6.3 METHODOLOGY FOR COUNTING UNPAID CARE WORK TIME
6.3.5 Approaches used
• “A few minutes” was taken to be three minutes.
• Where it was noted that sometimes one person helped with a care activity and at other times two people helped, it was estimated that 1.5 people helped over the illness period. For example, in the Ndaba household one caregiving activity was usually undertaken by one caregiver or if she was not there it was done by two others. Therefore it was estimated that 1.5 people undertook the activity to account for the possibility that more than one person was sometimes doing it.
• In order to determine the amount of care time that was undertaken by non-household members, the calculated caregiving time was divided up and apportioned. In the Sibiyo household where a friend drove the ill person and his sister to hospital – the care time was estimated as half for the sister (household member) and half for the friend (non-household member). In the Mbongeni household some care activities were undertaken by the ill person’s mother or by the daughter and the aunt or by the daughter and the neighbour. Here the care time was divided by six, with the mother undertaking two-sixths, the daughter undertaking two-sixths, the aunt undertaking one-sixth and the neighbour undertaking one-sixth.
• In the Shibe household the ill person’s chest was rubbed “when it was congested”. It was estimated that this happened once a day over the illness period.
• If something was done “only when requested” it was estimated as occurring 0.5 times a day. This was the case with regard to rubbing or massaging Zinhle in the Ngidi household.
• Also in the Ngidi household, it was noted that Zinhle ate “once a day, sometimes none”.
Therefore it was estimated that she ate 0.5 times a day over the illness period.
• Some of the figures given by respondents seemed questionable. For example, in the Mbongeni household the caregiver stated that it took 20 minutes to pour lucozade into a cup, put a straw in the cup, and then place it in front of the ill person. Another example was in the Ngidi
household where it took 45 minutes to turn/move the ill person in bed and this was done over ten times a day. While this may not be reflective of the time actually taken to undertake the activity, it could be reflective of caregivers’ perceptions of how long it took, which is also important to take into consideration. Nevertheless, where figures were clearly overestimates these were halved. Therefore instead of 20 minutes, the estimate for the Mbongeni household was taken to be 10 minutes, and instead of 450 minutes a day, the estimate for the Ngidi household was taken to be 225 minutes a day.
• If a care activity only occurred once over the illness period the minutes taken to do the care activity were divided by the number of days in the illness period. For example, in the Luthuli household the minutes taken to go to the hospital with the ill person were divided by the number of days in the illness period to obtain the number of minutes it took per day over the illness period.
• With regard to counting the time taken to buy special food, in some cases respondents gave only the time taken to get to the shops, in some instances they stated time to and from the shops, in other cases they gave buying time only, and in a few instances they gave time to and from the shops as well as buying time. These time estimates were simply used as is, in line with the approach of underestimating. There were no overestimates with time taken to buy special food, only a full estimate or an underestimate.
In a number of cases a decision was taken to estimate figures by calculating the average of stated figures. The following are examples of estimated averages in the study. These cover most of the cases that were presented in the study findings, with only slight variations across households in terms of amounts stated:
• In the Ngidi household, some medication was given to Siyanda two times a day, and other medication was given three times a day. Therefore the estimate was taken as the average of the two: 2.5 times a day.
• Similarly, in the Ngidi household the estimation for the number of times that food was prepared for Siyanda and the number of times she was helped to eat per day was given as “1 or 2 or 0 times”, therefore the frequency was taken as the average of the three: one time.
• The time spent bathing the ill person in the Yengwa household was stated as “45 to 60 minutes”. Therefore the estimate was taken to be the average of 52.5 minutes.
• Where there were inconsistencies an attempt was made to find an ‘average’ estimate. For example, in the Mbongeni household the ill person was dressed twice a day and undressed 3.5 times a day. The number of times the person was dressed and undressed should be the same as it is only possible to undress and dress one after the other. Therefore the average of the two figures was taken: the ill person was undressed and dressed 2.8 times a day.
• If the number of people stated as doing a certain care activity was “one or two”, the care activity was multiplied by 1.5 to account for the fact that more than one person was doing the caring activity for some of the time. For example, in the Mbongeni household some personal care activities were undertaken by Ayanda or by Ayanda and Aunt Pretty, therefore by 1.5 people.
• If there was no estimate for duration or frequency for a few households, or where it was not possible to make estimates, the average of the stated duration or frequency for a particular activity across all other study households was calculated. Estimated averages were not calculated where information across most of the households was missing (apart from the time taken to empty a bedpan/bucket, see below). Estimating averages was only necessary for some care activities, and these are listed below:
o The number of times he/she was bathed
o The number of times he/she was taken in or out of the bed o The number of times he/she was turned or moved
o The number of times he/she was helped to walk outside o The time taken to help him/her to and from the toilet
o The time taken to help him/her use the toilet
o The time taken to help him/her use the bedpan/bucket o The time taken to rub or massage him/her
o The number of times he/she was rubbed or massaged
o The time taken to prepare and pour a drink and help him/her drink or give him/her their drink
o The number of times to prepare and pour a drink and help him/her drink or give him/her their drink
o The time taken to prepare food and help him/her eat or give him/her their food o The number of times to prepare food and help him/her eat or give him/her their food o The number of times special food was bought for him/her
o The time taken to prepare special food
o The number of times special food was prepared o The time taken to put the linen on/off the bed
o The time taken to wash his/her washing where this was done separate to the household’s washing
o The time taken to or from the taxi rank without him/her
• The time taken to empty a bucket/bedpan was not specifically asked about in the care survey. However, it seems reasonable to assume that the bucket/bedpan was emptied each time it was used. It therefore makes sense to apply an average time taken to empty the bucket/bedpan for those cases for which it was provided (in some of these cases it was only emptied, and in others it was emptied and rinsed) to the remainder of cases. This time was assigned to the person(s) who assisted with use of the bedpan/bucket.
• Caregivers’ time was not only spent on care activities for the ill person, but also on activities for the ill person and the household. Regarding laundry washing, if the ill person’s laundry was done with that of the rest of the household it was possible to divide the time
estimation for the household’s washing by the number of household members in order to arrive at a time estimation for the ill person. However this was not likely to be accurate as the ill person
probably had proportionately more washing than the average household member, since illness usually generates more washing. Therefore the time taken to do the ill person’s washing was likely to be proportionately more than the time taken to do the other household members’
washing. In five households the ill person’s linen and/or clothes washing was done separately to the washing of other household members. Information existed for four ill people on time taken to do their clothes washing separately from other household members’ washing (an average of 31.1 minutes per day) and for four ill people on time taken to do their linen washing separately from other household members’ washing (an average of 24.0 minutes per day). These average time estimates were added to the time spent providing care in households in which the ill person’s washing was done together with that of the rest of the household.
• The time it took to get to the taxi rank or bus stop without the ill person in order to go to a health facility was not obtained from respondents directly. This information was obtained from two of the three field researchers after fieldwork was complete. This was not seen to be
problematic as the field researchers were very familiar with the time taken, since they lived in the study areas and used these forms of transport. However, it was not possible to obtain this
information from the third field researcher as he died. Therefore, the average of estimates for the four study areas was applied to the remaining two study areas. No estimations were given for how long it took for the ill person to get to a bus stop or taxi rank.