QUALITATIVE METH PH
QUALITATIVE METH PH HSERV 526
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This 6 page Class Notes was uploaded by Lincoln Hintz III on Wednesday September 9, 2015. The Class Notes belongs to HSERV 526 at University of Washington taught by Staff in Fall. Since its upload, it has received 29 views. For similar materials see /class/192012/hserv-526-university-of-washington in Health and Human Services at University of Washington.
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Date Created: 09/09/15
HSFRV 5261331 526 Qualitative Research Methods for Public Health Winter 1993 University or Washington Seattle WA 93195 Course Instructor Steve Bezruchka MD Lecture Le m g Ohjetllvvs tetihe the euheept u iist ieeeht deve up 11 Rapid Qualitative Research Tools 2r 39n is PAP and ueseiihe its histuiy i merits utRAP ihstiumehts discuss issues utvaiiuitywth RAP en n at is R tsauesti ns trim prwinus Sessinn Wh AP Hist heet tuithihhihg abuut iesesieh amung the iuisi puui Questiuhhsiie r Histuiy 7 came tium sestemiestu WME a thesis ui puhiish ih sh academieiuuihsi r quESlmn tuimuistiuh tit hut aHuW mslmmEnl tn diSEDVEV systems Expluve EugmlWE pEYEEplmnS ui iuehtity sueisi pvub ems euestiuhs WEYE simust siwsys tuimuisteu hum uutsiue ulwalm tn use it came tium eumtuit ih numbEYS iihe a ehiiu s hishhet r Methuu euhtsihs dEpEndEnl amp indEpEndEMvaHab Es stiiet statistiesi shsiysis piiet tn teteimihe itpreIomulated hypotheses sie accep et amphng amp mihimizstiuh uthisstu msihtsih seiehtitie iespeetshiiity isi humheis ut peepie euuiu he surveyed statistiesi shsiysisWith euhtiuehee iimits euuiu he achieved gEnEYahZalmn pussihie VVeaknesses Read Slune L and J G Campheii The Use and Misuse ut Suvveys ih ihteihstiuhsi Deveiupmem Ah EXpEHmEM hum Nepsi Human OYgamZalmn 1984 431 p 27737 7 es uie KAP survey and tuuhu nunrsamp mg eiiui wastsi gVEalEV thsh ssmpiihg eiiui much at it in tn titteieht mlEYpYElalmnS uteuestiuhsthsh euhsiueieu by dESignEY uteuestiuhhsiie what peepie say is het what peepie tn esuits sie euituisi she limerbuund context of an activity is not revealed person asking questions introduces a bias since degerence or untrue answers can be g39ven sampling is tricky where people do not have phones or mail boxes or not live on linear streets analysis takes time basis in rural sociology where called RRA in late 197039s PRA was an outgrowth also used in agriculture amp rural development especially community forestry health efforts began about 10 years later is now pretty common in HIV work others recognized that traditional surveys to assess health care wwere expensive slow and had poor validity Basics of Rapid Assessment Procedures RAP Predesigned study protocol Other Terms RA Rapid Appraisal RRA Rapid Rural Assessment FES Focused Ethnographic Study Userfriendly Interdisciplinary approach Speed amp cost Focused on topic or problem eg Crap Rap Rapid Assessment Procedures to Improve the Household Management of Diarrhea by Herman amp Bentley STD Rap The Manual for Targeted Intervention Research on Sexually Transmitted Illnesses with Community Members Acute Respiratory Infections FES Women39s Health S Usually exploratory Example Women39s Health FES for India quite sophisticated in including training syllabus using unstructed interviews and computerized analysis Purpose Carrying out a communitybased ethnographic study of women39s health The main goal ofthe protocol is to provide techniques for the generation and analysis of data that will facilitate program development and implementation in organizations working in women39s health The results of the ethnographic study are intended to assist in Developing recommendations for appropriate communication with women and to enhance development of effective home care recommendations and health messages Selecting appropriate forms of popular local terminology for health care workers to communicate effectively with women Improving household morbidity mortality and treatment surveys by suggesting ways of adapting questions to consideracknowledge community perceptions and practices Identifying constraints in improving the condition of women39s health and suggesting locally appropriate strategies to deal with these constraints Explanatory Model A systematic set of cultural knowledge beliefs and attitudes with respect to a particular illness or other aspect of health The quotexplanatory modelquot for an illness includes the presumed causes processes preferred treatments and expected usual outcomes Training Exercises over a 10 day period for data collectors Direct Observation Community Mapping amp Resources Key Informant Interviews with Local Healers amp Other Knowledgeable Women Free Listing of Women39s General Problems in the Community Free Listing of Women39s Health Problems in the Community exploring domain of women39s illnesses Free Key Pile Sort Grouping Women s Illnesses nformant Interviews with Women Health Concepts and Health Seeking Behaviors Ethnographic Field Guide Wo General issues related to Health Problems of Women in the Community Exploring women39s health by developmental state quotTell me the story of your life What was life like for you as a girl What were some ofthe good things you remember What were some ofthe problems you remember Were you ever ill Were your brothers or sisters ever ill How many times have you been pregnant How many live births have you had How many live children do you now have How have these pregnancies affected your health What was life like for you with your first pregnancy Tell me what you understand about the process of pregnancy Where does the baby come from How did you know you were first pregnant Where does the baby grow in your body How does it grow What did it feel like for you to be pregnant What did you think What did you not think about What did you wish you knew then that you know now What are questions that you still have about pregnancyquot You may be inspired to do a further piece of data collection for instance asking which of these different stages is quotmost joyousquot quotmost traumaticquot most important etc Health and HealthSeeking quotHow is your life going right now How would you say your health is What things have made you healthy What things have made you weaksick quotTell me about other illnesses you have had What were the first symptoms of illness X What caused those symptoms What did you think when you noticed those symptoms What did you do 39Where do you go or whom do you consult when you are illquot men39s StatusPower Ask for narrative accounts of what happens during meals And what happened the last time your child was sick etc Who eats first Who makes decisions about cash How are household jobs divided up may be important to determine status and authority among women What ways are men and women treated differently in your household Who is the most important person in your household Why How do others treat that person What responsibilities does each person have to the household What benefits does that person gain from the household Who is the second most important person How do they address that person What do they ask that person to do for them What benefit does that person get from being in the household Data Analysis Developmental Stages Table BIRTH NAMING FIRST MARRIAGE BIRTH BIRTH DEATH CEREMONY MENSTRUA OF OF TION FIRST FIRST CHILD GRAND CHILD Types of Practitioners Table Paired Comparisons Illness and Choice of Provider Preliminary Analysis and Devising a Coding Scheme for Textual Data begin the process of analysis of the entire data set develop a coding system for the textual data collected in this research identify areas of further research and areas which are no longer fruitful for each of the three topic areas evaluate which research methods worked well and which should either be dropped or modified Main Exercises carried out in subsequent 46 weeks Applying Data to Programs Health Education what is needed what is level of local knowledge creating messages identifying channels media etc lmproving Services usually means educating providers Design issues to consider Who gathers data How long does it take to gather data How much depth do we need Who interprets data amp communicates results Who uses the results How quickly are the results available The demand for rapid qualitative research protocols Programmatic relevance Community participation and development Cost and human resources Technology transfer RAP response to the demand Easily available qualitative tools for assessment or program evaluation purposes Highlight key health behavior constructs to behavioral scientists lntroduce qualitative research tools to health care workers and community members Address working relationship between primary health care workers and community members Incorporate expertise of small pool of technical experts Offer a ready to use set of field procedures and data collection guides to be customized Field experience with RAP Data collection guides lntended audience and actual audienceusers Explanation of data analysis techniques Questions of validity on the thorns of a debate Validity ls inductive nature of study compromised too much deriving general principles from particular facts or instances as opposed to deduction where a nding is arrived at by reasoning from principles Brief time frame of contact amp trust issues How does multidisciplinary team affect the process Technical lead and eld worker competence Level of commitment oftechnical lead What is quick and cleanquot an attempt to re ne RAP lntent of the tool amp audience clari cation Programmatic question Explain process to ustomizequot Community participation vs program managers vested Methods and data analys39s Comparing RAP amp PRA Table 1 TABLE RNA AND PRA COMPARED RRA PRA Pmod of mlor dzvntapnwm late mos mos me mm was Mam mumlion based m omen NCOs Mam users mu aginues Unwusilxu Cwemmenl held mgamuuons Ma mmmm Methods Behaviour Fmdommant mg Elclwexlrc1ve humann5 ynnxipimry ideal obyedwes Lam by outsiders Empowerment 01 kxal people m 1 w t Table 2 The RRAPRA Continuum TABLE 1 NBA AND PRA COMPARED RRA FR A Pan a nullquot drvzlnpm u lue mm me im mm was anr Innovators med m Unlvelsillu Ncm Mam users AM igrncies NCO Unlversihei Covemmlnl mm mgimuumu Main inmumn Mum Behavmur rndommm mod mum ammve human yummy 1m imam Leammg by Indus Empowermenl ol39 lxxal people m m i Principles Shared by RAP amp PRA Chambers 1992 pg 14 15 reversal oflearnIng learn from rural people directly on the site and facetoface gaining from local physical technical and social knowledge learning rapidly and progressively with conscious exploration flexible use of methods opportunism improvization iteration and crosschecking not following a blueprint program but being adaptable in a learning process offesetting biases especially those of rural development tourism by being relaxed and not rushing listening not lecturing probing instead of passing on to the next topic being unimposing instead of important seeking out the poorer people amp women and learning their concerns and priorities optimizing tradeoffs triangulating seeking diversity Additional principles stressed in PRA facilitatingthey do it selfcritical awareness and responsibility sharing of information This course has all the elements of RAP we have just been learning the tecniques isolated from one another but your projects ifthey were to be disseminated for others to do would be RAP s one difference between RAP s and questionnaires is that the surveyor gets more involved in the process rather than just checking boxes on a data collection form another difference is the richness ofthe information obtained Recommended Readings Grandstaff TB and DA Messerschmidt A Manager39s Guide to the Use ofRapid Rural Appraisal 1995 Bangkok FARM Program and FAQ HelitzerAllen DL and HA Allen Jr The Manual for Targeted Intervention Research on Sexually Transmitted Illnesses with Community Members 1994 Family Health International ch 1 pg 19 scan data collection guides pg G1G45 Herman E and M Bentley Rapid Assessment Procedures RAP To Improve the Household Management of Diarrhea 1993 Boston International Nutrition Foundation for Developing Countries pg 17 scan field guide Part III pgs 2165 Scrimshaw amp Hurtado scan pg 3565 data collection guides lectl 1doc 71010
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