Conducting high-frequency data collection in low-resource settings: Lessons from a financial diary study among women engaged in sex work in Uganda

ABSTRACT

Poverty and economic insecurity are driving forces in entering sex work among women in low resource areas. This increases their risk for HIV by influencing the decision-making process for high-risk behaviors. Few studies have examined the financial behaviors and capacities of women engaged in sex work (WESW). This paper describes the methodology used in a financial diary study aimed at characterizing women’s spending patterns within a larger prevention intervention trial among WESW in Uganda. From June 2019 to March 2020, a subsample of 150 women randomized to the combination HIV prevention and economic empowerment treatment was asked to complete financial diaries to monitor daily expenditures in real time. Two hundred and forty financial diaries were distributed to study participants during the financial literacy sessions at eight sites. A total of 26,919 expense entries were recorded over 6 months. Sex-work-related expenses comprised approximately 20.01% of the total. The process of obtaining quality and consistent data was challenging due to the transient and stigmatized nature of sex work coupled with women’s varying levels of education. Frequent check-ins, using peer support, code word or visuals, and a shorter time frame would allow for a more accurate collection of high-frequency data. Moreover, the ability of women to complete the financial diaries despite numerous challenges speaks to their potential value as a data collection tool, and also as an organizing tool for finances.

KEYWORDS:

• Financial diary
• sex work
• poverty
• Uganda
• female sex worker
• women engaged in sex work

Acknowledgments

We are grateful to women engaged in sex work in southern Uganda who agreed to participate in the study; this work would not be possible without them. Special thanks to the International Centre for Child Health and Development (ICHAD) at the Masaka Field Office, who coordinated the study in Uganda with study partners, Rakai Health Sciences Program, and Reach the Youth Uganda. Lastly, to the research teams at Washington University in St. Louis, Columbia University in New York, University of North Carolina at Chapel Hill, and New York University.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

FMS and SSW conceived the study and are the principal investigators. FMS, SSW, PN, and OSB developed the study protocol with contributions from JK and LJMW. EN and JN coordinated study tasks and data collection. JK coordinated financial data management and categorized all FD entries. LSY conceived the manuscript, organized the data, and prepared all data tables and figures, with assistance from JN and JK, and prepared the first draft of the manuscript. JK, OSB, LJMW, SSW, and FMS contributed to interpreting the data and editing the manuscript as needed. All authors have read and approved the final manuscript.

Data availability statement

Restrictions apply to the availability of these data due to the sensitive nature of the research. Requests may be made to the principal investigator, FMS.

Disclaimer

NIMH had no role in the study design, data collection, analysis, interpretation of findings, and preparation of this manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Clinical trial registration: ClinicalTrials.gov NCT03583541.

Additional information

Funding

This research was funded through resources and services provided by the National Institute of Mental Health (Grant: R01MH116768, MPIs: Fred M. Ssewamala, PhD, and Susan S. Witte, PhD).