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      How can we assess the burden of muscle, bone and joint conditions in rural Botswana: context and methods for the MuBoJo focused ethnography

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          Abstract

          Background

          Musculoskeletal diseases are the most common causes of long-term pain and disability worldwide and a growing international public health concern. However, the everyday burden and impact of musculoskeletal conditions are not well understood, especially among people living in low- and middle-income countries in Africa. Since 2011, World Spine Care, a nongovernmental organisation, has collaborated with the Botswana Ministry of Health to open spine care centres and to conduct research. The broad aim of the Muscle, Bone and Joint (MuBoJo) research project is to examine the sociocultural, organisational and clinical characteristics for the burden of living with and caring for people living with musculoskeletal conditions in rural Botswana. In this paper, we describe the community context, theoretical framework, and research methods to address the project aim with a qualitative study.

          Methods/Design

          This focused ethnography is based on eight months (November 2011, April 2013, October 2013-March 2014) of fieldwork in Botswana. The project was theoretically informed by the concepts of explanatory models of illness, social suffering, and biographical disruption. Data collection included fieldnotes, non-participant and participant observations, and informal and in-depth interviews with villagers and healthcare providers. Villager interviews were typically conducted in Setswana with an interpreter. Audio recordings were transcribed verbatim in the language spoken with Setswana contextually translated into English. Computer software supported qualitative data management. Analysis is ongoing using constant comparison and a template organising style to facilitate pattern-finding and reveal insights for the burden and care of musculoskeletal conditions.

          Discussion

          Findings from the MuBoJo Project will document the context of musculoskeletal burden, illness beliefs, self-care behaviours, and healthcare options in a Botswana rural village. These data will inform ongoing efforts to establish spine care clinics for underserved populations in low-middle income countries and sustain these healthcare services through local providers and volunteer health professionals. This study also will generate new knowledge about the burden and impact of muscle, bone and joint disorders for cross-cultural comparisons and patient-centred interventions.

          Conclusions

          Our systematic and transparent methodology to conduct musculoskeletal research in more than one language and in a cross-cultural setting may be useful for investigators and NGO healthcare personnel.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12998-015-0056-9) contains supplementary material, which is available to authorized users.

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          Most cited references60

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          Qualitative evaluation and research methods

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            Methodological challenges in cross-language qualitative research: a research review.

            Cross-language qualitative research occurs when a language barrier is present between researchers and participants. The language barrier is frequently mediated through the use of a translator or interpreter. The purpose of this analysis of cross-language qualitative research was threefold: (1) review the methods literature addressing cross-language research; (2) synthesize the methodological recommendations from the literature into a list of criteria that could evaluate how researchers methodologically managed translators and interpreters in their qualitative studies; (3) test these criteria on published cross-language qualitative studies. A group of 40 purposively selected cross-language qualitative studies found in nursing and health sciences journals. The synthesis of the cross-language methods literature produced 14 criteria to evaluate how qualitative researchers managed the language barrier between themselves and their study participants. To test the criteria, the researcher conducted a summative content analysis framed by discourse analysis techniques of the 40 cross-language studies. The evaluation showed that only 6 out of 40 studies met all the criteria recommended by the cross-language methods literature for the production of trustworthy results in cross-language qualitative studies. Multiple inconsistencies, reflecting disadvantageous methodological choices by cross-language researchers, appeared in the remaining 33 studies. To name a few, these included rendering the translator or interpreter as an invisible part of the research process, failure to pilot test interview questions in the participant's language, no description of translator or interpreter credentials, failure to acknowledge translation as a limitation of the study, and inappropriate methodological frameworks for cross-language research. The finding about researchers making the role of the translator or interpreter invisible during the research process supports studies completed by other authors examining this issue. The analysis demonstrated that the criteria produced by this study may provide useful guidelines for evaluating cross-language research and for novice cross-language researchers designing their first studies. Finally, the study also indicates that researchers attempting cross-language studies need to address the methodological issues surrounding language barriers between researchers and participants more systematically.
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              The sociology of chronic illness: a review of research and prospects

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                Author and article information

                Contributors
                mhondras@health.sdu.dk
                cmyburgh@health.sdu.dk
                jhartvigsen@health.sdu.dk
                scott.haldeman@worldspinecare.org
                hjohannessen@health.sdu.dk
                Journal
                Chiropr Man Therap
                Chiropr Man Therap
                Chiropractic & Manual Therapies
                BioMed Central (London )
                2045-709X
                16 March 2015
                16 March 2015
                2015
                : 23
                : 11
                Affiliations
                [ ]Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, Odense M, Denmark
                [ ]World Spine Care, 801 North Tustin Avenue, Suite 202, Santa Ana, California, USA
                [ ]Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, Odense M, Denmark
                [ ]Department of Neurology, University of California, Irvine, California USA
                [ ]Department of Epidemiology, School of Public Health, University of California, Los Angeles, California USA
                [ ]Department of Public Health, Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 9B, 5000 Odense C, Denmark
                Article
                56
                10.1186/s12998-015-0056-9
                4361207
                1e9062bb-cafb-49ac-8872-41fc5d4b0b83
                © Hondras et al.; licensee BioMed Central. 2015

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 1 October 2014
                : 27 January 2015
                Categories
                Methodology
                Custom metadata
                © The Author(s) 2015

                Complementary & Alternative medicine
                burden,developing countries,ethnography,joints,musculoskeletal system,qualitative research

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