Vol XI: Evidence for employing post-secondary educated youth as research assistants in global health disability research

Shaun Cleaver¹, Malambo Lastford Miyanda², Patra Likonge Kapolesa³, Lynn Akufuna Nalikena⁴

¹Faculty lecturer, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada

²Project Manager, Relief and Development Department, People In Need Zambia, Lusaka, Zambia

³Development coordinator, Care International Zambia, Lusaka, Zambia

⁴Coordinator, Disability Research in Zambia Knowledge Translation Project, Mongu, Zambia

Featured image shows authors PLK, LAN and MLM. Taken by SC.

This paper presents a participatory qualitative case review of the employment of post-secondary educated assistants in a global health research program. The research program was initiated by a visiting Canadian researcher who was a supervised principal investigator exploring disability in Western Zambia. This research was supported by eight paid Zambian research assistants (RAs), three of whom participated in the case review. The case review was informed by a dialogue in which participants identified and shared their perspectives regarding the effects of the employment of RAs in the program. The perspectives of the RAs about the effects of their employment were identified as two themes: professional skill acquisition and increased quality of life. The perspectives of the visiting researcher regarding the effects of the RA employment were identified as four themes: increased productivity, access to skills, increased integration in the community, and continuity. From the collective perspective of all co-authors, the employment of RAs made this research program more productive, rigorous, and equitable while also creating opportunities for Zambian youth. The co-authors recommend that global health researchers consider employing post-secondary educated RAs and engage in a wider dialogue about expanding and improving this arrangement. These perspectives and recommendations have been generated according to a radical, participatory action, research tradition that should be taken into account as other members of the global health community assess this evidence to inform their own activities.

Introduction

In the scientific literature there has been little discussion of the involvement of research assistants in global health research. Kingori and Gerrets (1) offer a rare example of an article that focuses on research assistants through a critical analysis of research practices in global health contexts. It is possible that research assistants are considered more frequently as a peripheral topic, for example, as one among others in a discussion about North-South collegiality (2) or in literature that is not identified as part of the global health field (3). With global health research often conducted internationally and cross-culturally, it could be expected that global health researchers would reflect upon their relationships to research assistants as have researcher colleagues in other fields. For example, members of the anthropology community have long been aware of their discipline’s history of white male ethnographers from imperial powers relying upon the contributions of racialized research assistants (4), contributions that have been largely unrecognized in the ethnographic publications (5). In social science research about the situation of refugees, there has been critical reflections about the development of a research economy premised on the exploitation of assistants (6). Certainly, the lack of attention paid to research assistants in publications is one reason to explore the involvement of these important contributors to science.

Regardless of the state of the literature, the incentive to write this paper came not from publications but from lived experience. The idea was initially conceived by an early career global health researcher (Shaun Cleaver [SC]), reflecting back to his experiences over a period of five years, during which he was a visitor in Zambia and the principal investigator leading a research program. The substance of the paper was developed collectively by the small group of colleagues, with the visiting researcher collaborating with the three most highly involved research assistants (Patra Kapolesa [PLK], Akufuna Nalikena [LAN], and Malambo Lastford [MLM]). The collaboration to produce this paper allowed the co-authors to unpack their experiences as individuals and collectively through a case review of the employment of post-secondary educated research assistants in the research program. The collaboration helped to address a gap in the research process: while the visiting researcher was supported by senior colleagues to review the dynamics of interacting with research participants (7), there was no similar process to support a review of the dynamics of interacting with the project’s research assistants.

The aim of this paper is to explore a collective experience (the paid employment of post-secondary educated research assistants in a global health research program), situate this experience into a wider context, and engage in dialogue with others in potentially similar circumstances. This paper is written by a small group of colleagues who are reviewing their own experiences as a case. For the purposes of this paper, research assistant is defined intuitively, as a paid member of the research team who assists with the implementation of a research project that has already been conceptualized and proposed.

Background: The research program

The research program to which the assistants were employed was conducted primarily in Zambia’s Western Province. Western Province is one of ten provinces in Zambia, geographically isolated from Zambia’s industrial central areas by the Kafue National Park. There are no major airports or rail lines in the province and the road access connecting the province to other parts of the country is poor: the two nominally tarred roads that cross provincial boundaries have significant stretches that have degraded to dirt tracks. Western Province is inhabited by approximately 900,000 people, with the majority living in rural areas. Among Zambia’s ten provinces, Western is consistently ranked among the top three for prevalence of both poverty and disability (8-10). The research program was conducted primarily in two communities of Western Province, one in a rural area of the outlying Kalabo District, another in a semi-urban area outside of Mongu, the province’s largest city.

The research program comprised three phases:

• an initial research project,
• a community development initiative (informed by the initial project), and
• a second research project.

The engagement of research assistants was priority of the research program even though the constituent projects had relatively small funding envelopes (C$60,000 and C$15,000, respectively, for the two research projects). The expenses of the second research project were greater than the funding envelope; the visiting researcher covered the funding shortfall from his personal resources. The visiting researcher also self-funded the community development initiative.

The first research project (2014-2016) was conducted as part of the visiting researcher’s doctoral dissertation to better understand the lived experience of disability in Zambia’s Western Province. Data collection for this research included 39 individual interviews and 8 focus group discussions with a total of 81 disability group members in the two communities (11).

The community development initiative that followed the first project (2017) entailed problem-solving discussions with disability group members in the two communities that resulted in the research team facilitating communication with government officials and providing a business development grant (12).

The second research project (2018-2019) was a component of the visiting researcher’s postdoctoral fellowship to explore the effects of Zambian disability policies at the community level. Data collection for this research included interviews with 51 persons with disabilities (or proxy respondent family members) in the two communities.

Post-secondary-educated research assistants were incorporated into the research program from the inception. Over the course of the five years of the global health research program, a total of eight research assistants were employed in Western Province. An additional two assistants were employed to support the program in Zambia’s capital, Lusaka. The Lusaka-based assistants played different roles, and were mostly independent, from the team in Western Province.

At the time of hiring, all research assistants were youth in their 20s and had completed high school and some post-secondary education (either trades college or some university). All assistants had either little or no research experience prior to joining the project; the assistants were trained by the visiting researcher, as part of their work hours, through a training program that he devised.

Five research assistants were employed in 2014, during the data collection phase of the first research project. Three of the initial five assistants were re-hired in subsequent phases of the research program. An additional three assistants were employed in 2018 to support the second research project. The three research assistants who joined the program in 2014 and have remained engaged since that time are the research assistant co-authors of this paper.

Purpose

The purpose of this case review is to explore the effects of the involvement of post-secondary research assistants in a research program, from the perspectives of four individuals involved with that research program.

Methods

We were inspired to pursue this inquiry by an ethnographer and his long-time research assistant who reflected about their relationship and their work through a series of recorded reflective conversations (13). Adapting this methodological inspiration for a different arrangement (of a researcher who had hired multiple assistants in varied roles), we opted to conduct a case review, guided by participatory action research (PAR) approaches (14, 15) and structured using a qualitative research design (16).

It is important to understand certain characteristics of PAR approaches. The core principles of PAR are presented through its name: these approaches are collaborative (participatory), oriented towards practical purposes (action), pursued through a methodical process of study (research). In effect, PAR approaches distinguish themselves from “conventional research approaches” by their fundamental commitment to a democratic process of generating locally-relevant knowledge. According to PAR thought leaders Kemmis and McTaggart (14), “At its best…[PAR] is a social process of collaborative learning realized by groups of people who join together in changing the practices through with they interact in a shared social world (p. 563).”

By definition, PAR approaches entail a blurring of boundaries between researchers and participants. These blurred boundaries intentionally challenge the social arrangements of conventional research, where there are people who are knowledgeable in research and responsible for conducting the study (the researchers) and others who are being researched (the participants or subjects). Nonetheless, in some research projects informed by PAR approaches, it could be appropriate to have an arrangement that approximates these conventional approaches. One example of a more conventional arrangement would be a study team composed of university-affiliated and community-member researchers who conduct research on fellow community members. According to a more radical use of  PAR approaches, as used in this case review, the boundaries between the researchers and the researched are eliminated, such that, “All the stakeholders are identified … [and] … are involved fully in all aspects of the research process as co-researchers” (15, p. 492).

For this case review of a research program guided by PAR approaches, the stakeholders are the three research assistants involved since 2014 (PLK, LAN, and MLM) and the visiting researcher (SC). Given the specifics of the PAR approach used, these four people are simultaneously the co-researchers and the research participants. The research program is the shared social world in which the case review is exploring the effects of research assistant involvement.

The data for this review were generated in an open dialogue between the four co-authors. This dialogue was of six hours’ duration conducted over a two-day period, initiated with the question: “What were the effects of research assistant involvement in this research program?” Participants initially reflected on this question from their own perspective, with each individual identifying processes and consequences that were personally meaningful. Participants described their individual perspectives in writing and then shared these orally.

In sharing perspectives, it became apparent that the three research assistants had identified similar ideas. Meanwhile, the visiting researcher’s perspectives were notably distinct from those of the research assistants. All co-authors subsequently discussed the initial perspectives of the research assistants to explore whether these perspectives could be further developed into themes that effectively represented the collective. The researcher’s perspectives were refined through discussion with all authors, reformatting the researcher’s reflections to into themes, each with its own description.

All authors collaborated on the development of a PowerPoint presentation, including a video of the research assistants each sharing their individual perspective on the effects of their involvement with the research program. The visiting researcher first drafted this paper before circulating it to the research assistants for further dialogue, which was used to refine the paper’s contents. The contents were then presented at the “Capacity Building in Global Health Rehabilitation” symposium in May 2019, further refined, and then once again reviewed by the research assistants.

Results

Through discussion, the perspectives of authors were most coherently organized according to their position in the research program: as research assistants and as visiting researcher. From the perspectives of the research assistants, the effects of their involvement could be presented as themes of professional skill acquisition and an increased quality of life. From the perspective of the visiting researcher, the effects of the involvement of research assistants were productivity, access to skills, increased community integration, and continuity (see Figure 1).

Figure 1: Overview of perspectives

Perspectives of research assistants

Collective discussion of the individual research assistant perspectives on participation in this research program produced two major themes: professional skill acquisition and increased quality of life. The two themes were not entirely distinct; in some regards, the professional skill acquisition contributed to the increased quality of life.

Professional skill acquisition: The research assistants’ perspectives of this theme included skills that were more directly focused on research and those that were more widely transferable.

In discussing the direct research skills, the research assistants expressed pride in having learned about research methods, data collection, transcription, and data management. To some extent, the research assistants were able to directly apply the research skills that they acquired; MLM and LAN first started working in the research program as undergraduate students and used these skills in the honours theses that they had to complete as requirements for their programs. In PLK’s subsequent employment commitments, she was responsible for data collection as part of needs assessments and program evaluation activities.

With regards to more widely transferable skills, the research assistants cited the skills they acquired through interacting with communities, particularly with respect to communication activities like public speaking, event coordination, and informal information gathering. Also, in relation to community interaction, the research assistants identified community development skills, such as the practice of identifying potential activities to be conducted with communities then selecting, designing, and implementing these activities. Finally, the research assistants cited computer and writing skills, with each having engaged in different activities of creating or assessing written online content.

Increased quality of life: the research assistants noted the way that their participation in, and income gained from, working in this program improved their quality of life.

Through their participation in this program, the research assistants had come to be better critical thinkers. When the visiting researcher probed the research assistants about the way that critical thinking contributed to better quality of life, the research assistants responded that this element was fundamental; they had become better people, more confident and able to substantiate ideas and defend these ideas when necessary. The research assistants also felt that they were able to better interact with Zambians with disabilities. For the research assistants, this ability to interact was premised upon improved understanding, but it was not a skill; instead, it was a way to be a more active member of an inclusive community. The research assistants also identified the friendships that they had developed with each other through their shared roles as research assistants. Although MLM and LAN knew each other as fellow students at a small university, they only became friends while working for the program. PLK did not know any of the others prior to joining the team but was now friends with them.

The money earned through this employment was important to the research assistants. This money allowed them to pay off important bills (like outstanding tuition) and make important purchases. LAN shared that she had used income from this project to “start a business.”[1] The research assistants primarily referenced the income earned directly through the project, but PLK and MLM also mentioned how the experience, skills, and letter of recommendation also helped secure subsequent employment – which was important for providing income, especially during the periods when there was no research program fieldwork.

Perspective of the visiting researcher

For the visiting researcher, there were four primary effects of engaging paid post-secondary educated research assistants in the global health research program. These effects were 1) increased productivity, 2) access to skills, 3) increased integration in the community, and 4) continuity.

Productivity: A large part of the research assistants’ working time was devoted to transcription, a task that could have generally been performed by the visiting researcher. However, the delegation of this task to paid research assistants meant that the researcher was instead available to engage in other tasks, completing more work in the process. With time, the research assistants were able to take increasing responsibilities. In the second project cycle of this research program, two research assistants identified and recruited research participants in the community while the researcher was elsewhere.

Access to skills: The research assistants brought to the program necessary skills, particularly those related to local languages, to logistical planning, and to cultural norms. Since PLK and LAN are native speakers of the Lozi language, they translated at community meetings and data collection activities. All research assistants were proficient in Lozi, with most of them as native speakers and a minority having gained proficiency as adults. These skills permitted a complex transcription system where speech in all auditory languages was transcribed and misunderstandings of translation could be accounted for in the data analysis phase. The research assistants also conducted much of the travel and event planning (e.g., developing a menu for lunch during focused group discussions and purchasing food), tasks for which the research assistants were far more capable than was the visiting researcher. In addition, the research assistants guided the visiting researcher to identify and respect local norms and expectations. This guidance was crucial for the visiting researcher to communicate clearly in community interactions and to better understand when community members were expressing thoughts and ideas that held deeper meanings than could be discerned through the literal translation of their spoken words.

Increased community integration: The visiting researcher and the research assistants engaged with the communities as a team. By engaging in this way, it was possible for team members to “compare notes,” with either individual perspectives of the same interactions or perspectives of different interactions. The team approach meant that the researchers were collectively better informed of the details of community life and able to integrate within it more fully. Moreover, by employing multiple research assistants, the program office was predominantly occupied by Zambians, outnumbering the visiting researcher and allowing him to participate in social environment that was “more local.”

Continuity: The visiting researcher was not in Western Province on a full-time basis. When away (either elsewhere in the country or abroad), the research assistants would visit the communities where the research was conducted for updates on recent happenings. These timely updates allowed for better continuity in the team’s engagement with the communities than would have been possible if interactions were limited to the times when the visiting researcher was present.

Discussion

This case review allowed four colleagues to unpack the details of individual and collective experience in global health disability research. As a visiting researcher, SC approached the employment of post-secondary research assistants without formal support; the case review was therefore his first opportunity to systematically review the processes and consequences of employing research assistants. Although the team had debriefed specific project activities on numerous occasions, this case review was the first opportunity for the research assistants to discuss their overall perspectives on employment in the research program.

As a participatory action research activity, we authors were committed to an action emphasis (14), to use the results of this review to inform ongoing activities. Translating the knowledge generated from the review will be an internal process composed of ongoing discussions and decisions based upon an improved shared awareness of the effects of the involvement of research assistants in the research program thus far. For the purposes of this paper, we emphasize an alternative process, one that places our experiences in a larger context and stimulates dialogue with colleagues external to the research team.

Our impression of our own perspectives is that these are best organized into two primary realms: global health research integrity and youth opportunity. In this discussion section, we will also reflect upon the “additional consideration” of power dynamics, a realm that emerged from feedback offered by participants at the Capacity Building in Global Health Rehabilitation symposium.

Research assistants to promote global health research integrity

We see the contribution of post-secondary educated research assistants as having promoted the integrity of the research by enhancing the rigour of the research projects and by allowing these projects to better respond to global health research principles that revolve around equity. The rigour of the research projects was enhanced through the increased productivity and the skills that the assistants contributed to the research. It should be noted that the skills that were contributed were not advanced research skills. On the contrary, the assistants effectively began their commitments without previous training, instead bringing energy, ambition, and most essentially, perspective that grounded the research in the local context. Whereas the contribution of research assistants to global health research could be important, there is little evidence of this in the literature. It should be acknowledged that some publications that report these contributions might not be identified as global health research (3).

With respect to equity-inspired global health research principles, the involvement of assistants in this research program addressed aspects of the six principles identified by the Canadian Coalition for Global Health Research (17): authentic partnerships, inclusion, shared benefits, a commitment to the future, responsiveness to causes of inequities, and humility. We should be clear that employing research assistants should not be considered sufficient to address the principles. Nonetheless, the inclusion of the assistants, their significant contributions to the program, the sharing of benefits including money and skills, and frequent deference of the researcher to their perspectives are characteristics that are consistent with the principles.

In this case review, we did not assess the costs of employing the research assistants (i.e., the actual money and visiting researcher’s time that was invested to pay and train the research assistants); nor did we assess the concordant consideration opportunity costs (i.e., the alternative uses of that money and time). Our sense is that the employment of research assistants was of tremendous value, likely outweighing costs by a significant margin. In the case that a cost-benefit analysis of this arrangement was investigated, we think that it is important to consider more than the benefits to the integrity of global health research, it should also consider the significant benefits accrued by the research assistants, their families, and their communities through their skill acquisition and improved quality of life, inclusive of the infusion and circulation of money into the local economy.

Youth opportunity

It seems to us that demographic and economic trends are having important effects on the opportunities available to youth. In particular we note the increasing availability of education for youth without a concordant increase in available employment positions. The resultant dynamic is one of diminishing returns for youth, where uncertain access to employment is dependent upon elusive levels of education (18). In Zambia, the imperative for youth to pursue education has spawned a proliferation of private institutions, many of which charge expensive tuition fees (19, 20). Although the benefits of higher education are more than just employment opportunities, it must be recognized that the tuition costs could mean that youth and their families are making large, high-risk investments.

We are more familiar with the realities of Zambia but under the impression that the phenomenon of youth being squeezed from economic opportunities is globally widespread. With automation, the deterioration of workers’ rights in many jurisdictions, the rise of the “gig economy,” and older workers remaining in the workforce, there is reason to believe that the situation in Zambia is not isolated.

It is apparent that the creation of youth employment through global health research assistant roles is insufficient to address the economic disjuncture faced by youth. Nonetheless, we do see it as a small way in which researchers (with funding) can make a small contribution – and hopefully become more generally enlightened with this economic disjuncture in the process. Often, global health research is conducted in areas that are especially deprived of youth opportunity. For this reason, global health researchers might be better placed to make an impact than their academic colleagues in other fields.

We would like to draw upon some aspects of our experience to inform researchers’ perspectives about the nature of the opportunities that could be offered to post-secondary educated youth. Of the three research assistant co-authors of this paper, none had seriously considered a career in research prior to joining the team. Despite overwhelmingly positive experiences working as research assistants, research is still not the primary career plan of any of the three. To any global health researchers who think that the main benefit of employing post-secondary research assistants ought to be the development of a next wave of global health researchers, we would like to propose that our perspectives have shown us that there are important positive benefits besides that of a career in research. In particular, we adamantly reject the notion that research experience and networking should be considered a form of compensation for research assistants that could be “cashed in” when the assistants become researchers.

Additional consideration: Power dynamics

During the interactive dialogue, neither the visiting researcher nor the research assistants discussed power dynamics that were at play in the collaborative relationship. Given that the research projects were informed by critical perspectives (e.g., Eakin et al.’s Critical Social Science Perspective (21)) the role of power in social relations was of consistent interest in the research itself. With this ongoing interest, it is remarkable that team members did not raise the topic of power dynamics in the interactive dialogue.

It is possible that power dynamics did not emerge because the dialogue was stimulated by a question about the effects of the research assistants’ involvement, a question for which “power dynamics” would have been an unlikely answer unless the power differential was particularly prominent (see Sukarieh and Tannock (6) for an example). One could imagine that power dynamics would have been a more likely a topic of discussion if the dialogue was instead about the internal characteristics of the research team.

The absence of discussion on power dynamics does not mean that these are not relevant. Ethnographers performing extensive international fieldwork have taken note that publications by their colleagues rarely mention research assistants despite ethnographers’ frequent reliance on research assistants (5). It is almost as if research assistants have been “written out” of the final record of the research. There could be multiple explanations behind the overlooking of research assistant involvement – which seems to also be a phenomenon in global health. Possible explanations include institutional expectations around productivity, ownership and authorship (22), the notion that research assistants’ contributions make visible the deficits of researchers (5), the positioning of research assistants as implementers of projects rather than innovators (3) and even more nefarious dynamics like academic racism-colonialism (4) or research cultures of exploitation (6).

All co-authors had a positive impression of the effects of assistants on this research program. The fact that power dynamics were not mentioned during the interactive dialogue may indicate that this was not a situation where unequal or unethical power dynamics were rampant. Nonetheless, in this situation, the visiting researcher had ultimate control over project resources while simultaneously benefitting from the social privilege of being a white foreigner (7). Meanwhile, the research assistants could have held certain forms of power: beyond their essential contributions to the program, they were also in advantaged positions in local communication, culture, and institutions. Despite not being mentioned in the dialogue, the issue of power dynamics within this research team is certainly a topic worthy of further investigation.

Strengths, limitations, and implications

In having been guided by PAR approaches (14, 15) which can be considered to be part of a radical research tradition (23), this case review has generated knowledge that is contextually specific and of immediate practical relevance. These characteristics are important strengths of this case review. With its commitment to the radical research tradition, this case review will necessarily seem limited for readers who have commitments to the positivist research traditions (23) that predominate in biomedicine and privilege experimental study designs, measurement, and objectivity. While the primary implications of this case review are local, that is to say within the research team, we think that other global health researchers can draw upon the processes, findings, and contextual considerations of this inquiry in order to inform their own work.

In suggesting that other researchers draw upon this inquiry, we are cognizant of a crucial contextual consideration that could distinguish this global health research program from many others: SC’s positionality as an early career researcher with small project budgets and significant time spent “in the field.” We therefore recognize that the research program that inspired the inquiry also informed a particular framing of a global health researcher within the inquiry. Examples of contrasting framings of global health researchers come to mind when thinking of global health research initiated through international partnerships of established researchers from abroad and within the country where the research occurs (24). With this international partnership model of global health research, the project budgets are often larger, the investigators are often less likely to spend significant time in the field, and research assistants are often an expected part of project implementation regardless as to whether they have a close relationship to the researchers. We acknowledge that this inquiry could be less directly applicable to researchers whose approaches differ significantly from the research program initiated by SC.

Conclusion

Through this case review of the employment of post-secondary-educated research assistants in a global health research program, we recommend that global health researchers consider this arrangement. We justify this recommendation through ethical, pragmatic, and intellectual evidence: we have reason to believe that this strategy is a small-scale intervention to economically support youth and leads to more equitable, voluminous, and rigorous global health research. We hope to be part of a discussion about the ways that this arrangement can be optimized and considered alongside other strategies that could also lead to the positive outcomes that we are promoting.

–

[1] In Zambian ways of speaking, the term “business” is used more widely than in many high-income English-speaking countries. Although “a business” could refer to a formal enterprise with significant revenue, this is an exceptional use. More commonly, when talking of a business, Zambians are referring to informal enterprises that individuals pursue with for purposes of supplementing income, of re-investing small sums of resources to delay their depletion, or of earning a meagre income when there are no other options. Common businesses in Zambia include selling foodstuffs from a small stand and individually re-selling items that were purchased in bulk.

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