The role of clinical vignettes in rapid ethnographic research: A folk taxonomy of diarrhoea in Thailand

Abstract

This paper presents the findings of a rapid ethnographic research methodology used to investigate the beliefs and practices of rural mothers and grandmothers concerning diarrhoeal diseases in children under five years of age in Khon Kaen Province, Northeast Thailand. The multi-phase study used a combination of focus groups and clinical vignettes, semi-formal questionnaires and open-ended interviews. The efficiency of the combination of focus groups and clinical vignettes in obtaining an understanding of the important areas of belief in a short period of time is discussed, as well as the importance of quantifying and validating this information using other methodologies. A folk taxonomy of diarrhoea and its management is presented, and the implications of this for health planners is discussed. Most diarrhoea in children under one year is perceived to be su, a normal developmental stage which requires no treatment. As su is not considered to be diarrhoea, health messages concerning diarrhoea are not considered by care-givers. The labelling of a child with diarrhoea as having su results in a delay in help-seeking, a risk factor for dehydration. Thus su needs to be taken into consideration in health education campaigns. The informants demonstrated little understanding of the role of infection in diarrhoea, nor of the role of personal and domestic hygiene for its prevention, nor of the place and function of ORS, highlighting important areas where education is still necessary.