Conducting a household survey in poor urban settlements in Ghana: challenges and strategic adaptations for fieldwork

Background: As the population in urban centers rise, researchers need to capture reliable and valid data that represent health needs of harder-to-reach populations such as those living in informal settlements. There is limited literature on systematic approaches for conducting fieldwork in urban settings in low-income countries. Using wireless-connected tablets, we collected baseline data from women living in poorer settlements of Accra, Ghana for a program evaluation. We describe emergent issues and adaptations to our fieldwork approaches that expand on previous guidance. Methods: Our study utilized a three-stage random sampling design to select 2,200 women who were then located and interviewed. We routinely examined quantitative indicators of data collection quality and collectively reviewed challenges in locating respondents. We tested modifications in our fieldwork approach in a subsequent study in a similar urban context. Results: Key challenges included: sampling dynamic communities; locating respondents who worked away from the home; maintaining interview privacy in densely populated settings; and delays in reporting data inconsistencies. Key adaptive strategies included utilizing household-specific GPS coordinates, using real-time fieldworker tracking statistics, and rapid communication with teams using instant messaging applications. Compared to 82% in the first, nearly all respondents in our second study were interviewed within 2 months of the household listing. We could not relocate only 6.3% of respondents in our second study compared to 14.1% in the first. During analysis there were far fewer data errors after implementing our new fieldwork protocols. Conclusion: Research teams in urban settings can leverage the widespread use of mobile technology to quickly implement changes to fieldwork procedures, collect data efficiently, and minimize errors. Taken together with proven, more traditional fieldwork approaches, strategies that rely heavily on wireless technology may be increasingly practical and efficient to produce timely, valid data in contexts similar to Accra as networks continue to improve.