The Save the Children/Bolivia "Autodiagnosis" Methodology

Name: The Save the Children/Bolivia "Autodiagnosis" Methodology

Purpose: To raise women's awareness of specific maternal and peri/neonatal health problems, to foster women's confidence in their ability to speak about their own problems, to motivate them to act upon these health problems, and to learn to pri oritize the problems that are identified.

Type of Design: Cross-sectional, community-based

Where Used: Bolivia.

Tool 12

BASIC INFORMATION

Name: The Save the Children/Bolivia "Autodiagnosis" Methodology

Origin: USAID

Source: USAID, 1994

Basic Description: A participatory research technique developed by Save the Children, Bolivia for use with the MotheCare project. It is an activity with several steps carried out within and by women's groups that allows both the community and Save the Children to learn about women's perceptions of maternal and peri/neonatal health problems and how they respond to them

Country Applications: Bolivia.

Language: A pictorial dictionary was developed to represent maternal and peri/neonatal health problems. Drawings are used to stimulate response. A glossary of terms was developed in Aymara, everyday Spanish and technical Spanish.

When working with groups of non-literate women, visual keys and other means of non-written communication are extremely important.

Technical Scope: Self Assessment of women's health; Overall assessment of newborn health.

Purpose: To raise women's awareness of specific maternal and peri/neonatal health problems, to foster women's confidence in their ability to speak about their own problems, to motivate them to act upon these health problems, and to learn to prioritize the problems that are identified.

Type of Method: Qualitative

Design: Cross-sectional, community-based

Key Users of Information: health - planners; women's groups; community authorities; teachers; health personnel and other community members

Goals and Scope of the Tool:

The goals are -

  1. For women in the community, is to raise their awareness of maternal and peri/neonatal health problems and for them to gain confidence in addressing these problems for themselves and the community.
  2. For the program staff, are to gain a better understanding of how and why women attend to their own health needs and those of their newborn infants, and to develop a sound basis for planning interventions.

Scope of the Tool -

This is a participatory research technique and there are nine steps to carrying out the complete autodiagnosis in a women's group. In Bolivia, Save the Children staff served as facilitators, guiding questions to help the women discuss and prioritize their health problems and to select two or three problems they would like to address at the community level with other women and men, specifically those with positions of influence. This decision-making process then serve as guide for the development of interventions.

The autodiagnosis process can be described in steps, as follows:

  1. Orient the Women to Save the Children's Project: The autodiagnosis fits into an overall health program and this step is designed to describe this to women's groups.
  2. Explore Attitudes of group members toward pregnancy, birth and motherhood: The objective is to orient and to motivate women to talk about and sharing their problems.
  3. Learn what the group members know and do about maternal and peri/neonatal health problems: In this step a pictorial dictionary and drawings can be used (see above, "Language").
  4. Encourage group members to think about what other women in the community know and do to resolve maternal and peri/neonatal health problems.
  5. Explore and design different ways to collect information from other women in the community: This is a crucial step. Exploring how they communicate with other women to obtain answers to sensitive questions provides program staff with important insights into how to make this process more effective.
  6. Implement the interviews.
  7. Share results of the interviews with the group.
  8. Prioritize the problems.
  9. Evaluate the autodiagnosis process.

Key Indicators:

In step seven, both qualitative and quantitative indicators are presented.

  1. The quantitative indicator consist on how many women experienced a particular problem (such as retained placenta, edema, mal presentation, hemorrhage, infection, too many children);
  2. The qualtitative indicators consist on women's practices and beliefs.

Research Design:

The autodiagnosis process varied (in Bolivia ) from two sessions of approximately three hours each (in communities were virtually all women of reproductive age attended the session and therefore the home visit sessions were not carried out) to four sessions of approximately two to three hours each, plus home visits over a period of one to two months.

Implementation and Training:

During step six the women go out in the community to conduct interviews with the "instrument" they have developed in the first five steps. They visit and interview other women who did not participate in the group. They ask open-ended questions, and use the drawing developed in their group to elicit responses.

Analysis:

The first three priorities determined through the autodiagnosis for each community are combined in a box and information elicit through this activity can be compared across communities.

Reporting and Dissemination of Results:

When the autodiagnosis is completed, the group should proceed to the next phase ("planning together") which consists of two to three sessions. The first session prepares the women's group for a presentation to the community of the results and for the planning exercises. The second session involves the women's groups, community authorities, teachers, health personnel and other community members. The women present their findings and a skit to help the audience identify barriers to solving the problems.

All the participants develop strategies to remove or diminish identified barriers. A formal document is drafted containing all the agreements including who is responsible for each action and when the action will take place. Then the document is signed by all presents at the meeting

The planning process can be completed in 1-2 months, and after 3-6 months, the community should meet to evaluate the results of their actions based on the plans they developed

Contact Information:

Lisa Howard-Grabman
Save the Children
2000 M Street
Washington, DC 20036
E-mail: lhowardg@dc.savechildren.org