Evaluating the Saleem Campaign in Sudan

Introduction

The evaluation study being critically analyzed is about Female Genital Mutilation and Cutting (FGM/C, herein FGM) which is a common and pernicious practice in Sudan with a national prevalence of 87%. The authors of the study: Andrea C Johnson; Douglas Evans; Nicole Barrett; Howida Badri; Tamador Abdalla and Cody Donahue, in 2017, sought to evaluate a national campaign known as Saleem (Means ‘to be whole’) that was developed by the Government of Sudan in a bid to curb the FGM social norm in the country. They initiated an interim evaluation conducted using focus groups with a primary aim of scrutinizing viewpoints of the Saleem poster exemplars and secondary aims of comprehending about the sources of information for the participants with regards to the campaign. This critique analysis commences by providing a brief background information regarding the evaluation study, then assesses whether ethical approval was sought and the importance of that. It then centers on the appropriateness of the research designs, study sample and data collection methods and finalizes by appraising the standard of the study reporting and conclusion.

Ethical Considerations

This section has detailed the ethical considerations in the study and whether the research sought for approval. It has gone ahead to outline the importance of ethical approval and backed it up with information from other studies.

It is crucial in each study that author/s address the ethical considerations in their research. This is so that one can have knowledge about authorization of the study by the relevant review board and if the research considered the consent of participant (Connelly, 2014). The importance of approval by an Institutional Review Board (IRB) or Ethics Review Board (ERB) is to protect both human and animal subjects involved in the research and ensuring that the participation in the study was fully voluntary and not involving any coercion (Saunders et al., 2012). Informed consent, on the other hand, is critical and is usually reviewed by the IRBs. The participants are entitled to withdrawing from the research when they feel the need to (Connelly, 2014). The researchers should be entirely careful in handling vulnerable participants or cases such as the FGM which might elicit unpredictable reactions or emotions (Pistil et al., 2020).

With regards to the study being critiqued, the authors obtained a written consent from all participants and they gave them free will to drop from the research at any time, this is evident by the female group from the Blue Nile whose information was not complete, hence not included in the study bringing the total number to 71 focus groups instead of the targeted 72 focus groups. The research also passed approval by the George Washington Institutional Review Board. This proves that the information generated from the research is truthful. The study highly put into considerations the ethical issues which is good, even though it was not clear whether it sought consent from the government concerning evaluating the Saleem Campaign, which was the brainchild of the Sudanese government

The researchers also maintained high levels of confidentiality for the participants as it is very important to maintain the privacy and anonymity of their subjects (Pietila et al., 2020). There is no evidence of the use of offensive or discriminatory language during focus groups discussions as the researchers have presented direct responses from the participants.

According to Meyer (2011), the use of the Crossmark is essential in linking the study to recent information and constantly updating the article, even when downloaded, as long as there is access to internet connection. This maintains the content up to date and alerts readers of any changes made. The subject study has a Crossmark symbol at the top right of the page that will alert readers of any new information and provide additional publication record information concerning the study.

An Overview and Critique of the Research Design

The research design used in the evaluation study has been described in this section. The relation of the design with the research and its relevance have been detailed below. The strengths and weaknesses of the research design used have also been highlighted and whether a relation between the design and the aims of the study has been established.

The research design utilized in the study is a longitudinal mixed method design. A longitudinal design uses observation and does not interfere with the participants. It measures the components of the same individuals on more than one occasion (Plano et al., 2015). The main aim being to detect individual variations and change. This type of design might be costly in terms of money and time but it yields more significant information, like the cause and effect of a phenomenon, as opposed to cross sectional studies which can be performed quickly but will not provide the desired results in this case (Whittaker et al., 2015).

In a mixed method research (MMR) design, one research method greatly apprises the other. The mixed method incorporates both the qualitative and quantitative techniques in a general research study (Cohen et al., 2013). The aim for the integration is to magnify the strengths and reduce the weaknesses of both data types. An MMR enables researchers to carry out in-depth research and yield a more significant interpretation of the data and the phenomenon being assessed (Bryman, 2016). in this design, both types of data complement each other therefore it benefits various types of research, especially in health science research. The limitations to the design are that data interpretation can be sophisticated and consumes a lot of time because the interpretations are often condensed (Plano et al., 2015.).

The nature of this study was evaluation of a Campaign that seeks to eliminate FGM, therefore the utilization of the longitudinal mixed method design was suitable in this case. The researchers needed to investigate the reactions of the people who practiced FGM to the Saleem campaign that was against the practice. They used focus groups to conduct various observations and recorded information about their reactions after exposing them to the three posters stimuli over a period of time. This is a longitudinal study, and the participants were given time to elicit various reactions to the three poster stimuli presented to them. In the study, a cause-and-effect relationship is discussed whereby the subject participated in the FGM because it was a social norm and they were afraid of the social stigmatization one is subjected to if the females are not circumcised. They were aware of the effects of the FGM which include acute inflammation, difficulties in giving birth, accumulation of menstruation, among others.

The gathering of information using focus groups is a qualitative research technique. Information about the process of FGM, how and why it was practiced was obtained using the focus groups. From them, the study recorded the sources of information regarding the campaign, such as local leaders, media-based outlets and discussions. The utilization of three graphical poster stimuli from the Saleem campaign was experimental hence quantitative in nature. The three posters portrayed a common theme with different types of information and graphics that elicited various reactions from the participants. The use of the longitudinal mixed method design enabled integration of academic knowledge with knowledge from local members of the community through Focus Group Discussions. It also aligns well with the primary and secondary aims of the evaluation study which were to evaluate the perception of the participants regarding the salesman campaign and getting to underrate the main sources of information regarding the camping. This design yielded results that were sufficient to support the discussion section.

An Overview and Critique of Study Sample and Data Collection Methods

This section provides information regarding the participants of the research, their numbers and who they are with regards to the research being done. It also describes the relevance of the recruitment process of the participants by the evaluators. It goes ahead, to describe any incentives that could have been provided by the researchers to motivate them or influence the decision of participants during the collection of data.

Study Sample: Research Participants

In this evaluation study, there was a target of 72 focus groups, constituting Sudanese male and female adults, across all states in Sudan with each focus group holding approximately 5-10 individuals. The One female group from the Blue Nile was excluded due to incomplete data, bringing the total number of focus groups to 71. The total number was approximately 710 participants in the research.

A Primary Sampling Unit (PSU) was used to sample the focus group from different geographical locations and random sampling of households was done using the same. Since the evaluation was done in two stages and there was clustering, the PSU was the suitable tool to use in selecting participants (Murphy, 2008). The study did not clearly state the source of the Focus Group Moderators, but it described that they underwent training and utilized a focus group guide that had been designed by UNICEF partners and the study team. There is no knowledge of whether the Focus group Moderators were ‘friends’ of the participants or whether they were known by the community. If this is the case, then they might have influenced the decisions of the participants causing bias in the study towards yielding favorable responses.

This study utilized the four principles of social marketing: Product; price; place and promotion, and the Health Branding Theory. These were incentives incorporated to aid in promoting high reception of the campaign message by the communities. The use of incentives might have caused bias in the study as it sought to gain more favorable responses (Kajackaite & Gneezy, 2017).

Despite the use of this, there was a small percentage of the participants that still supported FGM due to the fear of social stigmatization by the community. For instance, this is a report form a mother in South Darfur:

“The idea and habit of circumcision has appeared in our society, but I will circumcise my daughter due to social stigma, because circumcision reduces sexual desire, and if the boys knew that the girl is uncircumcised they will [be] looking for her and practice adultery with her, so I will circumcised my daughter.”

The study has also utilized extra subjects in the dissemination of the themes of the Saleem camping. There is the use of local church leaders because it is stated that the people, especially women listen to them more. A participant from North Darfur, for instance reported:

“I saw a national jazz singer in a poster, wearing Saleem’s standard, I was intrigued, so I looked it out in the internet, and discovered that he and the rest of the people in the poster were Saleema’s ambassadors. Then I attended the workshop and learned more

The researchers have also utilized the local musicians and people with talent by giving them shirts that have the same color portraying the themes of the campaigns. This has enabled members of the community who are fond of musicians and people with talent to obtain knowledge about the Saleem campaign, it has also been stated that the researchers have used the internet and social media to communicate the message of the campaign but this was not widely accepted as majority of the community member lacked smart phones and access to the internet.

The youth of the community were also willing to participate in the campaign. This is a report by a youth from Gezira:

“As youth, any service you want it from us, we are ready to do it for you. We do not have any problem to offer you the help you need. We will stand together with you, for promoting the campaign, such as by advertising, and anything required from us, we will not hesitate to help together with the People's Committee.”

Though there is the utilization of diverse groups of people in the passing across of the Saleema campaign message, it is not possible to ascertain whether the message received on the other end, especially by word of mouth, was in the original form or had been distorted.

Data Collection Methods

This study utilized Focus Group Discussions (FGD) as the tool of data collection. A focus group is a tiny but geographically diverse assembly of people whose reactions are assessed pertaining a particular topic (Hennink, 2007). An FGD is a suitable approach to collecting information by assembling participants with experiences and backgrounds that are similar in order to deliberate on a subject of particular interest. The groups are usually led by focus group moderators who might be familiar or unfamiliar to the participants (Colucci, 2007). These moderators help the participants in comprehending the topic for discussion and enables an active participation of the group members. FGDs are suitable in evaluating the meanings of research findings that cannot be extrapolated sing statistics (Hennink, 2007)

The study allowed the participants to express their points of views freely using the FGD, they were able to support the theme of the Saleem campaign while others openly disagreed with it. This provided a broader understanding about how the Sudanese adults felt regarding the campaign. Since the study was closing the gap between policy and research, the focus groups yielded an understanding into vast views among the parties supporting the elimination of the FGM and those opposing the elimination of the same. This will enable the process of change in the communities to be undertaken with limited difficulties

The advantage of using Focus group methods allows for various approaches of gathering information from consumers without using a survey. Survey instruments tend to be viewed as scientific, especially when they yield results that are quantitative in nature. Surveys may be over utilized by those who do not possess the confidence in alternative market research strategies.

The aim of the focus group in this study was not to reach have unanimity, a certain degree of agreement, or to decide what action to do pertaining a particular thing. The researchers developed these Focus groups to understand and recognize the feelings, views, and thoughts of the participants with regards to a certain subject, commodity, or solution. The various reactions of the focus group participants are evident whereby this was reported by an individual from the Red Sea regarding the themes of the three posters stimuli:

“The ones in blacks were either didn’t hear about Saleem or they are afraid” and conversely in East Darfur, “The people who are wearing the campaign’s logo are convinced of the campaign’s theme.”

Focus groups are very important because they use qualitative data collection methods. Just like in a real-life situation, the subjects have the ability to interact, influence, and be influenced.

This study utilized various people to pass the campaign message over to the community members. It is a possibility that the message might have been altered to suit the interest of an individual with the aim of creating bias in the results of the study.

Evaluation Study Reporting Standard

This section provides details of whether the study achieved a good or poor standard of reporting. It seeks to evaluate the claims of the researchers regarding comments on the findings, whether they provide a connection between the data collection methods and the relevant themes and if they have clearly outlined the limitations experienced during the evaluation of the study. The section has also explained whether the researchers provided an appendix section with materials that backed up the findings from the survey conducted.

This evaluation study has attained a good standard of reporting. This is evident in how the report has been divided into various sections that have fully discussed the research study design used, the tools of data collection and the methods of analysis utilized in the study. Each section has been well expounded on using simple and clear language that the readers can understand. The results section presented the data in both tabulated and explained formats. Data analysis was explained including coding of the themes from the Saleem campaign posters stimuli. The feedback from the focus group discussions was mainly displayed as direct speech and was comprehendible. An example from the suggestions elicited by one of the participants in Gezira is:

“It is important to keep this project going on and you can choose four young women and four young men from this locality to be the focal points, with whom you can continue the communications, they raise our concerns and you give them ideas to convey, and to provide them with the posters to distribute

The discussion part of the study has provided room for the researchers to link the results obtained from the focus groups to the relevance of the evaluation. They have explicitly commented on the results and connected the methods of data collection right from the beginning of the study to the end. The suggestions of the participants have been well summarized and the limitations of the study have been outlined. Providing the limitations faced during a research is critical for readers to view the results in the context of the limitations. The study has also outlined appendix materials including addressing the issue of ethical considerations and links of additional files used in the three poster stimuli. A reference list has also been provided to show that the research gained more information from previous work and the researchers are acknowledging the work of other authors.

Conclusion

This critique analysis began by providing a background information of the study of interest and addressing the ethical considerations. The study highly put into considerations the ethical issues which is good, even though it was not clear whether it sought consent from the government concerning evaluating the Saleem Campaign, which was the brainchild of the Sudanese government. The research design used was suitable for the particular research and the results obtained were analyzed and presented in an orderly, simple and clear manner. The utilization of Focus Group Discussions was deemed fit given the vast demography of the Sudan republic, the researchers however failed to state the source of the Focus Group Facilitators leaving the readers with questions of whether they influenced the decisions of the participants. The researchers also gave incentives inform of advertisement through the social media and musical bands. Their main aim, by doing this, was to ensure very member of the community got information about the campaign, but this does not eliminate the fact that the incentives might have interfered with the decisions of the participants causing a bias in the study. The results were analyzed and disused in a simple and transparent manner and suggestions from the participants also brought forward. The reporting standard was good ;this will enable the government of the Republic of Sudan and future researchers to incorporate the suggestions in future projects.

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