Data collection methods

My selection of methods was conditioned by the type of research I did, and the research setting. According to O’Brian (1998) action research is a holistic approach where various tools for data collection should be appropriate. Investigating numerous aspects of the context opened up for applying several different means for data collection. Taken into consideration the flexibility (Dick, 1993) and richness (Smith, 1991) of data that qualitative research methods may give, it was a natural choice for me to go that route.

The methods used to gather information will now be described.

Interviews and discussions

During the time of investigation for my research work I conducted numerous interviews. The format of the interviews has varied a lot; from fairly structured, to more conversation-like. The different types of interview techniques have several reasons. Caused by the dynamics of the field, new needs for information might appear as observations or interviews are done. This means that more or less ad hoc interviews could be required, and the questions would become thereafter. However, the flexibility of interviews and conversations makes it possible to obtain much information “on the fly” as responses may lead to additional data and produce new requests. Some interviews were also done as e-mail correspondence. When I had returned to Norway and needed additional information from stakeholders in MISAU I used this form of communication. Throughout my stays in Mozambique, in between and after, I had endless conversations and discussions with other HISP team members, not only from the Mozambican setting. This has given me valuable data for this thesis. Generally I did not encounter any special problems regarding getting people to be interviewed except in some occasions when an interview meant direct disruption of daily routines for health workers at more peripheral levels. One time we had to do an interview with a nurse while she was attending patients.

Observation

Action research is typically an approach where researchers abandon their conventional roles as observers of events (Cornford and Smithson, 1996). However, this does not mean that observation as a means of getting relevant information should be forsaken. To obtain a picture as rich as possible, a diversified bundle of methods, observation included, may be appropriate. For me, doing observations was an important source of information. The observations can be divided into two main categories; planned and unplanned. Regarding unplanned observations, when

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participating in meetings, doing development work, training, etc. responses from others actually became a crucial source for information for my research, even though initially unintentional. I found it important always to be aware of what happened around me when working. This helped me a lot in understanding how people react to input and output and how people understand things differently. Observing how people react when they are asked about critical issues could give good clues about how their attitudes are for these issues. An example of the importance of observing other peoples reactions could be from when we were holding a course about HISP and DHIS for health management in Inhambane and its districts. It became clear that missing response sometimes was due to the situation rather than lack of knowledge.

All the directors from the province were at the course, and many lower level management staffs were afraid of speaking in plenum. They rather sat still instead of taking the risk of saying something that could be perceived as “stupid” by the province managers. However, while talking with them one and one they revealed more knowledge.

However, at several instances I “stepped” into, or looked at, the context or a situation with clearer goals. Being an observer in the natural surroundings and watching common routine work gave many indications on how the day of health workers and management was structured. Other things than routines could for instance be looking for graphs and diagrams on walls, or other physical signs of how information was being handled and processed.

Literature and schemes

I never encountered any problems in obtaining any report schemes or forms from the health statistics system. At all levels in the hierarchy people were willingly providing any information wanted if they had what I requested. In MISAU I was met with an open mind from everybody if I asked. Several important documents regarding evolvement of the health sector in general, and as well about cooperation and planning with HISP, were provided. Many research papers and technical annexes have been written about HIS and HISP development in Mozambique and other countries. These have been essential for me regarding understanding processes in the Mozambican context in particular and other locales in general, also from before I was staying in Mozambique myself.

Field notes

According to (Hammersley and Atkinson, 1983), “it is difficult to overemphasize the importance of meticulous note taking”. Especially from important meetings in MISAU about decisions and planning for the development I found it highly important to take detailed notes. There were in general many disagreements, and to be sure to remember exactly what had been said, note taking started already “in action”.

Important, and what also could seem unimportant at the time being, was written down. During interviews and observation notes were taken at a regularly basis. This also counts for other field work settings. During the software development, two types of notes were taken; planning of what was still remaining with priority lists, and

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detailed descriptions of problem definitions and possible solutions for the problems that had to be solved.

Training

Important in action research is the objective of improving conditions where research is conducted (Greenwood and Levin, 1998). Among HISP processes training of health management is seen imperative to make improvements in information culture.

In addition, transfer of knowledge to local experts is seen as crucial for obtaining sustainability of action (Braa et al., 2003). I participated in/conducted several training sessions. For health management, they consisted of ad hoc training sessions of staff in province and district offices when travelling around, and a planned two days course for all province and district health management in Inhambane in August 2004. I tutored several new Mozambican HISP team members so they could manage to do appropriate work for the team. The applications we made for the Mozambican version of DHIS were developed in Microsoft Visual Basic. As I had no experience with this programming language from before I had to tutor myself. It went by a “learning by doing development at the same time” kind of principle, if it exists.

Exploring information systems

When staying at health facilities, hospitals, district and province offices I got a chance to see the information system in use. At facility and district level the system(s) was mostly paper based. At province level I saw the computer based systems in use, input, processing and output; the inscribed work routines and how they were actually used.

From MISAU I also got hold of the three main computer systems that were relevant for my work; Sisprog, SIMP and the so-called Modulo Basico. The developers of SIMP work(ed) in MISAU, and guidance I got from them regarding their system, and as well some special issues concerning other systems was crucial when own doing systems development tasks.

HISP team cooperation

Although much of the data for this thesis comes from my own experiences a member of the Mozambican HISP team, much information has been collected through the sources and resources of other Mozambican HISP team members. This is due to the fact that HISP has existed in Mozambique since 1999, and to be able to follow and understand the whole process, I must as well relay upon other sources than my own field studies.

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