Critical Reflections on Conducting Qualitative Health Research During COVID-19: The Lived Experiences of a Cohort of Postgraduate Students in a South African University.

COVID-19 ushered in public health guidelines restricting face-to-face contact and movement, and encouraging social distancing, all of which had implications for conducting field-based research during the pandemic. For qualitative researchers, this meant adapting conventional face-to-face methods and resorting to virtual variations of the same in adherence to stipulated COVID-19 health protocols. Virtual qualitative research introduced new concerns and logistical challenges. This paper presents critical reflections on experiences of conducting qualitative research during the pandemic, from the perspectives of a cohort of postgraduate fellows. A critical reflection framework was utilised to explore fellows experiences and meanings ascribed to their experiences. The research findings illustrate three overarching processes which, in turn, shaped ways of thinking, doing and being. First, explicating tacit assumptions about their anticipated research journeys and interrogating these. Second, shifts in power differentials demonstrated by role reversal between researchers and participants, and between fellows and supervisors as they re-negotiated their positionalities in virtual research spaces. Third, context specific sense-making, in which - narrative accounts support the notion of knowledge as a social construct. Our findings have important implications for qualitative research practice. Our study documents methodological nuances and social implications of conducting qualitative research during COVID-19 and in a-South African context. In addition, our study exemplifies the use of critical reflection in qualitative research practice in the specific context of postgraduate academic research. Further, our study illustrates how the use of technology shapes qualitative research protocol development, data collection and analysis phases.

Structural violence in South African primary healthcare facilities: insights from discussions with adolescents and young people seeking sexual and reproductive health needs.

INTRODUCTION: South Africa has an enabling legislative and policy framework that promotes the protection of adolescents and young people's sexual and reproductive health and rights. Much of the literature in this field has identified discriminatory and hostile attitudes from healthcare workers as a major underlying factor to negative sexual and reproductive health outcomes for this age cohort. Not as well understood is the role of structural violence although this type of violence, through its structures of injustice and inequalities, is closely associated with stigma and discrimination. DATA AND SOURCES: To contribute to closing this research gap, this paper draws on the findings of a larger qualitative study, specifically focus group discussions with young people aged 15-24 years. RESULTS: The consequences of these attitudes within the structural violence framework are illuminated as are recommendations for enhancing access to sexual and reproductive health and services by adolescents and young people. DISCUSSION AND CONCLUSION: Key among the latter is that young people's sexual and reproductive health needs and wellbeing should be pursued through a multisectoral approach that encompasses stigma reduction interventions involving the young people, families, and communities collaborating with healthcare workers.

Mobile sexual health services for adolescents: investigating the acceptability of youth-directed mobile clinic services in Cape Town, South Africa.

BACKGROUND: The Human Immunodeficiency Virus (HIV) epidemic is growing rapidly among South African adolescents and young adults (AYA). Although HIV counselling and testing, HIV prevention and treatment options are widely available, many AYA delay health-seeking until illness occurs, demonstrating a need for youth responsive, integrated sexual and reproductive health services (SRHS). While feasibility and cost-effectiveness have been evaluated, acceptability of mobile clinics among AYA has yet to be established. The objective of this study was to investigate patient acceptability of mobile AYA SRHS and compare mobile clinic usage and HIV outcomes with nearby conventional clinics. METHODS: Patients presenting to a mobile clinic in Cape Town were invited to participate in an acceptability study of a mobile clinic after using the service. A trained researcher administered an acceptability questionnaire. Mobile clinic medical records during the study period were compared with the records of AYA attending four clinics in the same community. RESULTS: Three hundred three enrolled participants (16-24 years, 246 (81.2%) female) rated mobile AYA SRHS acceptability highly (median = 4,6 out of 5), with 90% rating their experience as better or much better than conventional clinics. The mobile clinic, compared to conventional clinics, attracted more men (26% v 13%, p < 0,000), younger patients (18 v 19 years, p < 0,000), and yielded more HIV diagnoses (4% v 2%, p < 0,000). CONCLUSIONS: Given the high ratings of acceptability, and the preference for mobile clinics over conventional primary health clinics, the scalability of mobile clinics should be investigated as part of a multipronged approach to improve the uptake of SRHS diagnostic, prevention and treatment options for AYA.