In Study Sessions 10 to 12 you have been learning about the principles and guidelines for conducting health research, and the specific example of conducting a community survey using quantitative and qualitative survey techniques in your kebele. In this study session, you will learn how to make use of your community survey data.
First, we show you how to develop your community profile by writing the report of the survey data that you and your volunteers have collected from all the households in your community. Then you will learn how to use your community profile report to identify and implement small-scale research projects to suggest solutions for the health problems in your community. But how do you decide which topics to prioritise for further research and who should participate with you in making this decision? What should your research objectives be and what other sources of information should you consult? This study session will help you to make these choices.
When you have studied this session, you should be able to:
13.1 Define and use correctly all of the key words printed in bold. (SAQs 13.1, 13.2 and 13.3)
13.2 Describe the main components of a research report, such as your community profile, and the order in which they should appear. (SAQ 13.1)
13.3 Explain how you would identify and prioritise criteria for selecting health-related problems for further investigation through small-scale research. (SAQ 13.2)
13.4 Describe how you would clarify the objectives for a small-scale research project. (SAQ 13.3)
Your community survey has generated a large amount of survey data. Analysis of the results forms the basis of the report that you will write, summarising the findings and making recommendations for tackling the health problems in your community. This report is called the community profile. The report should address the directives of the health managers at woreda and strategic levels, and also refer to the interests of key members of the community who are opinion leaders and ‘gatekeepers’ locally.
Before you start writing your report, you should make a plan of what you intend to write. Use the report headings, described in the following sections, and jot down a few notes under each of them to guide you when you come to write the full report. You will also need to check that you have gathered together all the data and that it has been processed and analysed appropriately. Consider the best way to present your data, for example, using tables or graphs for numerical data; if you have qualitative data, you may want to include a few direct quotes that illustrate a point you want to make. Spend some time thinking about the findings and what they reveal. Can you relate the findings to any reports or documents you have read about community health? Think about your possible conclusions and recommendations and check they relate to the original objectives. Considering each section of the report in turn and planning the contents will make the task of writing it much easier.
Your community profile (i.e. the report of your community survey) should contain the components listed in Box 13.1. Note that this format is exactly the same for the report of a small-scale research project or for a large-scale national survey. It is recognised internationally as the standard format for all forms of research report.
The Results, Discussion, Conclusions and Recommendations sections should form the most substantial part of your report. The completed report should contain the following information in each section.
The cover page of your community profile report should contain the title, your name and the month and year that you submitted the report. The title should include the name of the study area, for example ‘Community Profile of Village X: Report of a Community Survey’.
The summary should contain very brief descriptions (in no more than a few sentences each) in the following sequence:
You may need to be prepared to write different versions of the summary for health managers, for health staff at your level or lower levels (e.g. volunteers) and for community members.
The Table of contents provides the reader with a quick overview of the major sections of your survey report, with the page number of the first page in each section. This enables the person reading to go straight to particular sections of interest. Look at the Table of contents for this Module to see the style you should use.
Your introduction should begin by stating the purpose (objectives) of developing a community profile for your kebele. Then give some relevant background information about the community, what was previously known about the health status of the population, and any health service data which is relevant to the community profile. You may also include any background information on any relevant environmental, administrative, economic or social issues.
This should be followed by brief descriptions of the main categories of information that you have collected and investigated. Refer briefly to any additional information which you have obtained during the implementation of the survey.
Any relevant reports or documents you have found helpful should be briefly reviewed in your introduction section. It should end with a paragraph on what you hope (or hoped) to achieve by surveying your community and developing a community profile.
The method you used to collect your data should be described in detail. This section should include a description of:
The results section should contain a systematic presentation of your findings in relation to the survey purpose and is a crucial part of your report. The description of findings should include a combination of data from qualitative and quantitative components of the survey. They may be best presented as Tables and/or Figures (diagrams, e.g. graphs, flow charts, etc.), each with a unique number (e.g. Table 2, Figure 7, etc.) and a caption describing the Table or Figure clearly. Figure 13.1 shows two graphs, each with a clear heading. The results should also be described in words, referring to any Tables and Figures you include.
The findings presented in the Results section should be discussed in this section. It is a good idea to refer back to the purposes of the community survey at this stage. The discussion may include findings from other related surveys that support or contradict your own. For example, if there has been a previous community survey for the same area, your discussion should refer to any features of community health, demographic or epidemiological factors, health service use, environmental conditions, etc. that have changed since the previous report.
The conclusions and recommendations should follow logically from the discussion of the findings. Conclusions can be short. For example, if the community survey showed that some parents have not brought their children for immunization, your conclusion could be that additional health education campaigns or more outreach immunization sessions should be organised to improve the coverage rate.
Your recommendations should be placed in the same order as the conclusions, i.e. for every conclusion there should be at least one recommendation. However, the recommendations may be summarised according to the groups to which they are directed (Box 13.1).
In making recommendations, it will strengthen your messages if you can use not only the findings of your own community survey, but also refer to supportive information from other sources. The recommendations should take into consideration the local characteristics of the health system, any constraints on introducing new services or working practices, and the feasibility and usefulness of the proposed solutions. They should be discussed with all concerned before they are finalised.
Imagine that a community profile demonstrated there is a shortage of insecticide treated bed nets (ITNs) in a kebele where there are also many malaria cases. What will be your recommendation and what constraints may delay your recommendation from being adopted?
Your recommendation would be to distribute ITNs to all households and educate the families on using them correctly. There may be a delay in adopting this recommendation if ITNs are not available locally, or if there is not enough funding to buy a sufficient number of nets. If you don’t discuss the policy of distributing nets with all concerned in the community, they may not support your recommendations.
It is good practice to thank those who supported you technically or provided resources for your community survey, including the volunteers or others who were involved in the house-to-house data collection phase.
If you used any reports, documents or any other sources to help you make sense of the data in your survey, you should quote the full references in this section, including the year of publication and the name(s) of the author(s).
The Annex(es) (also known as an Appendix, or Appendices if there is more than one) should contain any additional information needed to enable readers to follow your survey procedures and data analysis. Examples of information that can be presented in an Annex are:
In the next section, we consider ways in which the community profile can help you to identify problems for further investigation in a small-scale research project, and how you decide which topics to prioritise for further research.
All research starts with the existence of a problem, or a perceived difficulty. For example, in your community survey findings you may be aware that there are a lot of malaria cases, or that female genital mutilation (FGM) is occurring and is causing severe health problems for women later in their lives. A small-scale research study could help you clarify the causes of the problem and perhaps point to ways that the situation could be improved.
Think for a few minutes about what you consider to be the most important health problems in the community that you live in now. Make a list of three health issues that are present in that community and that you think might benefit from further research.
Of course the details of health problems in each area are different, so we don’t know what you identified in your area. Nationally, the major health problems are malaria, HIV/AIDS and TB, diarrhoeal and respiratory diseases, and deaths among newborns and women during and soon after childbirth. It is likely that at least some of these are priorities in your community.
We have chosen to illustrate how you could research a common health problem by describing an imaginary research project on malaria in a rural community.
Perhaps you are concerned about the amount of malaria that is present in your kebele. There are two steps that you can take to clarify the problem.
Step 1: Find out as much as you can about the problem. For example:
Step 2: Discover whether the interventions that are already in place are effective, and if they are not, what are the reasons? For example, with respect to the ITN distribution throughout your kebele, you may want to find out:
Although health research is not part of the central role of Health Extension Practitioners, it is really important that you are aware of possible research that is relevant to your work. This will help to keep you up to date with the health problems and their solutions elsewhere in the country, and support your work in planning and evaluating your own health service activities. But not all health problems require research. Whether the problem you identified requires research or not depends on three conditions:
These three conditions can be illustrated through an imaginary example of poor sanitary conditions in a rural kebele.
First read the following case study.
The sanitary conditions in kebele X are poor and very few households have latrines, perhaps only 5%. The diseases connected with poor sanitation, such as diarrhoeal diseases and intestinal worms, are very common. The woreda Health Office has therefore initiated a sanitation project that aims to increase the percentage of households with access to latrines by 15% each year. The project provides materials for latrine building, and the community members of the kebele should provide labour. However, two years later, less than half of the target has been reached (Figure 13.3).
Discrepancy: 35% of the households should have latrines after two years of the latrine-building project, but only 15% do have them.
Research question: What factors might explain this discrepancy?
Read Case Study 13.1 carefully. The situation with poor uptake of latrines has produced a clear research question. In Section 13.2.2 you learned about the two steps that might help to clarify a health problem. What two steps of further research do you think might help in clarifying the sanitation problem in Case Study 13.1?
Step 1: further research to help you find out more about the barriers to latrine construction, and if there are any specific factors affecting the slow progress towards achieving the target. Step 2: researching further details about the interventions that are currently in place will help you work towards answering the key research question about why so few latrines were built in the first two years of the project.
In every locality there will be a number of serious health issues that might benefit from further research. But how should these be prioritised? Which of these problems should be the subject of a small-scale research study?
The selection and analysis of your research topic should involve not only your own judgment and opinions, but also the views of local managers in the health and health-related services, healthcare workers, community leaders and other stakeholders.
Stop reading for a moment and think about which health issues in your community are priorities for further health research. If you asked some of your colleagues and community leaders this question, would they say the same issues that you identified, or could some of them be different?
Perhaps the health issues in your community that you think are important are not high on the priority list of some other people. However, it is likely that there will be a number of serious issues that are shared as a common concern (Figure 13.4). It is therefore essential to discuss the problem with the concerned stakeholders: community leaders, villagers, men and women, rich and poor, to explore their perceptions of the problem.
Each topic that is proposed for research has to be judged according to certain guidelines or research criteria (Table 13.1). There may be several research projects to choose from and you need to be able to make a considered and logical choice of which one to proceed with. Before deciding on a research topic, each proposed topic must be compared with all other options. The guidelines or criteria below can help you in this decision making process.
|Criteria||Questions to consider||Possible responses|
|Relevance (importance)||How large or widespread is the problem? Who is affected? How severe is the problem?||If a possible research topic is not addressing a priority problem, it is not worthwhile researching it, so you should drop it from your list.|
|Avoidance of duplication||Has the topic been investigated before within the proposed study area, or in another area with similar conditions?||Can you find answers to the problem in already available, published or unpublished information, or just by using your common sense? If so, you should drop the topic from your list.|
|Urgency of data needed (timeliness)||How urgently are the results needed for making a decision or developing interventions? Consider which research should be done first and which can be done later.||If the research can’t be done in time, then there is no point in doing it.|
|Political acceptability||In general it is advisable for you to research a topic that has the interest and support of the woreda authorities. This will increase the chance that the results of the study will be implemented.||Avoid any topic which does not have the support of the relevant authorities.|
|Feasibility||Consider the complexity of the problem and the resources you will require to carry out your study.||If you don’t have the manpower, time, equipment and money available, then don’t do the research.|
|Applicability of results and recommendations||Will your study be practically useful?||If your research isn’t going to be useful, then don’t do it!|
|Ethical acceptability||You should always consider the possibility of inflicting harm on others while carrying out research. Always consider whether there are any relevant ethical issues to be concerned about.||If you think the research isn’t ethical or might cause harm or disturbance then don’t do it.|
Look carefully at Table 13.1. Why should you consider these criteria before you undertake any research in your locality?
Going through each element in the table will help you think carefully whether the research is practical and whether it is worth doing at all.
The criteria for selecting your research topic can be measured by using a research rating scale, as shown in Table 13.2. Although the scale suggests that each criterion can be given a numerical rating, these should be used with great caution. For example, if a research topic is not practical or not ethical, then it should not be undertaken even if it is relevant, urgent and avoids duplication with other studies. However, Table 13.2 may help you to decide which of the possible research topics on your list is a higher priority than others.
|Criteria||Scale for rating|
|Relevance||1 = Not relevant to a priority health problem (don’t do it) 2 = Relevant 3 = Very relevant|
|Avoidance of duplication||1 = Sufficient information already available (don’t do it) 2 = Some information available, but major issues not covered 3 = No sound information available on which to base your research|
|Urgency||1 = Information not urgently needed (no need to do the research now) 2 = Information could be used right away, but a delay of some months would be acceptable 3 = Data needed very urgently for decision making|
|Political acceptability||1 = Topic not acceptable to community members and/or woreda managers (don’t do it) 2 = Topic more or less acceptable to all stakeholders 3 = Topic fully acceptable|
|Feasibility||1 = Study not feasible, considering available resources (don’t do it) 2 = Study feasible, considering available resources 3 = Study very feasible, considering available resources|
|Applicability||1 = No chance of recommendations being implemented (don’t do it) 2 = Some chance of recommendations being implemented 3 = Good chance of recommendations being implemented|
|Ethical acceptability||1 = Major ethical problems (don’t do it) 2 = Minor ethical problems 3 = No ethical problems|
Now attempt Activity 13.1 below. You will need a pen or pencil and about 15 minutes to complete this activity.
Select an important health problem in your community that has been identified by yourself and by others in your community as a priority for action. Use the research criteria in Table 13.2 to ‘rate’ this health problem and enter the details in the table below. A maximum score for any topic would be 21 points.
|Avoidance of duplication|
Considering these criteria in more detail will hopefully help you to decide whether to go ahead with your proposed research topic. If you have several possible pieces of research, using a list of criteria like this should help you to decide which one to tackle first. You may want to repeat Activity 13.1 for one or two other health problems in your community so you can compare them. For example, if one of your selected health problems is reducing the cases of malaria in your community, and it scores 20 points, you can see that this is a higher priority than a topic that only scores 15 points. Remember that consideration of some criteria might mean that you should not do the research at all; for example, if you don’t have the necessary resources or if the outcomes are unlikely to be accepted, then do not research that topic at this time.
In designing your small-scale research project, it is important to state and define your research question clearly (Box 13.2), so that you and other people involved can be certain that the whole project has been well thought out.
A clearly stated research problem is already ‘half solved’ because it:
Look carefully at Box 13.2. What do you think might happen if your research problem is not clarified in the ways stated in the box?
It is very unlikely that your research proposal will be accepted or given sufficient resources. People will not cooperate if they are not clear what the purpose of the research will be and how it will affect their lives.
At an early stage in your research it would be a good idea to find out what information is already available about the problem that you are researching, for example in:
If you were conducting a small-scale research project in your locality about the use of contraception by married couples, what sources might you want to look at as part of your consultation?
You may find that there are statistics available in your local health centre, or recent reports written by the Federal Ministry of Health or NGOs specialising in family planning.
The final part of clarifying your research project involves thinking in more detail about your research objectives. Research objectives should be closely related to the statement of the problem and summarise what you hope will be achieved by the study. For example, if the problem identified is low utilisation of antenatal care services, the general objective of the study could be to identify the reasons for this low uptake, in order to find ways of improving it.
Writing your research objectives clearly helps to:
What do you think might happen if you started a research project, but hadn’t written any clear research objectives?
Without clearly written research objectives, you might be confused about the limits of the study, what data should be collected, or how to conduct the research.
Objectives can be general or specific. The general objective of your study states what you expect to achieve in general terms. Specific objectives break down the general objective into smaller, logically connected parts that systematically address the various aspects of the problem. Your specific objectives should specify exactly what you will do in each phase of your study, how, where, when and for what purpose.
Your objectives should be stated using action verbs that are specific enough to be measured, for example: to compare, to calculate, to assess, to determine, to verify, to calculate, to describe, to explain, etc. Avoid the use of vague non-active verbs such as: to appreciate, to understand, to believe, to study, etc., because it is difficult to evaluate whether they have been achieved.
A research study designed to assess the accessibility and acceptability of the Voluntary Counselling and Testing (VCT) Services for HIV infection in kebele X had the following general and specific objectives:
General objective: To identify factors that affects the acceptability of VCT services and to assess community attitudes towards comprehensive care and support for people living with HIV/AIDS.
What is the difference between the specific objectives and the general objective of a research project? You can use the example in Case Study 13.3 to help you answer this question.
Specific objectives are detailed objectives that describe what will be researched during the study, whereas the general objective is a much broader statement about what the study aims to achieve overall.
In the next study session, we will move on to teach you about research strategies and alternative study designs that you may choose to conduct for a small-scale research project in your community.
In Study Session 13, you have learned that:
Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering these questions. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.
Below are some extracts from a report of a community survey, but they are placed in the wrong order. Read each extract (labelled A to I). Then list the correct order in which each extract should appear in the report and state the title of that section of the report. For example, F = the cover page, which should come first.
|A||Proper usage of latrines, handwashing, personal hygiene and sanitation are crucial features of hygienic practice. All the visited households in the survey were observed to have poor management of domestic hygiene.|
|B||Our thanks also go to the water and health sectors at all levels who took part in the survey process.|
|C||Development of a joint plan between the water and health sectors for the control and prevention of outbreaks of diarrhoeal diseases is recommended.|
|D||This survey was conducted because there were frequent outbreaks of diarrhoeal diseases in the kebele in all seasons of the year, and this was a concern to the community members, the woreda health officials and the Regional Health Bureau.|
|E||The low awareness of the community, low access to safe water supplies and the poor utilisation of latrines contributed to diarrhoeal diseases outbreaks.|
|F||Community Survey Report on Diarrhoeal Disease Outbreak in Kebele X in the Amhara Region of Ethiopia, by Abebe Belaw, January 2009.|
|G||To assess the knowledge, beliefs and practices of the community on the control and prevention of diarrhoeal diseases.|
|H||Some respondents reported the following belief on the cause and mode of transmission of diarrhoeal diseases: ‘Diarrhoeal diseases are transmitted by bad smells’.|
|I||All the adults in the selected households were interviewed using a questionnaire to identify their knowledge, perceptions and practices about diarrhoeal diseases and their transmission and prevention.|
The correct order and the appropriate section for each of the extracts from the report are as follows:
F = Cover page
D = Introduction
G = Objective
I = Survey methods
H = Results
A = Discussion
E = Conclusion
C = Recommendation
B = Acknowledgements
What criteria would prevent you from conducting a research project, based on the rating scales in Tables 13.1 and 13.2?
You should not conduct the research if there are major ethical problems, there is no chance of implementing the recommendations, there are no available resources for the project, it is not politically acceptable to the stakeholders, sufficient information is already available from other research studies, or the research is not relevant to addressing a priority health problem.
Read the following general objective for a small-scale research project.
‘The general objective of this research is to identify the reasons for malnutrition among children aged under one year in the community.’
Write at least three specific objectives that would be relevant to achieving this general objective.
We can’t tell exactly what specific objectives you may have written, but here are some suggestions (you may have thought of others that are equally relevant):