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HEALTH RESEARCH FOR DEVELOPMENT: A MANUAL ad. Joyce L. Pickering Canadian University Consortium for Health In Development HEALTH RESEARCH for DEVELOPMENT: A MANUAL ed. Joyce L. Pickering Canadian University Consortium for Health In Development (CUCHID) Printed by: McGill Printing Services McGill University Montreal, Quebec, Canada April 1997 ISBN 0-7717-0502-6 Any part of this manual, including illustrations, may be copied, reproduced, or adapted to meet local needs, without permission from the authors or publisher, provided parts reproduced are distributed free or for the cost of reproduction (not for profit) and the user credits the source. The Canadian University Consortium for Health in Development would appreciate being sent a copy of any materials in which text or illustrations have been used. CUCHID, 170 Laurier Avenue West, Suite 902, Ottawa, Canada KIP SVS Authors Frances Aboud PhD Nazilla Khanlou RN MSc Department of Psychology Clinical Health Sciences McGill University (Nursing) Programme 1205 Doctor Penfield Avenue PO Box 5 Montreal, Quebec H3A lBl McMaster University Canada Hamilton, Ontario L8S lCO Canada Peter Barss MD MPH ScD Injury Prevention Module Barthelemy Kuate Defo PhD Direction de le Sante Publique de Montreal Professor of Demography 4835 avenue Christophe-Colomb Department of Demography Montreal, Quebec H2J 3G8 University of Montreal Canada C.P. 6128, Succ. A Montreal, Quebec H3C 317 Will Boyce MSc Canada School of Rehabilitation Therapy - ICACBR Queen's University Charles Larson MD MSc Kingston, Ontario K7L 3N6 Dept. of Epidemiology and Biostatistics Canada McGill University 1020 Pine Avenue West David Fletcher B Art Sci M Ad Ed Montreal, Quebec H3A 1A2 Consultant Canada Holistic Community Pursuits 2528 Sherwood Street Deborah Lehmann MBBS MSc Halifax, Nova Scotia B3L 3G8 Papua New Guinea Institute of Medical Research Canada PO Box 60 441 Goroka, EHP Catherine Hagen MD MSc Papua New Guinea Clinical Instructor University of British Columbia Cathy Lysack MSc Dept. of Family Practice Assistant Professor Prince George Site Department of Occupational Therapy I Suite 3, 1230 Alward Street Shapero Hall I Prince George, B.C. V2M 7Bl Wayne State University ! Canada Detroit, MI 48202 USA James Hanley PhD Dept. of Epidemiology and Biostatistics Marilyn McDowell PhD McGill University Chair, Human Ecology I 1020 Pine Avenue West Mount Saint Vincent University ! Montreal, Quebec H3A 1A2 Halifax, Nova Scotia B3M 4H6 i Canada Canada I I l t I l • • Catherine Merritt MSc Joyce Pickering MD MSc Lab Coordinator, Cell Biology Rm • A4.21, Royal Victoria Hospital Department of Biology 687 Pine Avenue West • Carleton University Montreal, Quebec H3A lAl • Ottawa, Ontario KlS 5B6 Canada Canada • Kay Wotton MD MPH • Shree Mulay PhD Northern Medical Unit • Director of McGill Centre for Research Dept. of Community Health Sciences and Teaching on Women University of Manitoba • M4. 76, Royal Victoria Hospital 5100 - 750 Bannatyne Avenue • 687 Pine Avenue West Winnipeg, Manitoba R3E OW3 • Montreal, Quebec H3A lAl Canada Canada • David Zakus PhD • Sergio Nishioka MD MSc Director, International Health av. teresina 1415 Mount Sinai Hospital • Uberlandia, MG 38405/384 600 University Avenue • Brazil Toronto, Ontario MSG l:XS • Canada Joan Allen-Peters MSc • School of Nutrition and Food Science • Acadia University • Wolfville, Nova Scotia BOP lXO Canada • Acknowledgements • I would like to thank the International Development Research Centre (Canada) and the Canadian • University Consoi:tium for Health in Development for their funding and support for the development and • running of the first two workshops. • The success of the first workshop was due to the contribution of the facilitators (most of whom • are authors of the chapters in this manual), and to all participants who contributed their time, experience, • and ideas to teach us all. I thank Nazilla Khanlou, my research assistant for the Montreal workshop, and the International Health Office at McGill University for their support. • The illustrations are taken from the following sources: Where There Is No Doctor, David Werner, Hesperian Foundation; Helping Health Workers Learn, David Werner and Bill Bower, Hesperian • Foundation; My Name is Today, David Morley and Hermione Lovel, MacMillan Publishers; Clip Art for • Development, Paul Mundy, Hendi Bachtiar, Iowa State University, Ames, Iowa, USA. I would like to • express my appreciation for their generosity in allowing their pictures to be freely reproduced for non­ profit purposes. • Antoinette Sevensma revised and copy edited this manual with me. I thank her for her many • hours of work, without which this manual would not have been possible. • Joyce Pickering • Montreal, 1997 • • • • • TABLE OF CONTENTS INTRODUCTION • J. Pickering • CHAPTER 1 The Why and How of Research . 8 • J. Pickering, C. Lysack • CHAPTER2 Introducing Participatory Action Research . 18 ,.• K. Wotton, J. Allen-Peters, D. Fletcher, M. McDowell • CHAPTER 3 • Epidem.iologic, Demographic, and Biostatistical Methods: Assessing Numbers, Rates, Causes and Determinants of • Mortality and Morbidity in Developing Areas . 48 • P. Barss, D. Lehmann, C. Hagen, J. Hanley, B. Kuate Defo, S. Nishioka , .• CHAPTER 4 • Methods from Social Sciences: Overview of • Quantitative and Qualitative Methods . 101 • F. Aboud CHAPTER 5 • Evaluating Community Participation . 132 • W. Boyce, N. Khanlou, C. Lysack, S. Mulay, D. Zakus • CHAPTER 6 Practical Issues in Health Research in Developing Countries . 163 • C. Larson • CHAPTER 7 • Laboratory Issues in Developing Countries . 191 ,.• C. Merritt CHAPTER 8 • Translating Research into Action 220 • C. Larson • CHAPTER 9 • Working with Groups 232 • J. Allen-Peters • WRAP-UP . 266 • J. Pickering • • • • INTRODUCTION • J. Pickering • This manual is intended to serve as a resource for running a five-day workshop on health • research for development. • The original idea for this workshop came from members of the Canadian University • Consortium for Health in Development (CUCHID). Funding was obtained from the • International Development Research Centre (Canada) and the first workshop was held in • Montreal, Canada in 1995. The second workshop is to be held in Uganda in 1997 . • The objectives of the workshop are to learn research techniques that are particularly • applicable to health research in developing country settings. It is aimed at people who already • have some research experience, but have not had the opportunity to learn some of these • techniques . • This workshop uses participatory and interactive methods of learning. Thus, the time • for "talks" and "presentations" by leaders should be limited. No session in this workshop should consist entirely of a lecture. Problem solving by individuals and groups is the preferred method • of learning here . • , .• • • • Talk with people •.•..•..•.••....•.•..•. Not at them A suggested schedule for running the workshop follows. Each chapter in this manual • to corresponds to a session and, in addition information, includes exercises and a suggested • schedule for each session. An exception is Chapter 9, Working with Groups. Although group • processes occur throughout the workshop, this chapter was included to consolidate these ideas • and may be used as a reference throughout the workshop. There is no chapter for the optional session on the software program Epilnfo. Consult the Epilnfo manual if it is decided to hold • this session . • One of the most rewarding aspects of the Montreal workshop was the wealth of • experience that the participants brought to the workshop. This, together with the participatory nature of the workshop, resulted in a rich learning time for everyone concerned. It is our hope • that the workshop will be used widely, with similarly positive results . • • • • SUGGESTED SCHEDULE • Mon Tues Wed Thurs • Fri • 8:30 -12:00 Intro. Epid. & Methods from Practical Issues Translating The Why and Demographic Social Sciences Research into • How of Techniques I Overview Action • Research • 12:00-1:30 Lunch Lunch Lunch Lunch Lunch • 1:30 - 5:00 Participatory Epid. & Measuring Laboratory Wrap up and Action Research Demographic Community Issues Evaluation • Techniques II Participation • 5:00 - 5:30 Feedback Feedback Feedback Feedback • session session session session • Evening Welcome Optional • Reception session on Epilnfo. • • SUGGESTIONS • 1. Hold a meeting for all leaders of the workshop on the day before the workshop to go • over objectives and methods of facilitating. Refer to Chapter 9 for group processes. • 2. Emphasize the participatory nature of the workshop. Lectures should be minimal, group • problem solving should be maximal. If those leading the workshop are less comfortable • with participatory and interactive teaching methods, have a training session for them • before the workshop. • 3. Be sensitive to the feedback from the participants, and modify on the spot as much as • possible to respond to their needs. • 4. Aim for 30 to 50 participants in the workshop to maximize interaction among them. • Participants should already have some basic health research training or experience. • 5. An evaluation session held at the end of each day can give useful information for • improving the subsequent sessions. Have all facilitators and several representatives from the participants attend these sessions. Make them brief and to the point however -- they • do occur at the end of a long day. • • • • • • • CHAPTER I • THE WHY AND HOW OF RESEARCH ,.• J. Pickering and C. Lysack WHY
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