I. What is Applied Health Research?

RESEARCH is the Systematic collection, Analysis, and Interpretation of data to

answer a certain question or solve a problem.

The anthropological approach to Applied Health Research is characterized by:

- a clean Statement of the problem;
- the identification of the socio-cultural and economic Factors that are associated with
the problem;
- a plan for data collection related to the problem;
- building on existing data, using both positive and negative findings.

In identifying socio-cultural aspects of the problem, one should also try to understand
how the identified health problem is related to the various components of the local
health system, which, as put forward in Module 4, includes the professional, folk and
popular sector.

A HEALTH SYSTEM may be described as:

- The health promotion and health care practices that occur in the professional, folk
and popular sector in a specific socio-cultural setting;
- a set of cultural beliefs of illness and health which forms the basis for health
promotion and health care behaviour in the professional, folk and popular Sector;
- the specific health care and community institutions(for example the health centres
and households) within which the behaviour occurs;
- relevant contextual factors that determine people`s health seeking practices, and the
hrovision of health care services in tue various institutions-.

How well the different components of the health System Function depends to a large
extent on socio-economic, political, cultural, physical, epidemiological, and other
contextual Factors. For example, economic booms or depressions will affect the
health and nutritional status of individuals as well as the national budget available for
health services. In Applied Health Research, one should therefore aim at clarifying the
relevant context of the Problem.

II. Selective vs. Comprehensive in Applied Health Research.

Because Applied Health Research is Problem-oriented, it should ideally be selective

and concentrate on those factors that will help to explain and solve the problem being
examined. In designing the study, researchers should asses how much they know
about the problem. Often, it is advisable to start with an exploratory phase of the
study, during which the researchers identifies the socio-cultural and health factors that
are related to the problem and that need further exploration.
It is important to realize that Problems can be defined from different theoretical
perspectives (see Modules 3). Also, different levels within the health system have
different priorities and perspectives and may raise different types of questions. For
example, in the control of acute respiratory infections:

National health policy-makers may want to know:

- How can trends in national statistics of morbidity and morality of respiratory
infections be explained?
- How adequate are acute respiratory infections diagnosed and treated in health
centres; to what extent are pneumonia cases left untreated; and how often are they
treated inappropriately?

Managers at District/provisional Level may raise questions such as:

- How can differences in morbidity and morality of respiratory infections between
various districts be explained?
- Do pople in the community understand when they should bring a child with a acute
respiratory infection to the health centre? Do they recognize the severity Signs (such
as fast-breathing and drawing in of the chest)?

Hospital Directors may ask.

- why do we observe such a high rate of complications in acute respiratory illness?
Are the first-line services sufficiently available and adequate? Are out own services
adequate? Are patients delaying treatement and, if so, why?

Managers at village Level (village health committees and villages health workers)
may want to know:
- Why do people not consult community health workers when they have Symptoms
such as cough?
- How can we assist illiterate women in effectively preventing and treating acute
respiratory illness?

Community Leaders may want to know:

-What will be the effects of a colt-recovery program on drum costs and availability of
drugs?
(please add your own examples)

Problems at one Level of the health System are usually connected with Problems of
deficiencies at other levels. Applied Health Research should address problems from
the different perspectives of all those who are, directly or indirectly, involved.
Otherwise we rund the risk of coming up with results that partly explain the problem
and that are, therefore, insufficient to solve it.
The questions raised by the various actors involved may vary. Some are
largely medial ( `how do people perceive severity indicators of acute respiratory
infections`). Applied Health Research often requires inter-disciplinary research.

III. Who Should Be Involved in Applied Health Research?

The participatory nature of Applied Health Research is one of its major
characteristics. To ensure that the research is relevant and appropriate, everyone
directly concerned with a particular health or health care problem should be involved
in the research project. This could include policy-makers, straff members from the
health services involved, private health care providers, Professional researchers, and
the community itself. This involvement is critical if the research activities are to make
a difference:
- If decision-makers are involved only after completion of the study, the report may
just bei shelved.
- If health care providers are involved only in data collection and not in the
development of the proposal or in data analysis, they may not be motivated to collect
accurate data or carry out the recommendations.
- If the community is only requested to respond to a questionaire, the recommendation
from the study may not be acceptable.
- If Professional researchers are ot involved in the implementation of
recommendation, they may have little concern for the feasibility of the
recommendations.

The roles that various types of personnel will play in the research project will depend
on the Level and complexity of the particular study, as well as its area of focus. Some
projects are very complex and may need expertise from several disciplines (inter-
displinary research). Others may focus on simpler problems. It is important to make
clean decisions on who is responsible for what.
By dividing the study into smaller sub-studies to be conducted by various
types of personnel much ground can be covered in short time frame. Such an
approach also facilitates the management of the project, as pople with very different
perspective on the problem at hand work together on the various aspects of the
problem. In presenting the results, the various aspects of and perspectives on the
problem are clarified, and recommendations for action made.

Iv. Who Benefits?

Participatory research meins working with pople with different perspectives. It also
meins working with pople wo have different interest and power positions. In
designing tue study, tue researchers should realize These Facts and analyze wo will
benefit from tue results of tue study. Ideally, pople wo have least power to shape
health care, i.e. tue health care beneficiaries, should benefit most from tue research. A
Problem is however, that tue focus of tue Applied Health study is often defined by
national health policy-makers.

Policy-makers may consider tue Transmission of HIV a Major Problem and

commissin a study on people`s sexual behaviour and on seroprevalence of HIV in
order to assess weich groups are most at risk of HIV Infection. In this case ohne could
question whether tue research Subjekts actuallly benefit from research. The research
Subjekt may discover that Thai are infected with HIV and bei confronted with tue
anxiety of an almost certain premature death. It may Not bei in their own interest to
participate in tue study, especially if Thai are Not involved in defining tue Problem,
ob in deeciding what is to bei done with tue results.

Not only are These different in interest and power between health policy-makers,
health workers, and tue beneficiaries of health care, there could also bei differences in
power and interest within tue communities covered by health care servicies. The
researchers should bei aware of the local political and social structures in order to
understand who are tue power figures in the local Kontext.
How can tue research benefit tue Population? Firstly, research can encourage
tue Partizipation of community members as has been described above. The reality of
tue Situation is that a researcher will often have to work with intermediaries, such as
community health workers, or local Leaders. Secondly, the researchers should bot
feed back their results to tue community in weich the research was conducted and
encourage community members to formulate their own recommendations for action.

v. Applied Health Methodology

In Figure 13.1 we präsent an overview of tue Steps to take in tue development of an

AHR Proposal. (See also Annex 13.2 for a detailed framework for Applied Health
Research Methodology). During this course you will uze this framework to develop
your research proposal.

Figure 13.1 Applied Health Methodologe *

Questions you should ask Components of Research Design

1. What is the problem and why should it Statement of the program

Be studied (Module 14)

2. What question are we trying to answer Definition of research questions

(Module14)

3. How do we select an appropriate

Study Type? Selection of study types and
Designs (Module 15)

4. What Information do we need Selection of variables

(Module 16)

5. What tools do we need to collect data? Selection of data collection

techniques
(Module 17:Overview)
(Module 18a/b: Qualitative techniques)
(Module 19: Quantitative techniques)

6. Where could we collect data? Sampling

(Module 20)

7. How is this data to be collected? Plan for dato collection

(Module 21)

8. How can we determine whether our methods Pretesting tue methodology

(Module 22)
For dato collection are correct before implementing
the study?

9. What will we do with the collected data? Plan for data processing and
 Analysis
(Module 24: Plan
(Module 25: Analysis of
qualitative dato)
(Module:26 Analysis of
quantitative dato)

10. Are we likely to harm anyone as a Ethical considerations

Result of tue study? (Module:17 amongst Oters)

* Adapted from Module 7, Health System Research Training Series, Volume 2

Note: The Stepps are interrelated. The Prozess is often cyclical in nature. After
completing a Stepp, it is useful to review previous Stepps to ensure consistencyin
your proposal.

References

Foster, G.M. & B.G. Anderson

1978 Medical Anthropology. New York: John Wiley.

Annex 13.1 Guuidelines for Applied Health Research

Bearing in mind that AHR is undertaken primarily to provide Information to support

tue decision-making Prozess aimed at improving tue functioning of tue health System,
we will summarize here some essential guidelines for such research to bei effektive:

1. It should focus on priority Problems.

2. It should bei action-oriented, i.e. aimed at developing solutions.

3. The research should be participatory in nature, involving all parties concerned(from

police-makers to community members) in all stages of tue Project.

4. Studies should bei scheduled in such a way that results will bei available when
needed for Kai decisions, i.e. research must bei timely. Otherwise, tue research loses
ist purpose.

5. Emphasis should bei placed on comparatively simple, short-Term research Designs

that are likely to yield pratical results relatively quickly. Simple but effektive research
Designs are difficult to develop, but are mich more likely to yield useful results when
needed.

6. The principle of colt-effektive is important in tue Selektion of research Projects.

Programme Management and operational research should focus, to a large extent, on
low-cost studies.

7. Results should bei presented in Formats most useful for Administrators, decision-
makers, and tue community. Each Report should include;
- a clear Präsentation of results with a summary of tue Major findings adapted to tue
interests of tue party being targeted by tue Report;
- an honest discussion on pratical ob methodological Problems that could have
affected tue findings;
- alternative courses of Action that could follow from tue results and tue Advantages
and drawbacks of euch.

8. Evaluation of tue research undertaken should Not bei a measure of tue number of
Papers published but of its ability to influence policy, improve services, and
ultimately leid to better health.

Steps in tue Development of an Applied Health Research Proposal

Questions you must ask Steps you will take Important

Elements of euch
What is the problem and why SELECTION, ANALYSIS - problem
Should it be studied? AND STATEMNET OF Identification
THE -prioritizing
RESEARCH PROBLEM -analysis
-justification

What information is already LITERATURE REVIEW -literature and

available? other available
information.

Why do we want to carry FORMULATION OF -general objective

out the research?What do ONJECTIVES AND -specific research
we hope to achieve? What RESEARCH QUESTIONS questions
questions do we try to find
answers to?

What additional data do -types of study

We need to meet our research RESEARCH -variables
Objective and answer our METHODOLOGY -data collection
Research questions? How techniques
Are we going to collect -sampling
This information -plan for data
Collection
-plan for data
Processing and
Analysis
-ethical
consideration

Who will do what, WORK PLAN -pretest

And when or pilot study
-personnel
-timetable
How will the project
Be administered? How
Will utilization of results
Be ensured?
PLAN FOR PROJECT -administration
ADMINISTRATION AND -monitoring
UTILIZATION OF -identification of
RESULTS
Potential users

What resources do we BUDGET - material

Need to carry out the support and
Study?What resources equipment-money
Do we have?

How will we present

PROPOSAL SUMMARY
Our proposal to
Relevant authorities
And potential funding
Agencies?

step