title: How can we assess the burden of muscle, bone and joint conditions in rural Botswana: context and methods for the MuBoJo focused ethnography.
abstract: BACKGROUND
  Musculoskeletal diseases are the most common causes of long-term pain and disability worldwide and a growing international public health concern. However, the everyday burden and impact of musculoskeletal conditions are not well understood, especially among people living in low- and middle-income countries in Africa. Since 2011, World Spine Care, a nongovernmental organisation, has collaborated with the Botswana Ministry of Health to open spine care centres and to conduct research. The broad aim of the Muscle, Bone and Joint (MuBoJo) research project is to examine the sociocultural, organisational and clinical characteristics for the burden of living with and caring for people living with musculoskeletal conditions in rural Botswana. In this paper, we describe the community context, theoretical framework, and research methods to address the project aim with a qualitative study.
  
  
  METHODS
  This focused ethnography is based on eight months (November 2011, April 2013, October 2013-March 2014) of fieldwork in Botswana. The project was theoretically informed by the concepts of explanatory models of illness, social suffering, and biographical disruption. Data collection included fieldnotes, non-participant and participant observations, and informal and in-depth interviews with villagers and healthcare providers. Villager interviews were typically conducted in Setswana with an interpreter. Audio recordings were transcribed verbatim in the language spoken with Setswana contextually translated into English. Computer software supported qualitative data management. Analysis is ongoing using constant comparison and a template organising style to facilitate pattern-finding and reveal insights for the burden and care of musculoskeletal conditions.
  
  
  CONCLUSIONS
  Findings from the MuBoJo Project will document the context of musculoskeletal burden, illness beliefs, self-care behaviours, and healthcare options in a Botswana rural village. These data will inform ongoing efforts to establish spine care clinics for underserved populations in low-middle income countries and sustain these healthcare services through local providers and volunteer health professionals. This study also will generate new knowledge about the burden and impact of muscle, bone and joint disorders for cross-cultural comparisons and patient-centred interventions.
  
  
  CONCLUSIONS
  Our systematic and transparent methodology to conduct musculoskeletal research in more than one language and in a cross-cultural setting may be useful for investigators and NGO healthcare personnel.
authors.affiliation: Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, Odense M, Denmark ; World Spine Care, 801 North Tustin Avenue, Suite 202, Santa Ana, California, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Hondras
authors.affiliation: Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, Odense M, Denmark.
authors.forename: Corrie
authors.initials: C
authors.lastname: Myburgh
authors.affiliation: Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, Odense M, Denmark ; World Spine Care, 801 North Tustin Avenue, Suite 202, Santa Ana, California, USA ; Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, Odense M, Denmark.
authors.forename: Jan
authors.initials: J
authors.lastname: Hartvigsen
authors.affiliation: World Spine Care, 801 North Tustin Avenue, Suite 202, Santa Ana, California, USA ; Department of Neurology, University of California, Irvine, California USA ; Department of Epidemiology, School of Public Health, University of California, Los Angeles, California USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Haldeman
authors.affiliation: Department of Public Health, Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 9B, 5000 Odense C, Denmark.
authors.forename: Helle
authors.initials: H
authors.lastname: Johannessen
keywords: Burden; Developing countries; Ethnography; Joints; Musculoskeletal system; Qualitative research