A Reality Check Approach

We have recently come across The Reality Check Approach (RCA) is a qualitative research approach involving RCA-trained researchers living with people in their own homes and sharing in their everyday lives. The intention is to have unmediated conversations, observations, and experiences with people (in their own space and time) as they go about their daily lives. This is great and actually, it’s amazing really that research is done in any other way! It resonates so much with us as our approach is also all about bringing the conversation about improvements to child health, not just to families, but to the children themselves. We like this list of what is described by the RCA as ‘research tools’ – which could as well be the tools we use to work with local teachers. They use these tools in the discussions they have with children to identify health issues, causes, and possible interventions.
  • Informal conversations – ‘one-on-one’ and group conversations
  • Facilitating debates – triggering informal gatherings to discuss an issue
  • Listening
  • Naturalistic observation (of context and practice)
  • Experiencing daily life by being experiential, directly participating in chores, activities, social and cultural life
  • Following up on conversations with visits to facilities, services and places talked about in conversations
  • Using visuals (photos, drawings, charts, maps) to aid conversation and promote discussion
There are numerous examples of the application of the RCA methods and one that caught our eye was done in Ghana and around Adolescents’ Views on Sexual and Reproductive Health in Ghana’s Brong Ahafo Region. This Reality Check Approach (RCA) Study was undertaken during July-September, 2015 to provide insights into adolescents’ perceptions, attitudes and behaviours around sexual and reproductive health (SRH), based on the perceptions of adolescents themselves. Key findings include:
  • Sexual activity among youth: Sexual activity in BAR is high and starts in early teens. Youth are very open to talking about sexual issues and there is no basis to suggest that talking about sex will encourage increased sexual activity.
  • Age of consent and messaging about safer sex: Clear information which is neither advisory nor moralizing needs to be provided on risks of early sexual activity, the need for safer sex and contraception, informed choice for induced abortion.
  • Reducing the financial motive for transactional sex: Innovations such as education loans targeted to particular times in the education calendar may obviate the need for girls to engage in sex for money and other support.
  • Information on correct use of contraceptives key: Contraceptive access is easy (and mostly through drugstores and dispensers) although knowledge of how they work may be sketchy especially among younger middle class. Contraceptives are used primarily to avoid unwanted pregnancies.
  • Information about STIs lacking: Generally, there was very poor understanding of STI infection routes, prevention, cure or long term consequences (especially among the middle class youth). This should be addressed with clear factual information. Even though readily available, condom use is low mainly because it is still perceived as diminishing pleasure. Use of condoms are not seen generally as a means to protect against STIs.
  • Information, advice and assistance for safe abortion: Unwanted pregnancies are prevalent across locations, and induced abortions are commonly sought. Most youth are not aware that induced abortion is legal under certain circumstance under Ghanaian Law; this lack of awareness inevitably results in unsafe practices. This suggests that there is a need to provide information about induced abortion choices, assessment of risks associated with unsafe abortion and abortion counselling services
  • Emphasise the costs of raising children and youth lifestyle in delaying pregnancy: The desire for small families and recognition of the costs of bringing up children can be capitalized on to promote contraceptive use, as well as promoting youth as a time to be cool and have fun.
  • Using the internet and popular television for adolescent SRH messages Information sourced online or through television is most trusted. Access to internet and social media is increasing and should probably be the mainstay of information dissemination. Advertisements and popular television dramas which incorporate factual information for young people to make their own choices are likely to be effective
  • Peer to peer support and education processes which emphasise informality and street credibility: Information needs to be promoted through peers or through informal means in the youths’ own spaces. Religious and traditional leaders are not regarded as sources of information although they may help in some personal crises. Where information is provided in formal settings or in the form of advice or with implied judgement it is unlikely to be valued or accessed. Posters, billboards, or other printed material such as calendars are largely unnoticed by the young. .
  • Emphasise youth friendly facilitation and approachability rather than fixed centres for youth friendly services: Gossip and stigma are widespread and prevent young people from seeking formal service provision where they might be seen by others or have to queue/wait for services. For services to be ‘youth friendly’, providers will need to reach out to youth in their own private environments and through other private means, such as online or through mobile phone technology.