R ES E A R C H A R T I C L E Open Access
Perceptions of community-based field
workers on the effect of a longitudinal
biomedical research project on their
sustainable livelihoods
Christabelle S. Moyo
1
, Joseph Francis
2
and Pascal O. Bessong
1*
Abstract
Background: Researchers involved in biomedical community-based projects rarely seek the perspectives of
community fieldworkers, who are the ‘ foot soldiers’ in such projects. Understandin g the effect of biomedical
research on community-based field workers could identify benefits and shortfalls that may be crucial to the success
of community-based studies. The present study explored the perceptions of community-based field workers on the
effect of the Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for
Child Health and Development Project" (MAL-ED) South Africa on their tangible and intangible capital which
together comprise sustainable livelihoods.
Methods: The study was conducted in Dzimauli community in Limpopo Provinc e of South Africa between
January-February 2016. The sustainable livelihoods framework was used to query community-based field workers’
perspectives of both tangible assets such as income and physical assets and intangible assets such as social capital,
confidence, and skills. Data were collected through twenty one individual in-depth interviews and one focus group
discussion. Data were analysed using the Thematic Content Analysis approach supported by ATLAS.ti, version 7.5.10
software.
Results: All the field workers indicated that they benefitted from the MAL-ED South Africa project. The benefits
included intangible assets such as acquisition of knowledge and skills, stronger social capital and personal
development. Additionally, all indicated that MAL-ED South Africa provided them with the tangible assets of increased
income and physical assets. Observations obtained from the focus group discussion and the community-based leaders
concurred with the findings from the in-depth interviews. Additionally, some field workers expressed the desire for
training in public relations, communication, problem solving and confidence building.
Conclusions: The MAL-ED South Africa, biomedical research project, had positive effects on tangible and intangible
assets that compose the sustainable livelihoods of community-based fieldworkers. However, the field workers
expressed the need to acquire social skills to enable them carry out their duties more efficiently.
Keywords: MAL-ED, Biomedical research, Community-based field workers, Perceptions, Sustainable livelihoods, South
Africa
* Correspondence: bessong@univen.ac.za
1
HIV/AIDS & Global Health Research Programme, School of Mathematical and
Natural Sciences, University of Venda, Private Bag X5050, Thohoyandou 0950,
South Africa
Full list of author information is available at the end of the article
© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. 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.
Moyo et al. BMC Public Health (2017) 17:267
DOI 10.1186/s12889-017-4138-6
Background
Exploring the views of various interest groups involved in
community-based projects is an integral component of
community-based participatory research, yet it is rarely
part of biomedical scientific research projects. Biomedical
researchers involved in community-based projects mainly
concentrate on advancing medical knowledge, improving
treatment, care and quality of life [1] and generally pay
minimal attention to the social aspects of their work.
Although studies have investigated the perceptions of
research participants and what drives them to be involved
in biomedical research projects [2–6], there is little infor-
mation on the effect of participating in biomedical studies
on field workers, who are the real ‘foot soldiers’ or front-
line workers. Input from field workers could inform deci-
sions about how to train workers to ensure study quality,
and could aid in planning and implementing future
research initiatives. This kind of investigation would also
reveal the effects of community-based research beyond
those of generating new knowledge. The foregoing issues
led to this study which explored the views of community-
based field workers on the effects of working on the
Etiology, Risk Factors and Interactions of Enteric Infec-
tions and Malnutrition and the Consequences for Child
Health and Development Project" (MAL-ED) South Africa
on their tangible and intangible capital that compose
sustainable livelihoods.
The Sustainable Livelihoods Framework of the Depart-
ment for International Development (DfID) of the United
Kingdom provided a way to view potential effects of the
MAL-ED South Africa study on field workers. This frame-
work outlines human, financial, physical, social and
natural capitals as five key assets and capabilities that help
people to sustain their own livelihoods [7]. According to
the framework, human capital encompasses aspects such
as skills, knowledge, good health and physical capabilities
which enable people to undertake various initiatives in
order to improve their livelihoods. Financial or economic
capital includes cash, savings, credit, economic assets, re-
mittances of all types which serve as ‘catalysts’ for realising
sustainable livelihoods. Shelter, household goods and pro-
ductive equipment constitute physical capital. Moreover,
social capital is embedded within the framework of
creating friendships, family support, partnerships and net-
works. Lastly, water, soil, air and other environmental
sources from which human life derives its existence make
up natural capital. Scholars such as [8] have added
personal assets as another crucial dimension that supple-
ments or complements the sustainable livelihoods frame-
work. Personal assets include self- esteem, self-confidence,
motivation and emotional well-being, all of which are
positive attributes of sustainable living.
Some researchers and institutions view the knowledge
that grassroots community members possess as of
insignificant value [9]. This view overlooks the potential to
access and utilise grassroots knowledge to enhance the
development, implementation and evaluation of research
initiatives. Community-based field workers play a pivotal
role in research projects, devoting time and energy to col-
lecting data in understudied areas [10]. They determine to
a large extent the success or failure of a project or
programme. The data they collect should be of good quality
and credible [11]. Understanding the opinions and perspec-
tives of the field workers could provide a more balanced
understanding of the range of effects of community-based
projects. Community participation may allow for the shar-
ing of accurate information between researchers and the
participating communities [1]. This exchange of informa-
tion could serve as a valuable empowerment tool for both
researchers and project participants [11]. Furthermore,
exchanging ideas precipitates a sense of belonging for the
study participants [1, 2] if they see themselves as active
participants and joint owners of the research process.
Investigating the perceptions of community-based field
workers when e valuating a scientific biomedical study
such as the MAL-E D project might result in a more hol-
istic understanding of community-based research and
highlight its relevance to community members. When
community members understand the purpose of the
study and its possible effect s on their livelihoods they
often become eager and willing to participate. Thus,
researchers should make concerted efforts to actively
involve persons who play a central role in community-
based projects or programmes.
The current study focused on the MAL-ED South Africa
collaborative project, which was initiated in 2009, involving
theUniversityofVenda,SouthAfrica and the University of
Virginia, United States of America. It was an observational,
prospective, community-based birth cohort study con-
ducted in the Dzimauli community of Limpopo Province in
South Africa. The study was designed to investigate the in-
teractions of enteropathogens, malnutrition, growth and
cognitive development in young children. Field workers
were recruited from the community and trained to collect
data on childhood illnesses, vaccination history, feeding
habits; and to collect biospecimens such as stool and urine,
following standard protocols governing the eight field sites
of the MAL-ED network [12].
This paper is a product of engaging the community-
based field workers so that they could share their views on
the effects of the MAL-ED South Africa project on their
sustainable livelihoods. In this paper the term ‘livelihoods’
encompasses all factors that assist in developing and enhan-
cing the capabilities of community-based fieldworkers to
enable them to enjoy basic necessities of life, including
tangible assets such as income and physical assets and
intangible assets such as skills, knowledge, social factors
and personal development.
Moyo et al. BMC Public Health (2017) 17:267 Page 2 of 11
Although community leaders were not directly in-
volved in the study, their views were also solicited in
order to find out the effects of the MAL-ED project on
the live lihoods of community members under their care.
Thus, the views of the community leaders were sought
to corroborate the findings of the in-depth individual
field workers’ interviews.
Methods
Study site
As already indicated above, the study was conducted in
Dzimauli community in Mutale Municipality between
January and February 2016. The geographical positioning
coordinates of Mutale Municipality are 22°44′13″S30°31′
34″E. It is located approximately 200 km to the north of
Polokwane, the capital city of Limpopo Province in north-
ern South Africa. The demographic, socio-economic and
health indicators of the community have been described
[12]. Briefly, Dzimauli community is made up of nine
villages, namely Bhayimora, Madadani, Mbayela, Pile,
Tshandama, Tshangwa, Thongwe, Tshapasha, and Tshib-
vumo. The community has a population of about 9 000
inhabitants of black Africans, with a female proportion of
53%. The population is of low socio-economic status, with
high levels of malnutrition [13, 14].
Research design and approach
A Case study design was employed in this current study.
A qualitative approach was used to explore the views of
the study participants regardin g the effects of the MAL-
ED South Africa project on their livelihoods. A qualita-
tive approach was considered appropriate for this study
because it provides a better understanding of the
phenomenon through directly and deeply engaging par-
ticipants. Qualitative research approaches are commonly
used to explore, interpret or obtain a ‘deeper under-
standing’ of certain aspects of human beliefs, attitudes
or behavior [15]. The purposive sampling technique, also
known as judgmental sampling, was used to select study
participants. Purposive sampling was considered ideal
for this study because all the community-based field
workers who had taken part in the MAL-ED South
Africa project were eligible to participate in the current
study. Community leaders though not directly involved
in the MAL-ED project were also purposively selected
by virtue of their being custodians of their communities
on issues such as tradition, culture, values, land and
other day to day to day activities. Furthermore, some of
them assisted in the recruitment of field workers from
the community.
Study population
As alluded to in the previous section, all the 22
community-based field workers who had participate d in
the initial phase of the MAL-ED South Africa project
(24 months of study subject follow up) and nine
Dzimauli community leaders constituted the target
population for the current study. Four of the 22 based
field workers could not be reached to be consented per-
sonally or by phone; they had relocated to other prov-
inces in search of jobs. Two field workers declined to
participate. They did not give reasons as to why they
were unwilling to participate in the study. Attempts to
obtain reasons for refusal were unsuccessful. However, it
was realized that the two individuals who declined to
participate has been let go of their duties due to unsatis-
factory performance, and this could have been the rea-
son for their refusal. Therefore, 16 field workers
consented to participate in the study. Out of the 9 com-
munity leaders, four were unavailable for the individual
interviews due to other competing engagements. With
no forthcoming proposed timeframes from them to par-
ticipate, it was considered unreasonable to continu e to
wait withou t basis. Therefore, five community leaders
were consented to participate in the study.
Data collection and analysis
In depth interview guides and focus group discussion
were chosen as the data collection methods to ensure
that there was triangulation of methods of data collec-
tion [16]. Triangulation of methods was applied to cor-
roborate an d ensure the credibility of the findings from
the in-depth individual interviews. The questions on the
interview guides were checked by other investigators,
not a ssociated with the current study, who have the rele-
vant expertise and knowledge in the area to ensure that
the questions were correctly phrased and that they cap-
tured all the information needed by the study. Further-
more, pilot testing the research instruments made it
possible to test the reliability of the research instru-
ments. Added to that, the use of an audio tape recorder
made it possible to accurately capture the participants’
views.
Face to face individual interviews were conducted with
12 community-based field workers. Four community-
based field workers who were unable to schedule face to
face sessions were interviewed telephonically. Five
community-based lea ders were also interviewed in order
to find out their perspectives on the effects of the pro-
ject on the livelihoods of field workers residing in the
community. The interview guide used was in English
and Tshivenda (the local language of the community).
Both the individual and focus group discussion were
conducted in English. The services of an interpreter
were only sought when participants preferred to use
Tshivenda instead of English.
The interview guide for the community-based field
workers contained the following questions:
Moyo et al. BMC Public Health (2017) 17:267 Page 3 of 11
What are your general views about the MAL-ED
South Africa project?
What knowledge and skills can you recall having
prior to joining the MAL-ED project?
What knowledge and skills do you believe you gained
as a result of your involvement in MAL-ED project?
How have the knowledge and skills you acquired
through your involvement in MAL-ED project
helped you?
What other skills could have helped you execute
your duties more effectively in the MAL-ED project?
What other benefits (if any) did you get as a result
of your participation in the MAL-ED project?
What did you dislike about the project?
If the project was to be repeated, wha t things would
you want changed?
If a project of this nature was to be carried out again,
would you be willing to take part in it? If yes, why?
Would you advise people to take part in the project
if it were to be repeated in your community? Give
reasons for your answer.
Has taking part in the MAL-ED project influenced
your general understanding of research? If so how?
Has your involvement in the MAL-E D project
influenced your career prospects/career? If so, in
what way?
The community leaders ’ interview guide consisted of 6
relevant questions selected from the community-based
field workers’ interview guide. The questions included
their general view of the study; benefits of the study to
community-based field workers; what they thought the
community-based field workers did not like about the
project; what they thought the community-based field
workers would like to see changed; whether they
thought the community-based field workers would be
willing to participate in future studies of this nature; and
if they would encourage community members to partici-
pate a s field workers in future projects of this nature.
Piloting of the interview guide
The research instruments were pilot-tested with 4 partici-
pants. This was done in order to gauge the time taken to
conduct each interview, clarity of the questions and ease
of understanding the questions. The participants were
given a chance to express their opinions regarding the
interview guide, whether the questions were clear, other
issues that they wanted captured in the interview guide
and whether enough time was allocated for the interview.
After the pilot testing exercise, the research instruments
were adjusted. Questions that required similar informa-
tion were grouped together and those that required clarity
were rephrased using simpler language. Also, the time
taken for the interviews was adjusted accordingly.
In-depth interviews were conducted first with the
community-based field workers and then the community
leaders. Community leaders were only involved in face
to face interviews and not in focus group discussion
because they were not the focus of the study but were
there to corroborate the findings of the community-
based field workers. Participants were made aware of the
need for both parties (interviewer and interviewee) to
maintain confidentiality regarding the information
shared during the interviews. The purpose of the in-
depth interviews was to gather individual perspe ctives,
while the focus group discussion was meant to provide a
forum as a collective in order to see if other themes
emerged. After the in-depth interviews were complete, a
focus group discussion was held. Ten field workers par-
ticipated in the focus group discussion. The othe r six
were unable to participate in the focus group discussion
because of other competing commitments. Due to the
limited number of community-based fieldworkers who
turned up for the focus group discussion, only one focus
group could be formed. The study did not use individ-
uals who were subjects of the MAL-ED proje ct itself
because the main target group of the present report was
the community-based field workers and not other s
affiliated with the project.
In the focus group discussion, one person from the
group was chosen to chair the discussion. Another par-
ticipant served as the scribe. Participants’ responses were
written on flip charts once there was consensus among
the 10 participants. An investigator of the current report
served as the moderator durin g the discussions. The
moderator’s duty was to ensure the smooth flow of the
discussion and that participants did not deviate from the
topic under discussion. After the completion of the indi-
vidual interviews and focus group discussion, data were
analysed with the Thematic Content Analysis approach
[17]. It is part of the inductive approaches derived from
the grounded theory. The process involves analysing
transcripts, identifying themes from the transcripts and
gathering together examples of those themes from the
text. The thematic content analysis was ideal for this
current study because the study involved the transcrib-
ing of data and coming up with themes which matched
the data collected. Aud io tape recorded responses were
transcribed first. All the qualitative data were then cap-
tured, coded and analysed using the ATLAS.t i version
7.5.10 software. A diagrammatic representation of the
conceptual framework of the study is shown is Fig. 1.
Results
The findings of the study whose aim was to explore the
perceptions of community-based field workers regarding
the effects of the MAL-ED South Africa project on their
sustainable livelihoods are presented here.
Moyo et al. BMC Public Health (2017) 17:267 Page 4 of 11
Demographics of study participants
Twenty-one participants out of the target population of
31 people (16 MAL-ED project field workers and 5 com-
munity leaders) participated in the study. The participants’
ages ranged from 23–42 years for project field workers,
and 52–67 years for community leaders. Of the 21 partici-
pants, nine were women. Four of the nine female partici-
pants were married and five of the 12 male participants
were also married. Three community-based field workers
had post high school diplomas and 13 had high school
diplomas as the highest academic qualification. Two com-
munity leaders had high school diplomas, while the others
did not complete high school education.
Benefits of the project as perceived by community-based
field workers and leaders
Generally, all the community- based field workers
expressed positive views on how the MAL-ED South
Africa project had improved their livelihoods. They indi-
cated that they had been empowered through accruing
enhanced knowledge and skills (human capital develop-
ment), earning more regular income than before (financial
benefits), enhanced socialisation, acquiring physical/ma-
terial assets and personal development. In addition to this,
the field workers expressed the desire to receive training
in areas such as public relations, effective communication,
problem solving and confidence building. The general
observation is that the community-based field workers,
irrespective of age or gender, expressed similar views
regarding the effects of the study on their sustainable
livelihoods. The views of the community leaders on the
effects of the study corroborated the views expressed by
the individual field workers. All these issues are described
in detail in the following sections of the paper.
Human capital
Most field workers cited acquisition of research skills and
knowledge as one of the benefits that accrued to them
due to participating in the MAL-ED project. Participants
alluded to the fact that they were now aware that
The MAL-ED South Africa project
(Longitudinal, observational, birth cohort study)
STUDY: Perceptions of community-based field workers on the effect of a biomedical
research project on their sustainable livelihoods.
(Individual in-depth interviews; focus group discussion; thematic analysis).
Tangible and intangible benefits (effects)
Effects of the MAL-ED project on community-based field
workers
MAL-ED South Africa community-based field workers
(Workers recruited from the community in which the MAL-ED study took place)
Improved knowledge and skills;
Improved financial and physical assets;
Improved social networks;
Personal development
Fig. 1 A diagrammatic representation of the conceptual framework of the study. The perspectives of community-based field workers who participated
in the MAL-ED project on the effects the project had their sustainable livelihoods were explored. All field workers were eligible for the
study, and thos e from whom consent was obtained participated in the study. Th e categories of benefits sought (tangibl e and intang ible)
of sustainable livelihoods are indicated
Moyo et al. BMC Public Health (2017) 17:267 Page 5 of 11