA edited the manuscript. LO wrote programs to select GDHS respondents and output results. All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

None.

Paper context

Qualitative data provide substantial insight into health behaviors, but are rarely generalizable. Linking qualitative and mixed methods data to nationally representative data from large-scale surveys adds value to quantitative studies. This article reports on an innovative mixed methods follow-up study about unmet need conducted among a systematically selected subset of respondents to the 2014 Ghana Demographic and Health Survey. We share challenges and successes in design and implementation that may benefit future such follow-up studies.

Additional information

Funding

This study was funded by the United States Agency for International Development (USAID) through The Demographic and Health Surveys (DHS) Program (#AIDOAA-C-13-00095). The funder had no involvement in the collection, analysis, interpretation of data, nor the writing of the manuscript. The views presented here are the sole responsibility of the authors and do not necessarily reflect the views of USAID or the United States Government.