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SEX-RAR Guide

The Rapid Assessment and Response Guide on
Psychoactive Substance Use and Sexual Risk Behaviour

Mental Health: Evidence and Research
Department of Mental Health and Substance Dependence
Noncommunicable Disease and Mental Health Cluster,
World Health Organization

WHO Library Cataloguing-in-Publication Data
SEX-RAR guide : the rapid assessment and response guide on psychoactive
substance use and sexual risk behaviour.
1.Substance-related disorders 2.Sex behavior 3.Psychotropic drugs
4.Risk assessment 5.HIV infections – prevention and control 6.Harm Reduction
7.Health promotion – methods 8.Manuals. I.World Health Organization.
ISBN 92 4 154558 5
(NLM classification: WM 270)

© World Health Organization 2002
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CONTENTS

Acknowledgements v

Abstract vii

1 Introduction 1

2 Key concepts 5

3 Preparation stage 37

4 Assessment stage 53

5 Response stage 73

6 Methods and Tools 81

References 121

Annex 1 Assessment frameworks 131

Annex 2 Example RAR report 135

iv Acknowledgements SEX-RAR Guide .

was undertaken by Dr Andrew Ball and Dr Gundo Weiler from its inception in the late 1997 until November 1999. The overall management of the project. Mr Werasit Sittitrai. Jacobo Schifter-Sikora and Godfrey Woelk and revisions following the field-testing were coordinated by Mr Chris Fitch. Dr Andrew Ball. Acting Programme Manager. Stimson1 1 The Centre for Research on Drugs and Health Behaviour. Mr Alan Greig. Substance Abuse Department (October 1998-March 2000) and Dr Benedetto Saraceno. UK 2 Department for International Development HIV/AIDS Knowledge Programme. The work on psychoactive substance use and sexual risk behaviour. Mr Mark Davis. Imperial College of Science. Programme on Substance Abuse (June 1996-July 1998). UK Technical contributions and comments on this guide were provided by Professor Moruf Adekan. The field-testing of the draft version of the guide was carried out by Professors Gabriel Bianchi. Mrs Mwansa Nkowane. with editing done by Dr Ali Hussein. Department of Social Science and Medicine. Director. Ms Sujata Rana. Dr Suresh Kumar. Chris Fitch2 and Gerry V. .SEX-RAR Guide Acknowledgements v ACKNOWLEDGEMENTS This guide was prepared for WHO/UNAIDS by: Tim Rhodes1. Dr Mario Argandoña. Technology and Medicine. Technology and Medicine. University of London. Financial contributions for this project came from the Joint United Nations Programme on HIV/AIDS (UNAIDS). Dr Mary Jansen. was carried out under the direction of Dr Alan Lopez. Acting Programme Manager (August-September 1998). and Dr Gundo Weiler. Imperial College of Science. including the development of this guide. The layout and presentation design was undertaken by Mr Ian Harris. Department of Social Science and Medicine. Mr Martin Donoghoe. University of London. Dr Shekhar Saxena. after which Dr Shekhar Saxena took responsibility with Mrs Annette Nkowane working as the focal person for the project. which included the initial draft of this guide. Department of Mental Health and Substance Dependence (March 2000-present). Director.

vi Abstract SEX-RAR Guide .

. programme field staff. the guide is comprised of six main sections: (i) key concepts – this describes the main principles of RAR. the guide aims to provide help in (a) identifying the relationships between substance use and sexual behaviour in the local area. where local resource constraints rule out more conventional research approaches. researchers. and to identify appropriate intervention responses in time and resource poor settings. advocacy. and describes the possible assessment tools and methods to use.SEX-RAR Guide Abstract vii ABSTRACT This guide describes how to use Rapid Assessment and Response (RAR) methods to both profile local substance use and sexual risk behaviours. and a list of additional supporting resources. (vi) appendices – this section comprises a number of technical annexes and resources such as assessment matrices and suggested reporting structures. and where agencies require information to develop.this section provides an overview of the topics and questions that a RAR may need to address. and (c) assessing the existing capacity and opportunities for intervention development. Written primarily for those individuals about to undertake. monitor or evaluate intervention programmes. organise or commission a RAR (including principal investigators. (iii) assessment stage . (v) methods and tools – this section describes a range of qualitative and quantitative techniques which are used in RAR approaches. (b) describing the adverse health consequences associated with these behaviours. To achieve this. and programme and policy action. (ii) preparing for RAR – this introduces the key steps of planning a RAR and discusses the issues that may arise at each step. and key community stakeholders). RAR approaches are typically employed in situations where data are needed quickly. The guide also contains an overview of current research knowledge on the relationship between substance use and sexual risk behaviour. (iv) response stage – this considers how findings from the RAR can be used to inform intervention developments.

viii Chapter 1 Introduction SEX-RAR Guide Introduction .

SEX-RAR Guide Introduction Chapter 1 1 Introduction 1 INTRODUCTION .

monitor or evaluate health the country. 2 Chapter 1 Introduction SEX-RAR Guide 1 INTRODUCTION Introduction Rapid Assessment and Response (RAR) is a assumed that investigators are familiar with method designed to generate information to core social science research methods plan and develop health policies and (although references are. It is important health consequences of sexual risk behaviour to have an understanding of these in order to related to substance use design and implement an effective RAR. RAR relies on: planning and developing appropriate ● a set of tools and methods intervention responses. principal investigators. managers of the rapid ● assessment stage . relevant data to assessment of the local situation. This guide helps to: ● identify the relationships between substance ● a set of skills and attitudes within the team of use and sexual behaviour people carrying out the assessment (the "RAR team") ● describe the extent and nature of sexual behaviours associated with substance use ● a set of processes (such as planning.this section outlines the assessment team. implement. however. programme range of topics and questions that a RAR may field staff. context. is a necessary requirement for To do this. city or community) ● key concepts – this section describes the main (b) develop interventions to reduce the adverse concepts on which RAR is based. given to programmes. to develop locally appropriate interventions This document provides practical guidance on using RAR to: Using this guide (a) assess the current situation regarding substance use and related sexual behaviour The guide is divided into six sections: (within a country. consultation and assessment) within the ● be aware of the adverse health consequences assessment that help to identify and respond to associated with this problems related to substance use and sexual ● outline existing resources and opportunities for behaviour interventions ● understand the need and feasibility. placed in develop. city or specific community programmes. and programme managers. as well as Aims of this guide the resources and actions required. as well as specific health additional technical guidelines). It is need to address and the possible assessment .1-3 RAR is typically used in situations where: The purpose of this guide ● data are needed extremely quickly This document provides guidance on using ● time or cost constraints rule out the use of RAR to assess the current situation regarding other more conventional research techniques substance use and sexual risk behaviour. An ● organisations require current. ● preparation stage – this section looks at the key These guidelines are written for those people steps of planning a RAR and discusses the issues organising or undertaking a RAR including: that may arise at each step. interventions and services. researchers.

individual’ beliefs and provides a referenced review of the behaviours. substance-related problems (including injecting drug use) Audience ● the International HIV/AIDS Alliance guidelines HIV and Drug Use: A Toolkit on Participatory The guide is designed for use by Asessment and Response (contact the website organisations and groups who wish to plan www.4 This document provides a technical technical annexes and resources such as summary on the role. This networks. including citations to key published reports and case examples. This guide therefore aims to provide Response Guide on Injecting Drug Use (Draft for RAR teams with a set of tools which should be Field Testing. in order to 2000) of the International Journal of Drug enhance or develop health promotion and Policy entitled Rapid Assessment and harm prevention and programmes for Response. licit and illicit. planning programme and policy action on the basis of the findings of the assessment. international research literature on the economic and cultural contexts. This section should be places considerable emphasis on the risk of used in conjunction with the section of the guide HIV infection associated with sexual Introduction on methods and tools (chapter 6) to plan the behaviour related to a range of patterns of assessment activities.5 This document pharmacology.SEX-RAR Guide Introduction Chapter 1 3 tools and methods to use. substance use. comprising Evidence (UNAIDS. how to use it.RARarchives.aidsalliance. structures.nl/locate/drugpro. rationale and assessment matrices and suggested reporting background of RAR in HIV prevention. non-injecting and injecting. selected and adapted according to ● the website www. No single RAR connections between different types of substance use and sexual risk behaviour. ● appendices – this section comprises a number of 2002). Prevention: Principles and Practices (UNAIDS. why to use it. This useful readings and resources. guide could – or should – cover all of these ● the WHO guidelines on Rapid Assessment and issues. 2002).com)7 an assessment of the relationship between ● The special issue (volume 11. their families and social website www. and notes of of Rapid Assessment and Response in HIV interest.8 copies of which are available from UNAIDS Publications Department and via the substance users. and the influence of social. At the outset. These guidelines are supported by: Each method/tool is described in terms of what it ● the UNAIDS Best Practice document The Role is. Other resources ● methods and tools – this section describes the methods and tools that can be used in a RAR. The guide may also be used by document comprises over 20 commentaries those who are providing technical support to and papers on the use of RAR in the substance such organisations and groups.org contains the characteristics of the local situation. WHO. dependent and ● response stage – this section looks at ways of recreational. . it is important to note that the ● the UNAIDS Best Practice document Substance relationship between substance use and sexual Use and Sexual Risk Behaviour: A Review of the risk behaviour is a complex one. issue 1-2. 1998) 6 reviewed.elsevier. including document is designed to assist the RAR team guidelines on undertaking RAR on other in their thinking and discussions. March substance use and risk behaviour. The guide use field.

4 Chapter 1 Introduction SEX-RAR Guide Introduction .

5 Substance use and sexual risk behaviour .1 Rapid Assessment and Response (RAR) 2.3 Assessment frameworks 2.SEX-RAR Guide Key Concepts Chapter 2 5 2 KEY CONCEPTS Key Concepts 2.4 Community participation 2.2 Intervention development 2.

being prepared to analyse data as it is collected. and when there over a short period of time. Africa and Eastern Europe specific health interventions and services. pragmatic collection and use of data. the community or target population in which work is being conducted through mistakes or Principle 1: rapidity poor judgement. underpin RAR: Depending on their aims. Rapid constraints mean that conventional research assessments therefore aim to be completed techniques are impractical. evaluating intervention responses.making contact with important organisations. most rapid assessments take This leads to the five key principles which approximately three months to complete.1-3 pays testament to this. Time is of the RAR is typically used when data are needed essence when tackling rapidly unfolding quickly. as well as informing Southeast Asia. however. when resource or logistical social and health problems. as well as for collecting these core principles. 6 Chapter 2 Key Concepts SEX-RAR Guide 2 .allocating time for discussion and reflection on Whilst most assessments will adhere to what is being found. development and enhancement of practical rather than at the end of the project intervention responses .1 Forming the RAR team What is RAR? of new patterns of substance use and associated problems may occur more Rapid Assessment and Response (RAR) is a Key Concepts rapidly than the time required to undertake method used to generate information which conventional social science research. and regularly problems. The can help plan and develop health policies rapid spread of HIV infection in parts of and programmes. typically taking is a recognised need to use assessment as weeks and months. data collection and validity by using multiple methods in combination with multiple data Working rapidly and effectively requires: sources . or sometimes longer ● multiple methods – RAR seeks to maximise durations (with one study registering 486 days). The diffusion related to the RAR ought to be identified in . Any potential ethical issues The first principle is rapidity. rather key informants and data-holders in advance than attempts to attain scientific perfection where possible ● action oriented – RAR gives priority to the . enhancing or and years. in practice each of data these will be interpreted according to local Working rapidly can sometimes cause needs and context. rather than quarters a means for developing.sound planning and preparation ● practical adequacy – RAR gives priority to the . it is not ● rapidity – RAR aims to produce data and an uncommon for assessment to be undertaken action plan quickly over either much shorter periods of time (nine ● resource effectiveness – RAR aims to be cost days in the case of a 1998 UNAIDS effective in terms of human and time resources assessment in Kyrgystan). Harm can inadvertently be caused to supplemented with additional objectives. In practice.

or simply misinterpret questions. and can prove expensive. and rich descriptions of However. experience indicates that large-scale individual experience. present. critics have groups to collect complementary data which questioned the extent to which such methods can either inform survey design or explore can replace large-scale quantitative surveys. However. Employing a Consequently. meanings and actions. . Typically. specific issues in more detail. The third principle of RAR is or sexual behaviour because: therefore the importance of using multiple . limit their answers according to option for undertaking assessment and the relationship they have with those developing intervention. More rarely. surveys are not always feasible or practical: RAR studies are specifically designed to ● logistically. rather than complex situations. these have been reliability. this design is not particularly useful for situations where researchers want to Principle 3: multiple methods understand and explore individual experience. validity and representativeness of incorporated into large-scale quantitative surveys in the form of interviews and focus the data produced.SEX-RAR Guide Key Concepts Chapter 2 7 advance. detailed. methods and data-sources.general population or household surveys will methods and data sources to produce a only identify a small number of problematic more complete description of the local drug users. such surveys are usually combination of qualitative and quantitative completed at regular intervals. situation: . such surveys typically ask aim to address specific questions which extremely precise research questions. in- which have traditionally been seen as a depth qualitative and ethnographic research corner-stone in the development of public has been undertaken which provides health programmes and policies. applying RAR to simple and clear research questions. and resource poor’.even those large surveys which target drug to be prepared. This highlights the benefits of users can be time or resource consuming and cannot usually employ random sampling. frequently require a considerable investment of time and human scale surveys in situations which are ‘time resources. reluctance to use RAR-type One response to this situation has been the approaches in the public health field has increasing interest in qualitative research been grounded in concerns about the methods. Historically.such surveys only describe reported behaviour. such surveys are usually not an problems. and strategies to deal with them need . important. Principle 2: resource effectiveness individuals may under or over-report certain Key Concepts RAR aims to provide a resource effective behaviours. such surveys can often be complex collect data which can complement large- to organise and undertake. In particular. particularly those that are sensitive effective method of collecting data on sensitive or ‘hidden’ behaviours such as substance use or ‘hidden’. Such a can be fed directly and quickly into design allows a large amount of comparable intervention and programme development. data to be collected and analysed. A single method or data source cannot perception or behaviour. such studies ● methodologically. Without careful methodological checks. describe all aspects of complex social ● finally.

conflicts in the same research study is useful for or consensus between data sources. data collection should be The work highlighted that supposedly well guided by another concept: induction. In this way. This revealing different aspects of the topic under process of checking is called triangulation. the unsystematic and unthinking identify which sexual terms were most collection of data is not the sole aim of a appropriate to use in the survey instrument. this process of assessment is inductive research approach is also guided by four additional concepts: employed in rapid assessments.although triangulation is qualitative methodologies were used to help important. It is known terms such as ‘vaginal sex’. different research skills. investigation. methods makes it possible to identify reliable and valid. the line of enquiry informant interviews) against one another followed in a rapid assessment is mainly before conclusions are made.getting two researchers to examine the same low. and holism. 8 Chapter 2 Key Concepts SEX-RAR Guide ● using more than one method or data source possible to check for contradictions. often useful to identify some of the major and ‘heterosexual’ were not properly understood by a sizeable number of the research questions to be addressed before a British public. than investigations that information that might have been missed if a use a single research method or data single method had been used. These include: about a topic. or in different seasons. an Significantly. For example. This makes it determined through the critical examination . different information than a quantitative There are a number of different ways of Key Concepts survey would. Focus groups with injecting drug users subject and compare their findings. in a recent British national survey of sexual attitudes and lifestyles. Because of this. community involves a process of developing research consultation. improving validity aside from using different ● as well as revealing different information methods or data sources. modified to help explain these terms. questions and drawing conclusions as the Triangulation . However not all research questions can be identified in this way. interviews or Triangulation simply means examining things focus groups with street children on sexual behaviour would be likely to provide very from a number of different perspectives. Using multiple RAR methods are arguably more rigorous.undertaking research at different times of the statistics may suggest that the prevalence of day and night. research methods. and then actively data sources allows the RAR team to searching for information that confirms. The survey tool was therefore RAR begins (the ‘deductive’ approach). may indicate that very few of them have ever been offered testing for HIV-1. These and other ways of improving ● multiple methods can also be used to inform validity are discussed in the module on the use or development of another method. Induction .using multiple methods and data are collected. HIV-1 among injecting drug users is relatively . and some will only Additional guiding concepts become clear as new discoveries are made during the assessment. RAR. source. For example. continually check findings from different denies or modifies these conclusions and sources (such as government reports or key hypotheses. induction. be aware that each method can . an examination of official .using people in the research team who have conceal or miss potentially important data. Instead. This triangulation. For example. ‘oral sex’.

to understand the wider influence of the then it might be useful to examine existing community and the social and economic data sources. RARs are primarily undertaken to assist in decision-making about the need. situation. Health problems that are ● the influence of external factors .a substance use and sexual risk behaviour. lack of new data may be due to the RAR team Rapid assessments do not only focus on the using similar methods. This refers to any action which . Community consultation . consultation is important and can help Knowing when to stop using a particular identify and involve key local people with a method or to stop following a line of responsibility for developing interventions. The practical relevancy and applicability of the RAR team could consider: assessment. is key. For example. The utility and intervention development. identifying when this point of community who can help increase the saturation has been reached is not easy. the collection of too much data degree of flexibility. but also attempt focus groups and interviews have been used. if only activities of the individual. multiple perspectives and understandings resulting in studies that either collect too Key Concepts that different groups – such as drug users.holism is important in then consider using a different method. Rapid assessments RAR is an orientation to response and are not an end in themselves. can delay this decision-making process. This community thorough. The term success of local rapid assessments should be ‘intervention’ effectively means to act in a judged as much by their adequacy for manner which affects the outcome of a decision-making as their scientific rigour.SEX-RAR Guide Key Concepts Chapter 2 9 of the data.if the team have they feed directly into local intervention already used a large number then it’s responses at the community level. If only one or two have been used Holism . active participation of key people in the local In practice. or local residents – can too long to complete. The impact of local rapid ● how many different types of methods used so assessments are likely to be greater when far to research this topic . In these situations it is often useful to temporarily stop following a line of enquiry Principle 4: practical adequacy and return to the investigation at a later point. understanding the relationship between ● what types of methods have been used . in an attempt to be have on a situation. gather too detailed data or take health providers. feasibility and Principle 5: action-oriented relevance of interventions.often new emerging or rapidly developing may be data is not produced because of the influence of other factors (such as interviews being linked with the structural and economic conducted when street children are wary of situation of a country. probably a good idea to investigate a new line of enquiry. city or community.as well as Some assessments are unable to achieve drawing on multiple methods and data this and instead attempt to impose sources. giving the RAR team a large In a RAR. environment. much data. enquiry and to move on to another area of Rapid assessments should encourage the investigation. the RAR should also document the inappropriate methodological standards. strangers).

there Is RAR a new method? was ‘explosive’ HIV spread in the Ukraine.12 substance use among young people. their thinking.7 and applied strategies which: epidemiological studies. varying The RAR team should use this guide to from country to country. RAR are already used in social science research more generally.13 (structural change.9 water Key Concepts change) hygiene. the method communities to change (community change) has been used since at least 1993 by international agencies. This has included or cultural level alter the environment in which assessments focused on injecting drug substance use and sexual behaviours occur users. This includes development anthropology. The RAR team will It is now recognised that there are specific probably be familiar with some elements and intervention approaches which are effective concepts in this guide. cultural. economic. political. treatment or policy. It is important to remember RAR is not a new the Russian Federation. selected and adapted according situations. national and local ● at a legal.14 health promotion.8 The approach has also ● directly aim to help individuals to change their been applied to a diverse range of public health substance use and sexual behaviour (individual problems including cervical cancer. religious governments and NGOs. social and public health responses to substance use problems are RAR: case study: Ukraine15 also influenced by the local situation. reports of HIV infection among IDUs. risk reduction.11 ● aim to help the norms and practices of ● within the substance use field. religious and from a RAR conducted in Eastern Europe. Without this HIV epidemics in the Newly Independent ineffective. there was little evidence of the local situation exists. Substance use and its associated to the characteristics of the local situation. 5 related to substance use. harm ● some of the tools. skills and processes used in prevention. inappropriate or unacceptable States of Eastern Europe and virtually no interventions may be put into place. social. between social groups. Similarly. it and logistical activities. assist. Moldova. and by This section provides a case study taken social. Belarus. . political. 10 Chapter 2 Key Concepts SEX-RAR Guide either helps reduce or prevent adverse health ● outside of the substance use field. and also changing ideas and discussions. method: 4-6 and Kazakhstan. ‘total solutions’. However. this guide provides However. adverse health problems are diverse. over time. is essential that a thorough understanding of Prior to 1994. between 1994 and 1998. economic factors. the same approach to intervention RAR teams with a set of tools which need to cannot be simply reproduced in all local be reviewed.10 and diabetes. Before an intervention or and aims to highlight key methodological policy can be applied to a specific setting. RAR-type consequences and sexual risk behaviours approaches have been used since the late 1970s in disciplines such as rural sociology. rather than replace. in preventing HIV infection and other adverse Remember that RAR guides do not provide health conditions among substance users. Instead. between areas. HIV cases in the Ukraine. social and cultural change) and the development of HIV prevention These interventions may be targeted towards services for ethnic minority populations.

although this incidence of injecting-related HIV potential for future response development. extent and nature of substance use or sexual behaviour.SEX-RAR Guide Key Concepts Chapter 2 11 for example. health and social care needs. including prevalence among IDUs had risen to 31% in those not in contact with agencies and services.442 new HIV working – directly and indirectly – with such cases reported in 1997. and prevalence estimation drug use (including sexual behaviour) and to techniques. focus groups. jumped from 44 in 1994. It is clear specific tasks during the assessment. the epidemic was still considered to be in its early stages. geo-social the adverse health consequences of injecting mapping. medical. observations. By January opportunity to make contact with hidden 1996. incidence of sexually transmitted infections The majority of the team members conducted (STIs) in the general population. medical organisations. was increasing. . 5 NGOs. agencies or institutions in the . 5 law enforcement and intervention developments. agency representatives. three years. to 15.apart from official registered cases of enforcement.the region was experiencing increasing reports RAR) to plan the RAR. drug users. as and 5 members of the local community. HIV The RAR team was comprised of 12 prevention measures had the potential to have influential individuals representing local greater impact. and are enhanced by. and identify the . relatively little was known about the media outlets. public health bodies. government. Details are given below: improve existing knowledge about associated Interviews were conducted with 12 injecting risk behaviours. epidemics of STIs. These individuals surpass a prevalence threshold of 40% worked in social research. with the from international evidence that once HIV assessment being overseen and conducted by prevalence among IDUs reaches 10% it can a core team of 5-6 people. findings or problems. 6 religious authorities injecting drug users in non-treatment settings. in the South of the Ukraine. The RAR attempted to document and reduce review of existing data sources. Key Concepts Odessa and 57% in Nykolayev. 10 clinicians. NGO and within one or two years in as many as two to commercial organisations. discuss any emerging of HIV related to drug injecting. with well as establishing links between organisations no reports among IDUs. Methodology and sampling Aims The RAR employed interviews (semi- structured).17 HIV epidemics associated with A Community Advisory Body (CAB) was also IDU intersect with. 5 journalists and media The RAR also aimed to make contact with representatives. HIV populations of injecting drug users. or the future need for interventions. law . formed. 16 The rapid HIV spread among IDUs in Ukraine Composition of the team coincided with dramatic increases in the The RAR team was comprised 17 individuals. and HIV/AIDS. This aimed to provide an opportunity for RAR team members and local individuals The rationale for undertaking the RAR was (who represented the interests of based on the following three issues: communities. of which the populations. The RAR created an important majority were among IDUs.

This likely sources of information. health and social care the first time and agreed to meet on a monthly professionals. Such mapping was considered as Existing data on HIV prevalence. as well analysis of existing This mapping exercise was informed by legislation was done. with structured undertaken using snowball and network observations of drug use and preparation being conducted to identify user understanding of risk techniques. newspapers. law enforcement agencies. as well as media and legislative geographical districts. and one focus The first month: This month was devoted to group of public agencies and religious team training. This mapping A mapping exercise was conducted. media representatives and members of the local community. conducted on a key informant basis. planning fieldwork. The CAB also met for its well as drug users in contact with treatment second meeting. active in the substance use field and variety Fifth month: provided the last period of of cultural sub-populations. basis. interviews and focus groups with drug users. private accommodation) where substances The second month: Involved the RAR team were prepared and used. located and with sites where drugs were either sold or used. Observational work began in agencies. 12 Chapter 2 Key Concepts SEX-RAR Guide Five focus groups were conducted with 30 Timetable injectors (which in conjunction with the unstructured interviews made 42 contacts with In total. Sampling of drug users was project month three. with individuals being purposively selected on the Fourth month: analysis of existing data and basis that were considered the most able and documentary sources begin to take shape. involved data analysis of routine HIV prevalence sampling was aimed to reflect the diversity of data. the RAR was conducted over an eight IDUs). with analysis of . However. In addition. focus groups and with treatment services were recruited. range of organisations documents related to substance use. the first of the Target sample groups included injecting drug 46 unstructured interviews was conducted. Drug users not in contact Third month: mapping. beginning to map the local area. Other participants were behaviours. the formation of the CAB and Key Concepts organisations. During the second project month. needle exchange points. as well as potential studies on youth behaviour were analysed. as users (the primary focus of data collection). The CAB met for drug service workers. Over the course of the RAR it Observations were conducted in five areas near was agreed that the CAB would meet five times to needle-exchange services. content analysis of reports in 4 popular locations for future intervention development. was the first of 9 focus groups. treatment centres and needle-exchanges were possible sites of drug use (students and factory hostels and drug dens) and supply. treatment data. important in identifying potential areas for police data and information from previous recruiting study participants. as interviews continued. fieldwork and data collection. and in 10 public and would then meet regularly after RAR and private areas (such as apartments and completion to monitor and guide any outcomes. three groups comprising in total 20 month period: clinicians and medical workers. identifying aimed to familiarise the team with areas where narcological clinics.

the skills-base of the local community demonstrate that such interventions are . . short are likely not to succeed. 2 . The emphasis in RAR on working with rapid assessment can improve: such ‘difficult to reach’ groups can be used to . or longer case studies. planning and undertaking the option. interventions. on preparation of a large seminar and Sixth month: focused on translating collected conference in month eight. feasibility in positions of power to fund or support such and relevance of interventions. the assessment period. responses to reducing local health problems. with qualitative ● identifying appropriate interventions – RAR can data being powerfully employed to give a ‘human help to identify appropriate and feasible voice’ to the experience of substance users. This may occur during.are not considered to be a viable them in defining.repeated over time. educational.in ● strengthening community action .2 Intervention Development How can RAR inform interventions? ● providing persuasive data – RARs aim to produce data which can be used not only to identify RARs are primarily undertaken to assist in needed interventions. biographies. the fifth CAB meeting was extended recommendations to media. There are at programmes. This would be used Key Concepts data into a comprehensive RAR report. as well as may help to identify and evaluate the impact of after. Emerging Seventh month: RAR report and information from the RAR on user risk behaviour recommendations were submitted to the was also disseminated to key stakeholders and funding body. understanding opposition – for a particular where feasible.RARs can be some countries. development of interventions as soon as ● monitoring impact . RARs possible. but also to persuade people decision-making about the need. During to communicate RAR findings and this month. The CAB continued to meet even media outlets as part of an initial prevention though fieldwork had finished. engage in discussions about future response and to begin planning future response development for drug users.such as outreach organisations from the community and involving programmes . RARs should lead to the intervention. development. .help to create community support – or ● leading to rapid intervention development . ● demonstrating interventions are possible . interventions and avoid situations where health professionals and other key individuals resources are invested in interventions which through the use of direct quotations.increase the quality of the research findings possible.SEX-RAR Guide Key Concepts Chapter 2 13 quantitative and qualitative data. it is often wrongly assumed viewed as partial interventions themselves since that contacting substance users outside of they can help mobilise and strengthen community treatment or service settings is not possible. The collation of multiple data-sets least six different ways in which RARs can allows both a quantitative overview of the extent and nature of the local substance use situation to inform intervention developments: be presented to policy makers. The Consequently. interventions involving process of bringing together key individuals and community-based work . with an emphasis campaign. to involve local NGOs who were invited to medical and law enforcement representatives.

An NGO proposed that alcohol users should be educated about sexual HIV transmission risks through peer education programmes. The group was also successful in identifying some existing resources for distributing condoms to street children before the rapid assessment was completed. heroin users and injectors) are ‘hidden’ from outreach and health workers. certain groups (for example. OBSTACLES TO INTERVENTIONS The rapid assessment identified one of the most important obstacles to the effective promotion of safer sex in the bar setting to be the refusal among some bar-tenders to sell or distribute condoms. The intervention used targeted information-giving in bars. interviews in the rapid assessment found that in this particular community talking explicitly or openly about sex in public settings was considered socially inappropriate and unacceptable. This happened once every three weeks throughout the 12 week assessment. representatives from non- government organisations. but was also based in health centres. it has been decided that the advisory group should continue to develop community- level interventions for substance users based on the rapid assessment Action Plan. to a local advisory group consisting of health practitioners. Now that the rapid assessment is completed. 3. 2. different groups of substance users occupy different parts of the city and they are very spread out. APPROPRIATENESS OF INTERVENTIONS Key Concepts Rapid assessments can identify the appropriateness of interventions. Second. as they emerged. This meant that the advisory group was able to act on the rapid assessment findings as soon as possible. FEASIBILITY OF INTERVENTIONS The rapid assessment indicated that outreach interventions targeting substance users would need to be carefully targeted if they were to be feasible. CAPACITY BUILDING AT LOCAL COMMUNITY LEVEL It was decided that the rapid assessment team would report key findings. It was also recommended that condoms be distributed. However. doctors. but suggested an alternative intervention to raise women and men’s awareness about the negotiation of condom use in long-term and short-term relationships. and members of the local HIV prevention committee. drug and STD clinics. 4. Proposed interventions to allow condoms to be sold in bars will not be properly effective until bar tenders are encouraged to participate. The rapid assessment advised against peer education in bar settings. The rapid assessment recommended that the feasibility and effectiveness of outreach would be increased if some peer involvement from substance users themselves was encouraged. 14 Chapter 2 Key Concepts SEX-RAR Guide EXAMPLES Rapid assessments can be informatitive on many issues: 1. . The rapid assessment recommended a training programme for bar-tenders. First.

community. guide the assessment. This is achieved by developing multi-level Principle 2: incremental and interventions to bring about changes in risk hierarchical approach factors and risk behaviours. ‘Multi-level’ indicates that interventions will be at the A ‘public health’ response emphasises the levels of the individual. the prevention of ‘risk behaviour’ among substance users) and ‘tertiary prevention’ (for example. RAR is an integral component of RAR aims to use this evidence to rapidly response and intervention development. ranging from the primary prevention of substance use and associated ‘risk behaviours’ to education about the harms associated with continued substance use and risk behaviour (secondary prevention) to treatment and care associated with substance use related problems (tertiary prevention). They combine ‘primary prevention’ (for example. responses are therefore designed to: particularly among populations most ‘at ● assess the risks and harms to health risk’. At the local level. need for interventions to focus on the environment and policy. community. assessment. ● identify and prevent the individual. . A rapid response to emerging public health problems may need to give immediate or greater priority to public education (secondary prevention) at the same time as developing interventions on prevention. treatment and care. the prevention of substance use). including HIV prevention. The respond to emerging public health problems ten principles of effective public health with the aim of preventing risks and harms to responses outlined here should be used to individuals and populations. interventions may adopt a hierarchy of aims and objectives. there is now a wealth of research and evaluation evidence which Principle 1: sound assessment supports the effectiveness of a public health Effective responses are based on sound Key Concepts approach to preventing the harms associated with substance use. These are summarised below: In many countries.SEX-RAR Guide Key Concepts Chapter 2 15 What is an effective intervention There are ten main guiding principles to approach? developing such rapid and effective public health responses. policy and environmental factors associated with the risks and harms of substance use Principle 3: pragmatic approach ● focus on populations at risk and not only A public health approach emphasises the individuals who are already infected or unwell importance of rapidly responding so as to EFFECTIVE RESPONSES REQUIRE AN INCREMENTAL AND HIERARCHICAL APPROACH Effective responses adopt an incremental approach to behavioural change. with ‘secondary prevention’ (for example. the prevention of ill health among HIV positive substance users). The underlying assumption is that it is associated with substance use cost effective to prevent adverse health consequences among ‘at risk’ populations ● minimise or prevent the risks and harms associated with substance use before harm or illness occurs and before treatment interventions are required. Public health reduction and prevention of ‘risk factors’.

Furthermore. Pragmatic behaviour. there may be greater difficulties in encouraging behaviour change. sexual prevention of substance use itself. This may require that the These principles governing behavioural change reduction of risks associated with substance may be applied to all public health problems. use is given greater immediate priority than the including those related to substance use. services. legal and structural context. influence how individuals behave. it may be difficult to develop public health responses or risk reduction interventions. communities. and improving individuals’ negotiation also the practical means and personal skills to skills around condom use (personal skills). This can include the Interventions targeting individual behaviour distribution of condoms and clean syringes. the prevention of HIV epidemics and integrated interventions to promote health the reduction of HIV transmission. but means). INDIVIDUAL CHANGE (interpersonal context) Behaviour change is influenced by individuals’ awareness and beliefs about the risks to their health. the development of community- oriented interventions. or change are likely to be more effective if they providing treatment for drug problems (practical provide people with not only the knowledge. improvements in the provision of health Principle 4: multiple and integrated services. Where there are punitive drug laws or an absolutist reliance on abstinence from substance use. particularly if this is in the context of an emphasis on law enforcement approaches to particular substance use and sexual practices. the development of strategies supportive public and health policy and The need to encourage change at the levels of changes in the legal. by their intentions and motivations to change their behaviour and by the capacity they have to make behaviour changes happen. Principle 5: means for behaviour change change their behaviour. social and political individuals. Peer group norms. through individual behaviour change. and HIV/AIDS. COMMUNITY CHANGE (social and cultural context) Individual attempts at behaviour change are influenced by the views and actions of the social groups to which individuals belong and the social settings in which substance use and sexual behaviours occur. where there are constraints on health resources. Effective responses at approaches emphasise practical need . substance use. A public health response environments and policies are core underlying considers how these factors interact together. 16 Chapter 2 Key Concepts SEX-RAR Guide prevent health risks and harms associated with principles of an effective intervention response. .for the local level consist of a ‘package’ of Key Concepts example. for example. environment. for example. RESPONSES REQUIRE MULTIPLE AND INTEGRATED STRATEGIES POLICY AND ENVIRONMENTAL CHANGE (structural context) The effectiveness of interventions targeting individual and community change are influenced by the wider policy.

treatment and care).are a consequences of substance use may have necessary component of interventions targeting limited contact with existing health ‘hidden’ populations. the services provided (for example. needles. whether or not used syringes are returned and the numbers of syringes distributed).SEX-RAR Guide Key Concepts Chapter 2 17 EFFECTIVE RESPONSES PROVIDE THE MEANS FOR BEHAVIOUR CHANGE The distribution and exchange of clean needles and syringes to injecting drug users has formed the cornerstone of HIV prevention in many countries. . First. mixing ‘spoons’ or ‘cookers’. based in Key Concepts community drug projects. sterile water).involving local agencies and an effective means of delivering interventions organisations as well as non-agency as many people affected by the adverse approaches such as ‘outreach’ . Third. they Improving the availability and accessibility of need to be able to retain contact with target health services is a key feature of developing populations. the injecting equipment provided (for example. health services or pharmacies) or non agency-based (for example. services which are oriented to the target services need to be effective in making populations’ health and service needs. There are many different variations of syringe exchange. Second. EFFECTIVE RESPONSES REQUIRE CHANGES IN SERVICE DELIVERY Effective services are those which: ● are ‘user-friendly’ ● emphasise ‘low-threshold’ entry ● emphasise geographical accessibility ● emphasise a community-based response ● provide agency-based as well as non-agency-based delivery ● encourage client participation and involvement ● emphasise sustained and long-term support ● provide primary and secondary prevention as well as treatment ● are flexible to improvement and change Principle 7: community-based organisations. syringe exchange services may also provide education. cotton filters. and the rules of syringe distribution. exchange and disposal (for example. they need to provide an effective and pragmatic response. syringes. provided through outreach or by ‘mobile’ services). such as substance users. Principle 6: changes in service delivery contact with target populations. Such community-based Community-based intervention strategies are responses . They vary depending on whether they are agency-based (for example.

and communities operate within the legal and political environments. self-help or collective action groups) ● encourage or strengthen the active participation of local community members and substance users in planning and organising responses ● encourage the involvement of existing or new community organisations in planning and organising responses Principle 9: change in the social and individuals alone. a particular and sexual risk. condoms. Also called ‘street-work’. Community-oriented rural community). Evaluation also indicates that current or former substance users may be particularly effective outreach workers since they have good access and credibility with target populations. EFFECTIVE RESPONSES ARE COMMUNITY-ORIENTED A community-oriented response thus aims to: ● encourage community-wide changes in attitudes to substance use ● encourage community-wide changes in substance use behaviours ● introduce or strengthen interventions which encourage group behaviour change among substance users (such as peer education. treatment services. It is constraints of the wider social and political misleading to assume that by targeting environment. a particular community (for changes in responses. Effective public health . or a combination of these. and that outreach can provide an effective means of delivering prevention. This is because individuals approach is also dependent on the social. interventions will political environment necessarily create the conditions required to prevent problems with psychoactive The relative success of a public health substance use. 18 Chapter 2 Key Concepts SEX-RAR Guide EFFECTIVE RESPONSES ARE COMMUNITY BASED One of the most effective methods of reaching ‘hidden’ populations of substance users is through ‘outreach’. Evaluation shows that outreach can be an effective method for making contact with substance users with no previous or regular contact with health services. and to an extent. a particular behaviours associated with substance use geographical locality (for example. health promotion. Outreach is a non-agency or ‘street-based’ method of delivering interventions to people who are out of contact with existing services. injecting drug users). Principle 8: community-oriented interventions may target members of a general community (for example. attitudes and example. clean syringes) and encouraging risk reduction directly in the community. in A key feature of public health is the development of interventions which are encouraging attitude changes towards oriented to bringing about community-wide substance use). outreach is usually undertaken by community health workers who have good access to substance users and who are Key Concepts capable of providing prevention materials (eg.

SEX-RAR Guide Key Concepts Chapter 2 19

responses need to target the structural level interventions for injecting drug users (this
in order to enhance factors that help prevent was evident in the good relationship
psychoactive substance use and associated shared by the research team, the
risks, and to make changes that hinder authorities, the public attorneys and the
effective prevention and risk reduction. politicians of the city).
- because a series of basic HIV prevention

Key Concepts
Principle 10: policy changes interventions already existed in the city
At the political level it may be necessary to which could be built upon.
seek support for interventions that might
otherwise be seen as inappropriate. In some Aims
countries, for example, there may be laws The rapid assessment aimed to collect data
which make outreach work with substance which would inform the development of HIV
users or sex workers difficult. Public policies prevention. This required collecting information
both influence the adverse consequences of which embraced substance use, sexual
substance use as well as the likelihood of behaviour, and drug user knowledge of existing
developing effective public health responses. interventions and harm reduction activities.
International evidence associates the
prevention of adverse consequences Team, timetable and tasks
associated with substance use with pragmatic
The RAR was conducted by a research team
policy developments oriented towards the
of six people, with additional fieldworkers. It
preservation of public health.
took the research team approximately one
week to organise and prepare instruments,
RAR: case study: Brazil1
eight weeks to complete fieldwork and 12
This section provides a case study of a RAR weeks to analyse collected data. During this
conducted in South America and details the time, an extensive amount of existing data
use of rapid methodologies to develop were collected and 45 interviews and 4 focus
interventions which can reduce drug-related groups (with 42 participants) were
harms. There is increasing concern about the undertaken. Only one researcher was able to
spread of HIV related to substance use in dedicate a large amount of time to the
South America. This case study focuses on assessment (80 hours) and this was spread
the development of interventions following a across a variety of tasks. The other five
RAR conducted over five months. researchers worked almost exclusively on
data collection and analysis (around 40
Rationale hours). On reflection, the research team
agreed that if they could all have dedicated
The RAR was conducted for three main
themselves exclusively to the task, the rapid
reasons: assessment could have been accomplished
- a lack of data about drug use and HIV in around 6 weeks.
prevention The involvement and support of the community
- the existence of a political will and was felt to be important to the rapid
commitment to developing public health assessment’s success. To help achieve this,

20 Chapter 2 Key Concepts SEX-RAR Guide

an Advisory Community Council (ACC) was The process of intervention development was
organised. This group was created to steer the initiated through discussion with community
research process, membership included: representatives and key stakeholders. The
a) Director of the Health Secretariat following is what the researchers working on
b) Director of the Citizenship and Social Action the project reported:
Secretariat (SECIAS – a governmental "As soon as data analysis finished and the
Key Concepts

organisation that is responsible for interventions were designed, we organized a
operating programmes to tackle social seminar in São Vicente City, inviting all
problems) participants that were involved in the RAR
c) member of the City Council on Drugs, one process to attend to the event. The seminar
Municipal Legislator of the city and a happened in December 1998. At this
former drug user seminar, data analysis and proposed
interventions were presented and people
Intervention development could become acquainted with the results
Once the data analysis stage was completed, and transfer the information discussed to
the research team met to identify possible HIV their own community. There were participants
prevention interventions. In order to achieve from the community, from the Penitentiary
this, a list was compiled of the main problems System, from treatment centres and from
related to substance use in the city and key prevention programs. This seminar was
gaps were identified in the provision of important to start the discussion of the
relevant services (as indicated through data interventions with local authorities, especially
analysis). Using this list as a basis for the ones that belonged to the Health
discussion, a series of feasible and realistic Department (who also supported this event)."
interventions were then proposed. These "The community and key informants were
interventions included a number of involved during all RAR processes because
suggestions made by study participants during we realized their presence would help the
the data collection phase. access, the development of the study and
The STD/AIDS Programme of the city was given the intervention. We had the support of the
responsibility for implementing the intervention Advisory Community Council since the
plan devised by the research team. The main beginning of the study to compose focal
priority for action was to re-organise existing groups, to access key informants in the
HIV prevention programmes (with a specific community and to guide the data collection
focus on harm reduction programmes) and to process. They also attended to the seminar
improve interventions undertaken with the and gave us support to deal with local
community and the IDU/DU population. As a authorities. The support of the outreach
consequence, discussions were held with these workers and key informants were also
programmes on improvements that could be important to access the injecting drug users
made in the following areas: provision of good and the non-injecting ones in the data
quality information about substance and health collection phase. They were responsible for
consequences; the reduction of prejudice the recruitment of this group."
against IDU and DU; and informing the wider Another factor was the RAR team’s success
public and IDUs about STD/AIDS programmes. in securing high-level political support:

SEX-RAR Guide Key Concepts Chapter 2 21

"The main factor (driving intervention services offered by the STD/AIDS Program…
development in the city) was a political will to Concerning the Harm Reduction Program,
apply the RAR and to develop the which is coordinated by the STD/AIDS
interventions. Another reason to develop the Program, many interventions happened. The
study and the intervention in this city was the most important one was the creation of a
fact that no other research about HIV and Community Centre for drug users. The

Key Concepts
injecting drug use occurred there before." Community Centre has been working since
"The interventions happened mostly in the December 1999 and was a request from the
STD/AIDS Programme. The first step was the substance users during RAR focal groups. In
creation of a team within the STD/AIDS order to develop this intervention, we had the
Program to inform general population and financial support of the local government,
health services about the existing services STD/AIDS National Coordination and UNDCP.
offered by the program. This intervention was This place is also important to discuss with
necessary because we found out that few drug users about their rights, citizenship,
people knew about the structure and prejudice and drugs."

2 .3 Assessment frameworks

This guide uses three Assessment progress during the RAR. The framework is
Frameworks to help plan fieldwork (FIELD1), based on the six Assessment Modules
manage the data (DATA2) and identify and contained in this guide (see chapter 4), and for
develop responses (RESPONSE3). each module the RAR team are encouraged
These frameworks provide the RAR team with a to identify:
tool to record and present data collected during ● research questions
the assessment. Each framework is designed to ● data sources (including geographical locations)
help the RAR team identify the most important ● methods (including sampling approaches)
course of action to take and in the case of ● tasks involved in collecting data
DATA2 and RESPONSE3, to clearly present key
The structure of this framework is identical to
findings from the RAR. However, these only
that adopted in each assessment module. This
provide basic tools. The RAR team are therefore
allows the RAR team to review the guidance
strongly encouraged to adapt and modify these
given in each module and to supplement this
frameworks as necessary. We introduce the
in accordance with the local context.
three Assessment Frameworks here, but they
will become more relevant during the
How can the data be managed?
preparation and implementation stages of the
RAR (see chapters 3-5). The data management framework is more
sophisticated than that used to plan and
How can the fieldwork be planned? monitor fieldwork. This reflects the emphasis
The fieldwork Assessment Framework provides with RAR on holism, where the assessment not
a simple tool for planning and monitoring only seeks to understand individual behaviour,

appropriate and effective? Intervention Assessment.SEX-RAR Guide Example Assessment Planning Matrix FIELD1 FIELD 1 Assessment Modules Key Questions? Key data sources? Key methods? Key tasks? Importance (1-5) Context Assessment. and which interventions are likely to be feasible.5 What are the resources and actions required to develop and implement locally appropriate interventions to reduce the adverse health consequences associated with sexual behaviour related to substance use? 22 Key Concepts .3 What is the extent and nature of adverse health consequences associated with sexual risk behaviours related to substance use? Risk Assessment.4 What is the extent and nature of the relationships between substance use and sexual behaviour? And sexual risk behaviour? Chapter 2 Key Concepts Intervention Assessment. 4. 4. 4.2 What contextual factors influence: patterns of substance use? sexual behaviour and risk? adverse health consequences? feasibility of response development? Health Consequences Assessment. 4. 4.5 What are the needs for intervention responses.

SEX-RAR Guide Example Data management DATA2 Description Source/Rationale Action Importance Validity (1-5) (1-5) Key finding Legal. policy and Community level political situation influences Social and economic situation Other structural factors Substance use Key Concepts Structural level norms influences Sexual norms Setting Risk behaviours Chapter 2 Individual level influences Levels of knowledge Personal attitudes 23 Key Concepts .

policy and Goals and objectives Community level political situation influences Social and economic situation Other structural factors Substance use Chapter 2 Key Concepts Structural level norms influences Activities Sexual norms Setting Risk behaviours (human/financial/time) Individual level influences Resources Levels of knowledge Personal attitudes. concerns 24 Key Concepts .SEX-RAR Guide Example Planning responses RESPONSE 3 Important Feasible Urgent General response Opportunities Constraints (1-5) (1-5) (1-5) Key finding Legal.

On the left- to be given to structural. living together within a fixed geographic location. . team to help plan and develop interventions. or structural factors (such as to DATA2. or intervention development of action. critical to the success of most risk reduction and harm prevention interventions. The framework is split into two main sections. Without What is ‘community’? broad support and involvement from the community from the early stages of RAR. space is given for the RAR team to individual-level factors. given time programmes has long been recognised as and resource constraints. The structure of this framework is identical to The upper section encourages the RAR team Key Concepts guidance given in the Response Module. community and individual- analytically. For each factor. the framework attempts to get individual factors have with the key finding the RAR team to think more carefully about the under review. or identifying potential goals and objectives of the required response.4 Community Participation What is ‘community participation’? A key principle of RAR is that a wide range of people should be involved in order to ensure Community participation and ownership in the success of prevention projects. urgency and feasibility ● outlining any action which should be of such a response undertaken. either highlighting any potential level factors on response development. and also any constraints The lower section then requires consideration The lower section is split into two. start this process and the resources required. either in terms of further data ● to consider the opportunities of such a course collection. the make brief observations about the influence or RAR team are encouraged to think role of structural. The upper section records key important findings from the assessment and ● describing the data sources and methods on encourages the RAR team to consider: which the finding is based ● the general intervention response required ● rating the validity and importance of the finding ● to rate the importance. On the links these structural. implications these factors may have for the activities that need to be undertaken to response development. to record key findings from the assessment: The framework is divided into three main ● indicating the reasons why the finding is sections. community and hand side. This should be used by the RAR legislation and policy).SEX-RAR Guide Key Concepts Chapter 2 25 but also to document the wider influence of How can responses be planned? community factors (such as population The response development framework is similar norms). 2 . There are many definitions and concepts of even the best designed plan of action for community: intervention may not be implemented ● locality or neighbourhood . community and right-hand side.a group of people effectively.

26 Chapter 2 Key Concepts SEX-RAR Guide

● social relationships - a set of social information gathering processes. Such a
relationships mostly taking place within a fixed process does not concede any share in
geographic location; decision-making and professionals are under
● identity/common interest - a shared sense of no obligation to consider people’s views in
identify such as a group of substance users. designing interventions.
● material incentives - people are provided
Broadly, the term suggests people who share
Key Concepts

resources, for example, time or labour, in
some common interest or supportive social return for food, cash or other material or
relationships. non-material incentives.
Different people will hold and use different ● functional - people form groups to meet
definitions of a community. It is usually predetermined objectives related to the project.
advisable for the RAR team to use the Such involvement tends to occur after major
decisions have been made.
broadest definition of community available,
but at the same time remain aware that ● interactive participation - people participate in
joint analysis, which leads to action plans and
certain interventions will need to target
the formation of new local groups or the
specific communities. As the multi-sectoral strengthening of existing ones. It tends to
nature of rapid assessments will involve the involve interdisciplinary methodologies that
wide ranging participation of numerous seek multiple perspectives and make use of
individuals, groups and organizations, the systematic and structured learning processes.
RAR team will need to balance this These groups take control over local decisions,
and so people have a stake in being involved.
participation with the consideration that the
plan of action for interventions may need to ● self-mobilisation - people take initiatives
independent of external institutions to change
focus on a specific community or group.
system/situation.

What does ‘participation’ mean?
What is possible?
Although community participation is integral to
It is possible to involve the local community in
any research or intervention development,
a RAR. Although user and community driven
community participation can be problematic. In
RARs have been conducted (self-mobilisation
any activity involving a range of people, attention
- see below), these are relatively rare, and
should be given as to how ‘participatory’
interactive participation is likely to require too
everyone’s involvement actually is.
long a period of time to properly conduct. A
There are seven main types of participation well-planned RAR should involve forms of
ranging from manipulative, to self-mobilisation: participation based around consultation,
● manipulative - participation is a pretence - material incentives, and functionality.
people’s representatives on official boards but
having no power.
The most common format for participation in a
RAR is a Community Advisory Body. This is
● passive - people are told what is going to
happen or what has already happened. A usually formed of around 5 - 20 community
unilateral announcement by an outside agency; ‘stakeholders’ who regularly meet in a
people’s responses are not taken into account. facilitated group session to help discuss, plan
● consultation - people are consulted. External and undertake the rapid assessment, including
agencies define both problems and intervention development. It is important that

SEX-RAR Guide Key Concepts Chapter 2 27

this body meets regularly to discuss progress ● the time over which the assessment is being
during the rapid assessment, and that written conducted – building trust, rapport and
agreements exist so that all members are clear interest with local community groups can take
time. It is important to remember that such
about issues of confidentiality, data ownership,
community groups often have a number of
mechanisms for resolving conflict, and the ongoing concerns, compared to which the
likely role of the CAB once the rapid

Key Concepts
rapid assessment may appear to be a
assessment has finished. relatively minor issue.
● the perception of substance use - community
Barriers to participation members often view substance use as
Participation in a RAR is often constrained by "someone else’s problem" and its prevention
as an unsuitable community activity. There are
three main factors:
often conflicts within the community as to
● existing links with the local community - how to ‘deal’ with the ‘problem’ of substance
participation is often contingent upon the use. The importance of being flexible and
levels of trust and understanding which involving key stakeholders means that the
exists between the rapid assessment team RAR team will have to balance the differing
and community groups. The team needs to opinions of, for example, the police alongside
understand, and be receptive to, the that of a substance treatment worker. Part of
concerns of these different groups. This is the process of developing community
particularly important given that substance participation is to identify and bring these
use is both an illegal and stigmatised activity differing opinions together to help activate
in many communities. interventions at the community level.

ROLE OF THE COMMUNITY ADVISORY BODY

The Community Advisory Body is usually formed of around 5 - 20 community ‘stakeholders’ who
regularly meet in a facilitated group session to:

● support the process of the rapid assessment;

● establish a climate for intervention development based on the findings of the rapid assessment;

● provide on-going feedback on the findings of the situation assessment;

● determine the need for intervention during the situation assessment;

● participate in developing the action plan for interventions;
The two boxes presented overleaf provide a summary on the Community Advisory Board:
● evaluate the rapid assessment;

● share knowledge, responsibilities and resources on the issue of substance use in the community;

● support those who are working directly with substance users;

● link existing projects to the broader community;

● influence the way in which the community acknowledges and responds to substance users.

28 Chapter 2 Key Concepts SEX-RAR Guide

EFFECTIVE RESPONSES ARE COMMUNITY BASED
The work of the advisory committee can be most simply done by a single group of individuals. If
practical or political reasons mean this isn't possible (e.g. distrust, conflict, time), then the
committee could be divided into two groups:
The first group
Key Concepts

This group could be comprised of substance users, parents of substance users, former substance
users, and people who provide direct services such as street educators, public health workers and
teachers. The work of this group would emphasize local planning, service delivery and monitoring.
The second group
This group could consist of individuals such as government officials, medical specialists, influential
community members, international development workers, and policy-makers. This second group
would take responsibility for helping substance users gain better access to resources and for
advocating on behalf of substance users in the criminal justice system, governmental institutions,
and the media. If the committee is divided into two groups, it is important to establish mechanisms
for regular communication between the two groups.

RAR: case studies the study aimed to profile drug use in Jakarta
from substance users’ perspectives.
This section provides two short case studies
Importantly, as noted in the introduction to the
describing the different degrees of community final study report, the assessment was
participation possible in a RAR. entirely user-driven:
"This particular Rapid Situation Assessment
Case study 1:
is unique, because it was planned and totally
RAR by individuals with substance written by individuals with substance
dependence problems in recovery, dependence problems within their own
Indonesia 19991 Recovery Community…This is the meaning
of True Empowerment"
One strand of opinion, is that total
"You [non-drug users] write many reports
community participation and full project
about us, but do not truly know us…Few of
ownership is entirely possible in a RAR. This
us are scientists, professors or mental giants,
approach is relatively uncommon, but
nor do we pretend to be. We are just addicts.
provided the basis for the 1999 study "Rapid But we damn well know what we know."
assessment by people recovering from
substance dependence". Case study 2:
The RAR was conducted between October and RAR in India, 19982
December in 1999 by 57 former drug users Another perspective, is that full community
resident at the Yayasan KITA centre. Drawing participation is not possible due to time and
on a combination of qualitative and resource constraints. What is achievable is
quantitative methods – history writing (43 community consultation. This is evident in
participants), focus groups (43 participants), work undertaken in an Indian assessment in
and self-completion surveys (57 participants) – Madras in 1998.

substance can result in physiological effects The effects of a substance on behaviour are within the body. far as the transmission of HIV and other sexually ● there are also indirect relationships between transmitted infections are concerned. As part of the rapid . ‘psycho- possible that particular psychoactive pharmacology’ and ‘social-pharmacology’6. particularly as making skills being impaired.5. condom Substance use can have a critical role in use being given a low priority. It is interaction between ‘pharmacology’. assessment and intervention. NA and AA group members. The ways of . to The pharmacological properties of a wider economic. which in turn can alter the therefore best understood as a product of an way individuals’ perceive and experience their behaviour and surroundings. and representatives from community council.a prominent Muslim citizen. an assistant police making process was seen entirely as commissioner.1-4 This substance use and sexual risk behaviour.an elected political representative. assessment and response. The decision- . through to peer group and community ● the psychoactive effects of a substance may expectations and beliefs about the effects of have direct influence on sexual behaviour. that were addressed by the community board. Madras. methods of dealing .5 Substance use and sexual risk behaviour Introduction substances may result in sexual desire and activity being increased or reduced. sex and welfare was but was assisted by a small group of Key Concepts established. structural and political factors.a prominent Hindu citizen. users and their families.a catholic priest.SEX-RAR Guide Key Concepts Chapter 2 29 This RAR was undertaken over three weeks in . community were some of the crucial issues . negotiations around priority issues for . caste. November 1998. 2 .an evangelical church leader.6 It is also necessary to understand the social How do substances influence contexts in which substance use and sexual behaviour? behaviours occur. the sexual behaviour of substance users. Such contextual influences can range from the immediate physical settings There are two main ways psychoactive in which substance use or sexual behaviours substances can influence sexual behaviour: occur. . a member of local youth federation. assessment. accessing the unreached. including: and AIDS.a leader of Ambedkar Movement (Scheduled with legal issues and resistance from the Castes).a pharmacist. a community advisory board . The board comprised of twenty technical experts in the field of substance use members. with this group facilitating the . comprising key stakeholders representing various constituencies of differing groups of The board was empowered to generate ideas. It is section provides a summary of key findings incorrect to think that it is the pharmacological from research on the connections between effects of a substance alone which influences substance use and sexual risk behaviour. winning the trust of .a community worker. particular substances on sexual behaviour.the fishermen association representative. religion.a women’s group leader. or decision- mediating sexual risk behaviour. exchange of current information on IDU. politics.a primary care physician. .

while a household survey in studies support this association. for general population found that alcohol example. there is evidence which associates alcohol use with HIV positivity. economic and cultural contexts in which substance use occurs.26 behaviour In some cases. For example. How do different substances Scotland. a survey in South Africa among Alcohol is often associated with sexual 2. UK.16 as between amphetamine use and sexual risk well as with types of lifestyle more generally. heterosexual shows direct and indirect links between cocaine adults. Key Concepts Psycho-Pharmacology Individual beliefs and expectations of pharmacological effect ‘indirectly’ influence the effects of substances on behaviour and the ways in which substances are used.15-25 Some ● opioids. 30 Chapter 2 Key Concepts SEX-RAR Guide UNDERSTANDING SUBSTANCE USE EFFECTS Pharmacology The pharmacological properties of a drug have ‘direct’ physiological effects which influence human perception and behaviour. Other studies associate ● amphetamines and other drugs – there is some inconsistent condom use with the use of evidence which shows direct and indirect links alcohol in combination with other drugs.9-14 ● alcohol – research in many countries suggests direct and indirect links between alcohol use The inconsistent use of condoms has been and sexual risk behaviour associated with alcohol use among a variety of ● cocaine and crack – research in North America groups – including young people. Research in the United States. For Alcohol example. Social-Pharmacology Individual beliefs and expectations of pharmacological effect and the way in which substances are used are in turn ‘indirectly’ influenced by social norms and cultural beliefs. sex workers and the behaviour.27 Not all encounter7. . as well as by the particular social. and men who have sex with men – in a and crack use and sexual risk behaviour variety of settings and countries. including heroin – most research studies illustrate that those who use alcohol suggests no specific pharmacological or most frequently use condoms least indirect links between opioid and heroin use and sexual risk behaviour consistently. especially condom use: higher average of number of sexual partners. found that 82% of people aged influence sexual risk? between 16-30 said they used alcohol last time they had sex.8 Some studies have also There is research evidence available on how found alcohol use to be associated with a the following substances are associated with higher likelihood of unprotected sex and a sexual risk behaviour. suggests that between 75%-80% of consumption was associated with HIV women had used alcohol in their last sexual incidence in both men and women.231 mine workers.

Slovakia In a RAR with men in the Slovak Army.38. where heavy drinking.4.45-47 Research has found similar causation.50 . vary cocaine have been found to be more likely to depending on the specific social and cultural have STDs than women who do not.39 For example. The empirical injectors to be twice as likely to test HIV positive question of whether alcohol ‘causes’ people to than opioid-only injectors.28 the frequency and amount of cocaine and crack It is important to recognise that: the causative use which is associated with inconsistent relationship between alcohol use and sexual condom use.SEX-RAR Guide Key Concepts Chapter 2 31 CASE STUDIES: ALCOHOL USE AND SEXUAL RISK Zimbabwe Research shows strong statistical associations between STDs and alcohol use. women who use of alcohol. as with other substances. with men with STDs being approximately seven times more likely to be alcohol drinkers than men without Key Concepts STDs.13.4.36 a study among gay men in Australia found that likelihood of unprotected sex and HIV/STD substance use – but not alcohol use – was transmission. There are studies which show no associations between non-injected forms of associations between alcohol use and cocaine and crack use. drinking was the main form of recreation. Most studies emphasise that a using injectors to be more likely to have correlation or association between alcohol use unprotected sex than non-crack using and inconsistent condom use does not indicate injectors.34 While alcohol in itself may not necessarily lead to risky sexual behaviour.49 though in A largely North American literature associates some studies condom use does not differ cocaine and crack use with an increased between cocaine injectors and non-injectors.9.32. and drinking to intoxication is often the norm.24.25. crack injectors to have unprotected sex is extremely difficult to have a higher number of sexual partners and to prove.33. inconsistent condom use and likelihood of HIV infection appears to vary according to Cocaine and crack whether cocaine or crack is injected. This suggests that there may be a ‘situational link’ between alcohol use and sexual risk behaviour under specific circumstances.37-44 Studies suggest it is both associated with HIV seroconversion.35 soldiers reported that when separated from their families.48 In contexts in which it is used. This is because the relationship between be more likely to exchange sex for money or alcohol use and sexual risk behaviour is substances than non-crack injectors.36.30 addition.28-30 The effects and STD. the environment in which alcohol use occurs can play a key role in the sexual transmission of HIV and STDs.42 Studies have shown: cocaine risk behaviour remains unclear. the ‘beer hall’ or ‘shebeen’ is a key focal point of recreational activity for Zimbabwean men. One study shows that 75% of Zimbabwean sex workers seek clients in bars. and crack complex.31 In Zimbabwe.33 The bar is also a key setting for initiating extra-marital and commercial sexual contacts. sexual risk behaviour inconsistent condom use 9-11.25. that drinking venues were the main access to sex partners and that alcohol improved ‘courage’.

with the findings that it can be steroids74.52 With among gay men using amphetamines has crack use in particular.81-84 amphetamine users report sex more frequently Many countries have witnessed increases in and a greater number of sexual partners than the incidence of STDs among the general heroin users.63.93 There is an users and amphetamine users in relation to increased risk of sexual transmission of HIV HIV transmission or sexual risk behaviour.84 general population samples. it is important to note especially in areas of high HIV and STD that an individual’s choice of substance is prevalence.57-59 Which population groups are at risk? The research points to the importance of four Opioids population groups: injecting drug users.53 For used purposively to enhance sexual Key Concepts example.80-83 Injecting drug use is the that levels of sexual activity and the number predominant mode of HIV transmission in of reported sexual partners by opioid users Eastern Europe.82.85.70 while Australian and STDs are more common in developing research found no differences between heroin and transitional countries.87 as well as among IDUs.4.51.77-79 difficult for women to negotiate for condom use in some settings. including: amyl nitrates.64 Surveys – Injecting drug use occurs in every continent primarily among heroin injectors – highlight of the world. findings point to the emphasised that the substance may have a influence of ‘high risk’ sexual cultures in the reputation as an aphrodisiac and is therefore specific settings where crack is used. crack use may be associated with interaction. the Middle East are similar to those reported among local and parts of South and South East Asia.75 viagra.51.73 crack use. North Africa.86 In some of these IDUs and non-IDUs.2.65-67 There are no and is becoming increasingly significant in differences in condom use between heroin parts of South America.76 and marijuana. . reaching prevalence rates Amphetamines of over 40% within one or two years of first There are studies which show that being reported. enhancement of sexual activity.72 A number of other substances commercial sex work.68 countries HIV has spread among IDUs extremely rapidly.53-56 Unequal gender used recreationally may have links with relations are also associated with cocaine and sexual practice. As with all substances.60-62 frequent opioid use is often associated with a Injecting drug users reduction in sexual activity. Ethnographic research sex and social factors play a key role.83.88-91 The amphetamine users report that the substance presence of untreated STDs enhances the increases their sexual desire but that it sexual transmission of HIV per exposure92 interferes with performance.60. there is no simple association related to their perceived expectation of between cocaine or crack use and unprotected substance effect. men Whereas studies indicate that stimulant and who have sex with men.69 Other studies show that population.71 between IDUs and their sexual partners.83. 32 Chapter 2 Key Concepts SEX-RAR Guide Like alcohol. young heterosexual alcohol use may be associated with an people and commercial sex workers.

the second wave of the primary partners ranged from 50% in Rome epidemic was among IDUs.86 partners of IDUs and bisexual men. and that 40% of all positive IDUs report higher rates of condom female heterosexual transmission cases of use than HIV negative IDUs in Thailand.1-3 In the indicate that injecting risk behaviour is the United States.1103 In some high prevalence of HIV among IDUs was cities. However. yet who never used condoms with opposite a few years later.67 This suggests that condom partners who are not IDUs themselves. and from there. there may condom use among IDUs generally reflect exist gender differences. Condom use among IDU is generally low.85.51.1.43.108 More recent were men. North-East India. a transmission among IDUs. HIV associated with IDU.109.SEX-RAR Guide Key Concepts Chapter 2 33 Sexual transmission is an increasingly important transmission via the sharing of injection determinant of the course of HIV infection equipment among IDUs. by the sexual as likely to be associated with sexual diffusion of HIV among heterosexuals with no transmission as with syringe sharing.102. some heterosexually transmitted cases of AIDS.98-100 Relatively HIV positive IDU found that 70-80% of high proportions – in some studies sexually active couples practised unprotected approximately 50% – of the sexual partners of sex always or almost always. many of whom were whereas 78% of IDU reported that they also substance users.96 In Some studies suggest that IDUs who also use Brazil.113 and London.114 HIV positive IDUs are also more likely to use a A key determinant in assessing potential HIV condom with non-injecting sexual partners. the first wave of the HIV epidemic use in thirteen cities. at least were the source of HIV in 70%-80% of among current injectors. it has been estimated that crack report less condom use.101 use reflects wider social behaviour norms and There is also uncertainty about the extent of is not merely an outcome of differences in sexual HIV transmission relative to patterns of substance use.97 NewYork.94-97 In Bangkok. some years later.3 studies have shown that unprotected sex is Key Concepts Similar trends have been observed in independently associated with HIV Thailand. The third wave of the epidemic research in Rio de Janeiro found that was among sex workers.1.112 Amsterdam. most of whom to 82% in Rio de Janeiro.94 In Manipur.3.102.2.67. only 12.65-67 Additionally. 6% of the non-injecting of IDUs never use condoms.104-106 history of IDU.5 % epidemic spread to the female sexual reported that they always used a condom. the always used clean needles.2. India and Brazil.103 Most studies among IDUs and their sexual partners. it has been estimated that IDUs primary means of HIV transmission.116 Levels of IDUs are non-IDUs. the proportions of IDUs was among men who have sex with men.115 transmission is the extent of sexual mixing A study of partnerships where one was an between IDUs and non-IDUs.110 Condom approximately 25% of HIV infections are use may also be influenced by HIV status.107 In the World sexual partners of IDUs were also infected.111 AIDS are the sexual partners of male IDUs.96 .95 Health Organization study of injecting drug In Brazil. HIV transmission among IDUs may be followed. in that male IDUs patterns of condom use in the local general may be more likely to have female sexual population.1. with within two years of the first reported case of most studies suggesting that at least a third HIV among IDUs.

These are: to be "inconsistent".28 Recent noting that 52% reported never using condoms. and sex workers involved in . the links among young people.121 ● homeless young people – studies suggest that In some countries there is a significant STD and HIV transmission is more likely among minority of MSM who inject drugs. and that 20% of all male IDUs An involvement in substance use may often with AIDS report having had sex with other overlap with an involvement in commercial men. the research among young people condom use among MSM have been found emphasises four main areas. This is the younger substance users who are also case in Australia.118-123 For example.128 use (not alcohol) and HIV positive serostatus ● young people in detention – a study in Brazil. approximately homeless. HIV and AIDS surveillance data shows that 11% of MSM with AIDS report having Sex workers injected drugs.134-136 Estimates of the who inject drugs are relatively neglected in proportion of substance users involved in HIV prevention. has also been found among MSM in for example. marijuana use with inconsistent condom use amyl nitrates.118 In general. 129. research has found that the same pattern that half had used one or a combination of exists among ethnic minority MSM in the solvents.9%. amphetamines and cocaine.220 MSM in six cities in the of 1. and especially.152 young people aged between 16-19 United States found that higher risk for found that 17% reported that they were less unprotected sex was associated with heavy likely to use condoms after drinking. found that seroconversion to be associated with higher amphetamine was the most commonly injected rates of substance use. found an HIV prevalence of 4. crack or cannabis. between inconsistent condom use and use particularly if they do not identify themselves of alcohol and drugs. 34 Chapter 2 Key Concepts SEX-RAR Guide Men who have sex with men Young heterosexual people A number of surveys among men who have Heterosexually active young people may sex with men (MSM) show associations combine alcohol and sex purposively. 130 12% of MSM surveyed reported that they ● young people involved in recreational had injected.77 between substance use and inconsistent Overall. including amyl drug among 14-20 year olds and that many young people underestimated their risk of HIV nitrates.119 This transmission through sex compared with general pattern of association between drug needle sharing.160 Other substance use – several studies emphasise the Australian research has found that injecting importance of links between recreational drug was more common among younger gay men use – particularly that associated with clubs or ‘raves’ – and inconsistent condom use. 129 United States. In Sydney.125 In the United States. 117.122 ● young people involved in injecting drug use – a One cohort study in San Francisco found HIV study in Australia. for example.126 female sex work.93. cocaine. Vancouver120 and in Sydney. 131-133 and HIV positive men. a as part of a ‘risk group’. mostly amphetamine. and that 11% had injected cocaine.122 Researchers have noted that MSM sex work (CSW).11 A telephone survey Key Concepts study among 3.127 Other alcohol use as well as the use of large surveys also associate alcohol and/or hallucinogens and stimulants.

there is a strong levels of alcohol use. it has injecting drug use.55 levels of sexual risk behaviour. cocaine. For example. In the UK.142 that between 14% and 22% of female IDUs As regards condom use. and duration of involvement in CSW. sex workers .138 What are the implications of these findings? Studies tend to show that sex workers who use substances have a higher likelihood of Taken together.144 Clients’ alcohol use overlap between the use of alcohol and has emerged as an important determinant of commercial sex. these findings emphasise the HIV infection.34 In Brazilian and condom use in some studies.141 Other studies associate been estimated – depending on geographical HIV infection not only with an involvement in and social setting – that between 29% and drug injecting but also with the frequency and 59% of CSWs are also involved in IDU. and to was associated with drug injecting and the some extent amphetamines use of crack. the extent to which substance use private encounters.140.145 Other Colombian cities.SEX-RAR Guide Key Concepts Chapter 2 35 substance use. In London.33. most studies are involved in exchanging sex for money or suggest that there is a greater consistency Key Concepts drugs in a six month period. young people. In condom use are not necessarily altered by Zimbabwe. vary widely. socio-economic status has studies have found no differences in condom been found to be a key factor influencing use between CSWs who use substances and both substance use and sex work as well as those who do not.136 In other of condom use in commercial sex than in contexts. crack.137 In some settings – for example. HIV infection ● populations – injecting drug users. men who among CSWs is most often associated with have sex with men. a study among importance of the following: 697 CSWs in Santos found that HIV infection ● substances . for example. Vietnam – substance use is not a feature of sex work.alcohol.143 and that levels of overlaps with CSW may be greater.

36 Chapter 2 Key Concepts SEX-RAR Guide Key Concepts .

4 Designing the assessment 3.6 Analysing data 3.SEX-RAR Guide Preparation Stage Chapter 3 37 3 PREPARATION STAGE 3.10 Preparing for possible problems .5 Managing fieldwork 3.7 Developing responses 3.1 Identifying RAR objectives 3.2 Forming the RAR team Preparation Stage 3.8 Writing reports 3.9 Disseminating findings 3.3 Training the RAR team 3.

and other local and when? national stakeholders. These are used to: broader set of substance-related harms (physical. including alcohol) or concentrate only on illegal psychoactive drugs? methods and tasks involved in the RAR.will the RAR provide a basic tool to start thinking about focus on all psychoactive substances (legal and the key research questions. and provides an ● which substance-related harms will be important reference point for the entire RAR investigated? .will the RAR focus just on team. sex workers who inject drugs? 2. Key activities There are four activities which may help the Key questions RAR team in producing such a list of objectives. or would it be more profitable to FIELD1 to facilitate discussion or examine the sexual behaviours of commercial brainstorm sessions.will the RAR supplement the FIELD1 framework with this concentrate on a specific sub-population. This involves significant contact with substance methodological guidelines. with an emphasis on identifying and solving related problems. Some RAR teams may like to included in the RAR? . illegal. such as young crack users from ethnic minorities. reports. or district within a city? ● and if necessary. presentations) and users. short written description of what the RAR or migrant populations? Or will the RAR have will involve. The information is then be carried out? used to gain support from stakeholders to ● What is the time-scale for the RAR? . health issues more generally or a of key objectives. social and economic)? ● gain the support of key stakeholders ● What should be the geographical scope? . for the RAR to focus on all sexual now and the RAR team may wish to use behaviours. reminding each member of the key . city. This protocol is usually no longer a broader remit? than 3-4 pages long. A written Assessment Protocol could be ● which populations and samples should be (see: below). The fieldwork Assessment Framework number of key questions including: (FIELD1) described earlier in this guide will ● which substances to focus on? . data sources.Will ● make basic planning decisions about the RAR the RAR be national in scope or will it focus on process (Where? When? With whom?) a particular region. when in place – can be evaluated and refined. To achieve this. the RAR should consider a 1.1 Identifying RAR objectives Preparing for RAR begins with the identification HIV/AIDS. Definite decisions do not have to be taken ● which sexual behaviours to focus on? . psychological. proposals. 38 Chapter 3 Preparation Stage SEX-RAR Guide 3 . community groups. which - outputs is the RAR expected to produce (e.g. secure funding or resources ● What political or ethnical issues are there? - to carry out the RAR Preparation Stage How might the RAR be affected by political and The RAR will aim to collect and analyse funding commitments (or resistance)? What information about substance use and sexual community expectations are there? How should risk behaviour in order to develop effective the RAR objectives reflect the potential expectations of the communities in which it will intervention responses.is it feasible. training manuals.What mobilise programmes and polices.

use observation and existing data sources to cross-check ● data source/sampling: recruit IDUs around central station ● key questions: what substances are injected? how are they injected? what are major health problems? ● who is responsible? Mr X. agenda for CAB meetings Preparation Stage (regularity. If updated and archived. submit proposal to donors. access to computer facilities etc Ethical issues: indicate any ethical issues arising from the rapid assessment issues to address and any individual roles 3. This is usually undertaken before the full this protocol can also provide a record of rapid assessment study begins and involves new research questions and major decisions an organised and facilitated meeting of as they emerge during the rapid assessment national. organise advocacy meeting with politicians and service providers etc). regional and local experts. For example: Example: Mr X from Organisation Y: 30% of his work-time over 3 months.2). For example: ● method: conduct 8 focus groups with IDUs. An Initial Consultation (see: section 4. time-scale Objectives: major objectives of assessment including aspects of mobilising the community and developing proposals to refine existing and/or implement new interventions RAR team: list of RAR team members. proposal to donors’. indicating their professional background and their organizational affiliation Community: main tasks of the Community Advisory Board (CAB). population groups. Include report on RAR process and outcomes. outreach worker/RAR team ● projected timeframe: 3rd to 5th week of assessment Data analysis: who will analyse the data? How will it be analysed? Products: indicate what products expected from the RAR. Resources: indicate what human and other resources will be commited to the RAR. tentative list of members of the advisory board (names and/or organisations). to help make final report. parameters of the study. as well (which can be valuable when producing a as community representatives. and also to plan .SEX-RAR Guide Preparation Stage Chapter 3 39 EXAMPLE: ASSESSMENT PROTOCOL Title: title of assessment Scope: location. working procedures etc) Assessment: specific activities for each method of data collection. rationale for assessment. and responsibilities. and action plan of concrete proposals for interventions Dissemination: indicate how to follow-up and disseminate RAR findings in the country (for example. or justifying a change in initial judgements about the focus and research direction with funding bodies). inform media of results.

A brief consultation of existing data this should take no longer than one day. It is envisaged that 4. or who are familiar with. the local time needed to make decisions. economic class and opportunity to speak in regular team social status) meetings. ● reflect the diversity and characteristics of the Although large RAR teams can be used. plan and undertake the RAR. substance use situation. In previous RARs.3).2). or those with good communication/language skills) Community Advisory Body ● belong to. helpful contacts or data sources A poor RAR team could result from the and potential obstacles can all be identified inclusion of persons who are affiliated with through CAB discussions. or hold positions of local an opportunity for community representative influence or expertise (making it easier to plan to help discuss. teams people who: have ranged from four to 15 people.2 Forming the RAR team The RAR team is a core group of people who one side of a political or local conflict. Depending on the objectives of The size of the RAR team depends upon the RAR. and are are responsible for the overall organisation. The RAR team should be guided by a substance using populations Community Advisory Board (CAB). 3 . assessment. sources (see: section 6. age. and credibility with the improve their understanding of the local target population and local community). . . the CAB provides a have the appropriate balance of research and valuable resource for the RAR team to intervention expertise. The CAB ● are available for the whole duration of the RAR comprises the RAR team and influential ● either having skills in undertaking social community ‘stakeholders’ and aims to provide science research.RAR team project manager (a person with plan and undertake the rapid assessment and research and/or project management expertise) the intervention developments which result. as well as identifying interventions and advocacy The Community Advisory Body is usually activity at a later point). formed of between 5-20 community ‘stakeholders’ who regularly meet in a A typical RAR team may comprise: facilitated group session to advise on how to . or who have credibility with. local situation and context (see: section 4. this RAR target population (in terms of can make it difficult to give everyone an race/ethnicity. unable or unwilling to communicate and Preparation Stage direction and completion of the rapid relate to the study population. assessment. community (these could be people who are respected within a certain social grouping. Key issues for . the initial stages of the rapid assessment. or could increase the amount of ● belong to. and any and would be facilitated by the principal immediately available information on the investigator and other team members. a good RAR team could include study objectives. 40 Chapter 3 Preparation Stage SEX-RAR Guide the rapid assessment.five and six other persons (who between them In research terms.additional fieldworkers if necessary. gender.

This line can then be numbered from 1 to 10 (representing an axis). . group or organisation who holds an important or influential community position. NA and AA group members. . caste. politics. .a catholic priest. Preparation Stage . community members and groups.an elected political representative. In terms of interventions. groups important. understand and anticipate their likely position on the rapid assessment and intervention development process. an assistant police commissioner. careful facilitation. the adverse consequences associated with Forming and operating a CAB needs substance use.a leader of Ambedkar Movement (Scheduled Castes). the media and other bodies.a community worker. welfare organizations. and who might be affected by. or interested in.an evangelical church leader. The numbered axis allows an evaluation to be made of their utility. This can include a range of influential parties including current or former substance users.a women’s group leader. The process should then be repeated to the right of the line for those individuals who could obstruct or hinder the assessment. To the left of the line. The board comprised 20 members. . the process and outcomes of the rapid assessment. . governmental organizations. including: .a primary care physician. the CAB performs a Experience from previous RARs indicates different function: providing a forum where a the latter process to be extremely diverse range of influential individuals.a member of the local youth federation. . a pharmacist. health care representatives. it is often useful to undertake a stake-holder analysis. SOUTH INDIA "A community advisory board comprising key stakeholders representing…differing groups of religion. At its simplest. one method of doing this involves taking a sheet of paper and drawing a line down the centre. Those invited to EXAMPLE: STAKE-HOLDER ANALYSIS The term ‘stakeholder’ refers to any person. more importantly. sex and welfare was established. human rights services. those individuals who can help facilitate the rapid assessment process should then be listed (along with a short rationale for their inclusion). and representatives from community council. To identify stake-holders and.a prominent Muslim citizen. a prominent Hindu citizen. .SEX-RAR Guide Preparation Stage Chapter 3 41 CASE STUDY: FORMING A COMMUNITY ADVISORY BODY. youth organizations. and one where the CAB has and organisations can be brought together to been reported as continuing to function identify and implement strategies to reduce after the rapid assessment has finished. . the fisherman association representative.

challenges and (see example opposite). and as a aims of rapid assessment and to disseminate minimum requirement should address at least written guidelines and materials. Sessions range of aims. ● to encourage individuals to think about the encouraging teams to produce ‘protocols’ influence of their own attitudes and values which detail the aims. 2. then this will members of the Community Advisory Body. This programme is longer provided in a different format. Initial training should take intention is to introduce audiences to the basic place before the RAR begins. and target population groups. A tension four main aims: between the limited time available and large ● to provide team members with the skills amount of information that can be conveyed. target groups. introductions and planning sessions. needed to conduct a RAR. each of which is example overleaf). on RAR data sources. If there is no commitment a stake-holder analysis. Typically conducted without training being provided to conducted over a half or full day. are aware of exactly which individuals or organisations need to be targeted for their Stake-holder analysis support . This focus on backgrounds and aims of the RAR logistics and planning often means that skills building or detailed discussion of particular Team training programme research techniques is neglected. and involving a number of attempt to not only provide methodological differently skilled individuals. The four or five day planning workshop ● to provide the RAR team with time to discuss some of the tasks. These can include means that these sessions are often lecture- research skills. There are three main types of RAR team 3. whilst the body or social hierarchy. A short induction seminar. Preparation Stage 3 . but also . Benefiting from a ethical issues that will be experienced during longer time-span. data-holders. This can also provide to the assessment by those in positions of a useful method for identifying potential influence or authority. participant skills.3 Training the RAR team RAR studies cannot be successfully 1. methods. may contain individuals or groups in One method of ensuring that the RAR team conflict with one another. with a wide and comparatively less common. and resources needed to ● to provide important information on the conduct the rapid assessment. 42 Chapter 3 Preparation Stage SEX-RAR Guide participate may often have to be become apparent throughout any political persuaded of its benefit. such sessions frequently the RAR focus on methodological planning issues. The skills and planning workshop (see training programmes.and conversely which parties might To succeed. the main all team members. a RAR requires community and oppose the rapid assessment – is to conduct political support. as well as sessions on working based and consequently ineffective in building with community stakeholders.

levels of local expertise. in-depth consideration. The afternoon session was dedicated to country teams preparing an outline plan of their study (the ‘assessment protocol’). The training took place over five days: Day 1 encouraged teams to compare the situation regarding young people in their own countries. . this afternoon session of the 12th World AIDS Conference in 1998 aimed to introduce the methodology. and problem solving exercises. and to think about available resources to undertake rapid assessment Day involved teams receiving training on different research methods used in rapid 2 –3 assessment and the areas of assessment to which they could be applied. and also make provisions skills training to be provided at more appropriate for the complexity of the topic under points in the assessment (for example. GENEVA. information and preparation time. Latvia. EXAMPLE: BALTIC RAPID ASSESSMENT TRAINING. gay bar. harm once a number of focus groups have been Preparation Stage reduction best practice and intervention undertaken. Lithuania and Poland to undertake rapid assessments on substance use and sexual health among vulnerable young people. and also over an extended period of time. and disco) to consider the situations in which they would later be working. case-studies. teams submitted their revised protocols to UNICEF/UNDP/WHO for approval to begin assessment. and to encourage participants to adopt the technique and provide initial feedback. disseminate copies of the draft guidelines. market place. This session was primarily based around short talks. The advantage of this type of approach It is important that when planning training is that it provides regular opportunities for the programmes. process. offer training on specific research skills.SEX-RAR Guide Preparation Stage Chapter 3 43 EXAMPLE: 12TH WORLD AIDS CONFERENCE. with allows issues that have been encountered in the participants attending several programmes at field to be discussed and resolved (often using different points in the rapid assessment actual field data). After their return home. 1998 An important part of the development of rapid assessment has been raising its profile among scientific and public health audiences. and qualitative data analysis training to be given resource availability. This involved a field visit (‘confronting reality’) to four different sites (needle-exchange. Day 5 involved teams finalising their protocols and then presenting them to trainers and the other groups. Day 4 focused on how the teams would assess which interventions were already in place and which would need developing. LATVIA. the RAR team includes trainer assessment teams to meet. rather than as one issue among development. Attended by over 60 people working in the substance use field. These sessions may be provided many in an introductory session). UNICEF/UNDP/WHO. 2000 This workshop drew on two WHO RAR guidelines – IDU-RAR and SEX-RAR – to prepare teams from Estonia.

and use these The RAR team should now decide: as the basis for discussion within the team. EXAMPLE: TRAINING ON HARM REDUCTION AND RAR IN THE RUSSIAN FEDERATION In September 1997. For example: These should be clear to every member of "to make contact with opiate users in the Old the RAR and CAB teams. As part of this training. ● what are the central objectives of the RAR? as well as with the CAB and other key ● what are the key questions? stakeholders. Notes from the Initial failure to meet heightened community and user Consultation and review of data sources and expectation and damaged team morale contextual information will be helpful. The training programme supporting this aim was based on a cycle of activity where participants attended an Initial Training Course in Moscow lasting 11-12 days. Each training course was scheduled to overlap. and undertake interviews with 15 people objectives. MSF-H began a project to provide training and support for HIV/AIDS prevention among injecting drug users (IDUs) in the Russian Federation. ● objectives are selected which are not clearly defined – it is important that the RAR team Determining the objectives of the RAR carefully define each objective and consider attaching specific targets or quotas. and was followed by participants returning to their cities and conducting a rapid assessment of approximately 12 weeks in length. . to help undertake this task. and to use these for initial program planning. This focused on providing training in harm reduction philosophy and practice. To finalise the Quarter. and research skills. The cycle then concluded with participants returning to Moscow for a Return Training Course (of 5-6 days) to discuss each city’s results. the RAR team is now in a each of the Assessment Modules contained position to design their RAR in more detail. with participants in the Initial Training Course spending their last day listening to the results of RSAs carried out by participants of the Return Training Course. The number and type of objectives will obviously depend upon the ● who will be involved? context in which the RAR is being Preparation Stage ● which methods and data-sources will be used? undertaken and the resources available. in this guide (see chapter 4). 44 Chapter 3 Preparation Stage SEX-RAR Guide 3 . 200 participants from 65 cities in Russia and other CIS countries were asked to carry out rapid assessments in their city or region as a step towards designing and implementing an effective program to prevent HIV transmission among IDUs.4 Designing the assessment At this stage. the RAR team should review injecting opiates by week 5 of the RAR". ● where to work? Previous experience indicates that problems ● how will progress in the RAR will be arise when: monitored? ● too many objectives are selected – over-ambition The RAR team should use the FIELD1 framework typically results in the poor use of resources.

team can add these at a later point (as well ● contact agencies – those who are currently as eliminating any questions which turn out responding to the problems of substance- to be relatively uninteresting). . agencies and organisations to ● representative – these questions assess how participate in a RAR is undertaken with the common a behaviour or event is aim of obtaining as representative a sample How much? How often? How common? In as possible (see also section 6. selecting or sampling Why? Why not? How? individuals. Engaging data-holders become apparent during the RAR and the early in the RAR will be important. different groups in the community. or who are identified as a sexual risk course of a RAR situations will change. This comparison to…? sample of individuals. As noted ● data holders – those who collate and maintain earlier. It which are: is recommended that money should only be ● descriptive – these questions will help the RAR team to describe a situation given in exceptional circumstances. also revised. if necessary. Instead. who are most affected by substance-related ● objectives are not regularly reviewed – over the harm. group Consequently. objectives will need to be ● gatekeepers – those who control access to monitored and. and some RAR teams may wish to ● substance users and sexual risk groups . further research questions will specific data-sources. Such questions will topics or issues. This is particularly the case with those bodies offering financial or other forms of whom are also stakeholders): support.SEX-RAR Guide Preparation Stage Chapter 3 45 ● objectives are not agreed with the RAR team.3). participate in the assessment. In general. and activities of the population that help the RAR team decide who should the RAR team is interested in. related harm. there CAB and funders – it is vital that everyone with are six main groups of people it is important to a role in the project is aware of what is taking work with directly in an assessment (all of place. Identifying Preparation Stage formal and informal gatekeepers for substance Key questions for the RAR users will be very important ● key informants – those who have a particular Identifying key questions for the RAR to knowledge of specific groups or of specific address is important. but who are not directly help to structure the initial stages of the involved in providing services to substance RAR and will guide the selection of users or using drugs themselves methods and data-sources. agencies and organisations (known as ‘cases’) should aim Who to involve in the RAR to reflect the diversity of characteristics. The RAR The RAR team will need a consistent team may also want to think about questions incentives policy for research participants. team to understand a situation As noted earlier.those agree to such objectives in writing. What? Where? When? non-financial incentives such as food or ● analytical – these questions will help the RAR refreshments should be offered. The selection of topics and key questions will beliefs. ● community members – those who live in or The Assessment Modules contained in this belong to the communities participating in the guide will provide assistance to the RAR assessment team in identifying key questions.

Along resources available to the RAR team with random selection. and in services. Key methods and data-sources Historically. selection and sampling designs. in main methods used in RAR (chapter 6). and this may be the case with they are used. such conditions are ● the design and application of theoretical often important to large-scale surveys. should be determined by the regard to patterns of substance use. These can be feature of such sampling designs – described useful in identifying not only important data. . 46 Chapter 3 Preparation Stage SEX-RAR Guide Although representativeness is important in Two further important characteristics of such a RAR. as sampling techniques such as network. the team should: impossible to select a random or statistically ● attempt to identify and exploit any existing data representative sample. The most countries. often benefit from the guidance of key informants and about the behaviour of a large population of indigenous fieldworkers (who are often ex or cases on the basis of data collected from a current drug users). Given this These questions will evolve and change over hidden status. and quota sampling. theoretical samples are usually cases to produce findings and descriptions relatively small.2 – is that in the absence of pre. and it is usually stages of the RAR. sources . in Module 6. this situation has not been uncommon to the substance use field. they allow researchers to make statements purposive. Preparation Stage smaller sample.these include routinely collected sources such as HIV prevalence data. sampling frames. and order in which of users. reflecting the time and which are ‘statistically representative’. beliefs and ● immediately begin to arrange contacts – these activities thought to be shared by a larger population include with individuals and agencies who are likely to be difficult or reluctant to participate ● or they are considered to be the most important and likely source of information and Further guidance on research methods is insights given in chapter 6. Those in contact with services are what order? often not reflective of the broader population The selection of methods. it is not usually possible to select approaches should be noted: and contact a large enough number of ● in a RAR. and summarised below. ● they reflect characteristics. but also ‘gaps’ in existing knowledge which the existing or statistically representative RAR may attempt to address. risk research questions the RAR is addressing. The key research papers and articles. behaviours. Illegal This guide contains descriptions of the substance use is a hidden activity and. behaviour and health status. issues. This means interviews and focus groups which can be used that substance users and other key to explore and discover opinions. In the earlier number of substance users. and geographical places of importance informants are selected on the basis that: to the study. time and resource constraints the course of the RAR and the team should may make it difficult to contact a large be prepared to be flexible. the majority of users remain RAR team should review these and consider hidden from treatment and agency-based which methods should be used. as well RAR therefore usually relies on alternative as documentary sources such as reports. sampling methods aim to ● employ qualitative methods – these include be ‘theoretically representative’.

come from a informants and research directions about a topic. large-scale survey. surveys are typically short. money or physical situation. by seeing what people do. carefully listening to the answers given answer questions on what is going on understanding a particular topic or issue is called interviewing. important background data on respondents (such as survey may produce useful data on the team. behaviours. meanings. This could be through gain an understanding of local behaviours. surrounding region. map key areas. Observation . Changes in opinion and emerging findings. where the findings of the RAR could Chapter 3 use non-random sampling techniques. similar background. to key locations and who the researcher feels may help in crosscheck findings from other methods. and national and practice which could be investigated other methods SEX-RAR Guide would not the time. highlight areas for research. sociodemographic profiles). further. further key exploring further what the group feels assessing the representativeness of common experience. Participants may be able to identify cultural obstacles and problems.includes involves the collection of background data on the can identify gaps in current knowledge can monitor and cross-check findings from routinely collected data that researchers local area. or being used to map extent and nature of a particularly be used to develop or inform the design of a and support other research methods. the availability or type of existing data sources behaviour or activity.these are people interviews can be used to validate and systematically asking questions and locations for further research. further repeated observations in different areas Preparation Stage vocabulary and customs outline potential problems and possible solutions for future interventions Surveys – not recommended unless being used to produce if informed by previous research. a brief can provide a useful ‘next step’ for the RAR In a RAR. or hold a particular understanding local vocabulary and terms for attitude over what constitutes a risk judgement of the reaction of selected groups expertise particular behaviour. discovering opinions and behaviours that the RAR validating and cross-checking findings validating and cross-checking findings from number of individuals interviewed team may not know about from other data and hypotheses other methods together because they have had a generating hypotheses and ideas. data sources and hypotheses present. appropriate body language and behaviour could be recorded and possibly to suggested interventions arising from the appropriate and inappropriate customs related to wider external factors rapid assessment. data sources and methods. aware they were engaged in explore specific topics or behaviours emerging findings. individuals and individuals or groups . in which the study is being conducted Focus groups . Key Methods Early stages of a RAR Middle stages of a RAR Later stages of a RAR Existing data sources . brief.these The collection of data through terminology. Interviews – interviews are important in producing lists of local interviews are often used with targeted targeted individuals or groups . This is useful in understanding the context further resources to otherwise collect. validate and cross-check findings from validate and cross-check findings from other The researcher learns by being establish means of access other methods. 47 Preparation Stage . available to the RAR team. and identify risk behaviours that people were not even hypotheses assess the representativeness of the by listening to what they say.

often difficult-to-reach target populations. letters of introduction and/or to participate due to distrust and suspicion. The RAR team should be prepared to undertake especially when contacting people who are work in the locations where the target wary of strangers or who are connected with population is situated. and preferably more often. politely but recruiting indigenous workers it is important to firmly. A staff or people who are helping them. For some former users. 48 Chapter 3 Preparation Stage SEX-RAR Guide Where to work Assessments may be carried out in difficult and sometimes dangerous circumstances. (these need to be short and should aim to or near to other sensitive areas. Indigenous field staff – who frequently tend to be former substance . an interviewing respondents. rather than just showing the type of data that is being ● identifying any training or security needs – the RAR team should decide in advance how to collected). The emergency contact numbers (agreed with the Preparation Stage RAR team will need to draw on the assistance of local police beforehand). This raises three issues: illegal behaviour.being aware of one’s own and other people’s users – can be valuable in conducting such verbal and non-verbal communication and what work as they will have good access links to it means. or undertaking data appointed chair-person. and who demonstrate stability in their daily Monitoring progress functioning. Training least weekly. When .informing the rest of the team about time and these problems (potentially being able to make location of assessment work beforehand. important introductions). monitor progress. the RAR It is recommended that in rapid assessments team should consider the ethical aspects of taking 12-16 weeks the RAR team meets at asking them to re-enter situations where substances are likely to be available. if there are fears for personal safety. . comfortable and convenient location for a formal manner with an agenda. to should be given to all indigenous field staff. These could include: whilst others will be easier to reach but reluctant . ● identifying physical locations – it is useful if a the RAR team should conduct the meeting in quiet.carrying ID cards. good communication skills. field.ending the interview/discussion. meetings with avoid situations that threaten the safety of their the CAB do not need to be as frequent. select those with a high social status in the target group. raise a particular issue. This location summary papers or exemplar data segments should not be situated in a treatment centre. monthly meeting of all members is adequate. gate-keepers and key-informants to overcome . Unless requested. To avoid time being wasted. and pre-circulated collection is identified in advance. use local knowledge to decide how to avoid or difficult to research – some groups will be risks and decide on procedures for dealing difficult to locate due to the fact that they are with difficult or dangerous situations in the involved in an illegal or stigmatised behaviour. as this may deter participation. RAR team members should ● contacting populations that are difficult to reach.

the degree of accuracy or detail required Where possible. inferences can be mistaken for actual In terms of data recording. problems and misunderstandings often mean whilst running commentaries and opportunistic that such data-sets – particularly when notes can miss key details. . making sure that missing items are written down. Keep an when significant events occurred. Whilst the other sensitive data are not identified in these notebooks. diplomatically research took place. in a toilet break). but very time-consuming to conduct. or opportunistic notes (taken when it is appropriate and safe to sets are tagged and dated. Spend as much time as members and indigenous workers should be possible on this and list in full anything that you made aware that any completed instruments feel is useful. divide the notes into smaller sections.SEX-RAR Guide Preparation Stage Chapter 3 49 3 . the characteristics of negotiating access to locations and informants. This can include descriptions of where the carefully collecting information.g. and to otherwise these efforts can be wasted and highlight any impressions or thoughts to avoid the researcher’s own perceptions and valuable information lost. date and upon the RAR team. compiled ‘on request’ by third parties – can lack ● review and expand on notes immediately after vital information. Care should be taken that There is always a risk that a large amount of individuals.members of the RAR team can A secure and central research archive should be either take verbatim records (an almost exact created to allow the RAR team to quickly locate record of everything that occurs in a research and review materials. being said . If this process has to be left to a later time. and indicating individuals. key geographical locations and unnecessary data will be collected. it may be useful just noting Data quality control is an essential element of down any details that you feel are important or the research process. the data management framework will be of ● systematically record what is happening or use in undertaking this task (DATA2). Communication are exact. as this could have serious RAR team should try and identify in advance implications if this data were lost or seized.5 Managing fieldwork Rapid assessments can place heavy demands ● take notes that include the time. for such information. and compared with any other Data quality researchers present. You may spend time background to the research situation. and then carefully do so – e. running commentaries (summaries of establish a routine where information and data- the key behaviours or points). the RAR team should: ● carry one or more notebooks with which to Data management take notes. Verbatim records checked before being archived. or surveys will be randomly checked. fieldwork. each member of behaviour or discussion. or contain errors. It may effective record of what happens during this also be valuable to use sub-headings to Preparation Stage process. The RAR team should also situation). Both RAR team that may be forgotten. and conducting research in where people left or entered the setting or difficult and unusual situations. codes should be substituted when answering specific research questions. and their roles. and manage this information.

differences in the types of agencies. Triangulation sampling methods. taking 12-16 weeks that the RAR team meets at least weekly. the reliability and ● quality .differences in the validity and validity of the research findings are established reliability of individual sources through cross-checking multiple sources of ● coverage . These profiles should pay issue.differences in the amount of conclusions based on a systematic information provided . it is often useful in these person. regions covered triangulation’ and is based on the premise that ● quantity . rather than just showing the type of attention to factors such as data: data that is being collected). collected data. To How should the RAR team decide avoid time being wasted. data. as with other elements of rapid information from a single source or method – Preparation Stage assessment. themselves. or where the RAR team are able to dedicate time data collection procedures – are even more throughout the assessment to data analysis. Many of the difficulties involved in interpreting Instead. users. and pre-circulated summary papers situations to draw on descriptions of the data- or exemplar data segments (these need to be source compiled as the rapid assessment short and should aim to raise a particular progresses.differences in definitions. and procedures In a rapid assessment. an appointed chair. This means that carefully selected information sources are planning the analysis is not about allocating a usually more credible than investigations that number of weeks at the end of the assessment use only a single data source. and preferably more often. requires planning. it is important to establish a routine such as lack of detail about case definition. This can make comparison present and discuss findings. difficult when two or more data sources give It is recommended that in rapid assessments different results. ● comparability . and pronounced when a number of different data where regular team meetings are organised to sources are used.6 Analysing data The analysis of data is conducted throughout examination and comparison of two or more the rapid assessment process. 50 Chapter 3 Preparation Stage SEX-RAR Guide 3 . to pulling together and examining all of the The process of triangulation. the RAR team which data source is ‘correct’? should conduct the meeting in a formal Although such conflicts can be revealing in manner with an agenda. This is sometimes referred to as ‘data drugs.

names and contact details of likely identify in advance a joint dissemination and decision-makers. advocacy strategy for the report. and what might the constraints be? team will need to address three core questions: The response development framework ● what type of response is required? (RESPONSE3) can help in addressing these ● how important.the area of the rapid assessment that the the key findings and recommendations of the decision-maker is associated with. at an early stage of the rapid assessment.those with influence over them. it should also target specific . response? Preparation Stage 3 . 3 .9 Disseminating findings Where appropriate. .8 Writing reports Usually. Whilst .7 Developing responses The development of responses is described in ● what opportunities exist for such a course of chapter 5. the RAR team should . Although this . them (such as conferences and meetings open to the public).data-sources from which the information was report detailing the process.SEX-RAR Guide Preparation Stage Chapter 3 51 3 . assessment protocol (if developed). key findings gathered and recommendations of the study. To do this. should aim to achieve wide dissemination of . the RAR team should begin Remember that different people will respond compiling a profile list of: to different types of data and messages. Throughout the assessment the RAR action.overall strengths and limitations of the study. agencies and organisations who course of the rapid assessment to talk with may be key in future intervention development. it is An example report structure is included in important that the report clearly states the: Appendix. strategy. urgent and feasible is such a questions.reasons underlying major research or this can draw on the planning assessment intervention decisions in the assessment framework (FIELD1) and also a written . the RAR team strives to produce a .any opportunities which may arise during the individuals.

women. ● community access .g. youth.access may be difficult ● inequalities within communities . Special efforts may be needed to reach out to ● community suspicion . team should discuss these issues among follow through on commitments made. more marginalised sections of the community The team needs to define what their (e. legal situation. poor people. sexual minorities). and themselves before beginning the assessment. discussions of such issues effectively. people living with HIV/AIDS. and power can make it difficult to work with the lack of permission from community leaders. may be naturally suspicious of outside organisations offering help because of broken ● lack of understanding of key issues . Inequalities in climate. ethnic/racial minorities. The open and accountable decision-making.communities for a number of reasons including geography. are usually not homogenous. political situation. substance problems of access might be in order to try users.10 Preparing for possible problems Unanticipated problems will arise during the clarity about what the RAR team can and RAR.RAR promises in the past.community members and work with these groups of people. Build a relationship of trust and can prevent them from facilitating group credibility through honest communication. . 52 Chapter 3 Preparation Stage SEX-RAR Guide 3 . Substance users may team members may lack an adequate also be suspicious because of their fear of understanding of some key issues and this arrest. These can include: cannot do. Preparation Stage and address them.

SEX-RAR Guide Assessment Stage Chapter 4 53 4 ASSESSMENT STAGE 4.3 Context assessment 4.2 Initial consultation 4.4 Health consequences assessment Assessment Stage 4.1 Introduction 4.6 Intervention assessment .5 Risk assessment 4.

3 seven questions central to any rapid assessment ● Health Consequences Assessment – Module 4. 4. 54 Chapter 4 Assessment Stage SEX-RAR Guide 4 .Module 4. but are most useful when used in combination with one another. and which interventions are likely to be feasible.6 Assessment module structure contained units. 4.2 2 what contextual factors influence patterns of substance use. They The five Assessment Modules contained in should be used in conjunction with the this chapter outline the key areas of assessment to be covered in a rapid research methods described in chapter 6. 4.6 Assessment Modules: Along with local discussion and input. There are five ● Intervention Assessment – Module 4. 4. and any methodological or practical parameters? Initial Consultation.3 Assessment Stage 3 what is the extent and nature of adverse health consequences associated with sexual risk behaviours Health Consequences related to substance use? Assessment. 4.4 on substance use and sexual behaviour: Key question Assessment Module 1 what is the local situation with regards to the potential sub- populations. adverse health consequences associated with sexual risk behaviour. which may be included in the RAR. patterns of sexual behaviour. these ● Initial Consultation .5 6 what are the needs for intervention responses.1 Introduction This chapter contains the SEX-RAR ● Risk Assessment – Module 4. and the feasibility and development of interventions? Context Assessment. in a similar manner and comprises these areas: .6 7 what are the resources and actions required when developing and implementing locally appropriate interventions to reduce the adverse health consequences associated with sexual behaviour related to substance use? Intervention Assessment.5 5 what is the extent and nature of sexual risk behaviour associated with substance use? Risk Assessment.4 4 what is the extent and nature of the relationships between substance use and sexual behaviour? Risk Assessment. 4. 4.2 modules will help the RAR team address the ● Context Assessment – Module 4.5 Assessment Modules. They may be used as self. assessment on substance use and sexual Each of the Assessment Modules is structured behaviour. appropriate and effective? Intervention Assessment.

RAPID ASSESSMENT: AN OVERVIEW SEX-RAR Guide FOCUS GROUPS EACH ASSESSMENT EXISTING DATA MODULE IS OBSERVATION INFORMED BY QUALITATIVE AND QUANTITATIVE INITIAL METHODS CONSULTATION ASSESSMENT MODULES ARE USED IN COMBINATION WITH EACH OTHER HEALTH INTERVIEWS CONTEXTUAL MAPPING ASSESSMENT ACTION PLAN CONSEQUENCES TECHNIQUE ASSESSMENT Assessment Stage FINDINGS FROM ONE ASSESSMENT MODULES ARE CROSS-CHECKED WITH FINDINGS FROM ANOTHER RISK INTERVENTION ASSESSMENT ASSESSMENT Chapter 4 OTHER RESEARCH ESTIMATION METHODS TECHNIQUES MULTIPLE METHODS TARGETED AND DATA SOURCES ARE USED SURVEYS 55 Assessment Stage .

the same time. it is likely that each of the Assessment team will want to ask. RAR team will need to undertake to address these ● in conjunction: each module should be used ● highlights of the most useful research methods with multiple methods and data-sources. The Initial Consultation aims to help the RAR team make initial judgements about the focus Key questions and parameters of the study. 56 Chapter 4 Assessment Stage SEX-RAR Guide ● an outline of the aims and objectives of the module about the same time and as a complete rapid ● a description the key questions which should be assessment package.each module requires local Assessment (4. as well as community representatives. It is important that the RAR team assessment and understand the environment in consider local issues and problems when which this is being conducted. a more valid areas and questions may be addressed at the and complete picture is produced. The remaining reviewing each assessment module. The and data sources for answering the research Assessment Modules should employ more than questions one method or data-source to avoid bias and inaccurate results. often at are not described in the Assessment Module. and the questions asked.2 Initial consultation The aim of the initial consultation regional and local experts. involving an adverse health consequences associated with organised and facilitated meeting of national. the Initial Consultation (4. it is likely that there will be arise in the field. This is because a range of key ● in combination . The Initial Consultation is questions: usually undertaken before the full rapid ● what is the local situation with regards to the assessment study begins.2) and Context ● creatively .3) modules to help plan the rapid adaptation. The modules are best undertaken at objectives of local rapid assessments. and also as data-collection opportunities Assessment Stage topic areas and components of the rapid assessment. Emphasis on one particular Assessment Modules are most effective when the findings from one module influence the Assessment Module over another will depend on approach taken. used? in combination. the In what order should the modules be assessment modules should be used creatively. Once the rapid assessment additional research questions that the RAR begins. 4 .used together. (An emphasis on the use addressed during the RAR of one particular module over another will depend on particular local interests and the ● an overview of the key practical tasks that the specific purposes of local assessment). sexual behaviour among substance users? . Using the assessment modules As shown on the following page. and in conjunction with the It is recommended that the RAR team begin with methods modules. The same time. and to plan the The Initial Consultation addresses three key rapid assessment. Although the Assessment Modules describe the basic modules can then be employed according to this plan. or practical tasks that Modules will be used in combination. in particular local interests and the specific another.

These discussions should plenary presentations and small group not exclude the rapid assessment team sessions focusing on: key issues emerging. with this assessment. local experts and key informants in the Q2. arrange a meeting between the RAR team. Consultation aims to gain expert and key informant opinions about the prevalence. Key among substance users? considerations include: . AIDS. public health and HIV/AIDS may be included in the rapid situation to identify and discuss potential research assessment? questions for the rapid assessment This question aims to generate discussion 2. integrate into the written assessment Q3. The RAR samples which may be given particular team should provide an outline on what emphasis in the rapid situation each participant should discuss. The RAR team principal investigator groups of substance users or other should also give a presentation introducing populations that may be considered at the aims and objectives of the assessment. ask selected participants to prepare in among local expert and key informants advance a short presentation (5-10 minutes) Assessment Stage on the potential sub-populations and with which to generate discussion. from including a wide range of sub- key questions to be addressed. sexual behaviour.SEX-RAR Guide Assessment Stage Chapter 4 57 ● what are the potential sub-populations and This question provides an immediate samples of substance users which may be overview of the country. and particularly HIV The RAR team should also identify other infection. The Initial interest. record the key points from the meeting and sampling strategies. and plans samples in the assessment. what are the methodological and protocol practical parameters of the rapid situation assessment? Guide to key questions The Initial Consultation should lead to Q1. increased risk of adverse health 3. city or included in the rapid situation assessment? community situation with regard to ● what are the methodological and practical adverse health consequences associated parameters of the rapid situation assessment? with sexual behaviour. and samples of substance users which social research. what are the potential sub-populations fields of substance use. distribution and extent of There are four key tasks: adverse health consequences associated 1. This question for the rapid assessment will assist in decision-making about initial 4. with substance use. and other sexually questions which cover issues of specific local transmitted diseases (STIs). Key tasks frequency. Such discussion may lead to being based on the RAR team’s assessment initial judgements about particular social plan. conduct the workshop in a series of large consequences. what is the local situation with regards preliminary judgements about the to the adverse health consequences methodological and practical parameters associated with sexual behaviour of the rapid assessment.

● discussion: facilitated by RAR team member as above ● closure: summary of key points of session. 58 Chapter 4 Assessment Stage SEX-RAR Guide ● potential sample groups and sampling assessments on substance use and sexual strategies. target populations. sample groups. and a method of recording this information and Assessment Stage subsequent group discussions identified (e. interest or geographical region. RAR team meet to discuss how these can be developed into a more concrete research design. . sexual behaviour.g. allocation of resources. and the methods that will be used. as well as feasibility issues MEETING (PM SESSION) ● group work on identifying key issues: smaller groups are formed according to expertise. potential methods and data sources behaviour. agreed date for next meeting if initial consultation will form the basis of a steering group or community advisory body POST MEETING: produce brief report of key points and distribute. and existing data sources. Possible EXAMPLE: AGENDA FOR INITIAL CONSULTATION (ONE DAY) PRIOR TO MEETING: The Principal Investigator and RAR team should identify and invite potential participants (bearing in mind both the contribution certain individuals will make. local and implementation of interventions experts and key informants in the fields of This question can assist in the development substance use. nominated note-takers). MEETING (AM SESSION) ● welcome and introductions: welcome and introductory statement by respected health or community leader ● study introduction: RAR team to describe rationale and background to the rapid assessment. Each group are asked to identify: the topics/key questions to address in the rapid assessment. public health and HIV/AIDS. as well as their symbolic importance). ● management of the rapid assessment team and coordination of the assessment Key methods and data sources ● resources required The Initial Consultation is best undertaken ● expected timetable and outcomes through an invited meeting or ‘focus group’ ● practical aims with regard to the development between the rapid assessment team. social of funding proposals for rapid situation research. objectives and expected outcome of the meeting ● prepared short presentations: 3-4 short presentations (5-10 minutes) prepared in advance by participants which highlight potential areas for assessment and intervention ● discussion: facilitated by RAR team member and focusing on priority assessment areas. selected participants might be asked to prepare short presentations on key areas of expertise or knowledge. In some cases.

The Consultation also noted that there was no existing or Assessment Stage conclusive evidence about the effects of alcohol on condom use among a variety of sample groups. ● media. or ‘data quality’. ‘research questions’. The aim is to create an understanding of the Appreciating these contextual factors is context in which patterns of substance use valuable when attempting to interpret and sexual risk behaviour are occurring for existing data and reports. the Context from the immediate physical setting through Assessment addresses three key questions: .SEX-RAR Guide Assessment Stage Chapter 4 59 participants include representatives from: ● political and policy organisations ● national or local Health Departments ● international agencies resident in the area ● health and community organisations The RAR team will need to identify a method of ● hospital and community health clinics documenting the findings and discussion of the ● non-governmental organisations Initial Consultation.3 Context assessment The aim of context assessment to the wider economic. at least initially. structural and political situation (see example below). it is also possible to ask ● social science and health research participants to complete pre-printed grids or ● youth affairs ‘workbooks’ which contain headings such as ● law and criminal justice ‘assessment area’. with influences ranging additional local questions. because individual behaviour is typically shaped not only by individual choices and Key questions decision making. EXAMPLE: USING THE INITIAL CONSULTATION TO FOCUS THE RAPID ASSESSMENT ON PRACTICAL NEEDS The Initial Consultation identified existing data which highlighted that crack and cocaine smokers may be engaging in ‘high risk’ sexual behaviour. ‘data sources’. This is studying specific trends or patterns. allowing the RAR the swift introduction of appropriate and team to take these into account when feasible intervention responses. 4 . but that greater emphasis. but also by the context in Although these should be supplemented with which it takes place. Health workers from one of the city’s health clinics indicated that there are increasing numbers of crack and cocaine smokers who report themselves to be HIV positive. would be given to assessing the sexual behaviour of crack and cocaine smokers. In addition to nominated note-takers. including the general population. education ‘methods’. It was decided that the rapid assessment would focus on alcohol.

. Aside from a likely increased risk of exposure to sexually transmitted infections. This should be considered further in the assessment. the emergence of sex work markets can lead to the creation of geographical ‘no-go’ areas. as well as using substance use and sexual behaviour? individual and group interviews ● which contextual factors influence the health 2. considered socially acceptable in casual and short-term relationships. On a structural level. Condom use is. these Conducting the module will involve the RAR tasks represent an ongoing cycle of activity team undertaking at least three tasks: which continues throughout the assessment. One form of condom use reportedly common among heterosexual men is the use of condoms for ejaculation only. considering how these factors could affect existing and future interventions Key tasks As with the entire rapid assessment. businesses and surrounding transport links. identifying contextual factors through rather than a linear set of stages to be consulting sources of existing national. Differences in social groups include: commercial sex workers generally report high levels of condom use. This may result in the partner becoming involved in sex work to earn additional income. on a community level such sex work may be socially stigmatised and could lead to social consequences such as violence or sanctions against the individual and their substance using partner. SOCIAL AND CULTURAL EXAMPLE: CONDOM USE Social norms regulating condom use vary by social group and social setting. describing the influence of factors on and social consequences of substance use and substance use and sexual behaviour (with sexual behaviour? attention being paid to the ‘quality’ of the ● which contextual factors might obstruct or data used) facilitate the development of interventions? 3. In the context Assessment Stage of such relationships. there is generally a ‘norm’ of unprotected sex and condom use is viewed as communicating ‘mistrust’ between partners. particularly among young people and in male same sex relationships. 60 Chapter 4 Assessment Stage SEX-RAR Guide ● which contextual factors influence patterns of regional and local data. All of these factors have consequences for the quality of life and health of local people. heterosexual men are least likely to view condom use as socially acceptable. completed and then forgotten. EXAMPLE: INTERACTION BETWEEN SOCIAL AND STRUCTURAL LEVELS At an individual level the sexual partners of substance users may be the sole financial means of supporting their family’s needs as well as their partner’s substance use. This may lead to responses at the structural level such as an increased police presence in the area. Condom use is not generally considered socially acceptable in long term heterosexual relationships. various religious groups disapprove of condoms. 1. and a gradual disinvestment in local shops.

improvement of major road systems and increased exposure of formerly insulated communities and persons to outside contacts have exacerbated the vulnerability to HIV of the Cambodian people. Usually patterns of substance use and sexual more difficult to identify than structural factors. these two highways link Cambodia to its neighbours of Thailand and Viet Nam. hotels. Highway One and Highway Five. intermittent political instability. restaurants. behaviour. serve as catalysts for the spread of HIV/AIDS. To simplify this task. The physical sites (such as public places) and social settings either give a clearer understanding of the (such as particular relationship types) in which main features of the rapid assessment these take place are also included. behaviour? these can include cultural sexual norms and To answer this question. RAR teams Q2. location. Increased population movement including short-term movements between village and cities. use/non-use. or the activities of health or criminal different groups associated with condom justice systems. pose a number of challenges in the battle against HIV/AIDS transmission. which contextual factors influence which may influence health behaviours. which contextual factors influence the often tend to divide the context health and social consequences of assessment into two sections: (i) a substance use and sexual behaviour? structural context assessment. guest houses.SEX-RAR Guide Assessment Stage Chapter 4 61 STRUCTURAL EXAMPLE: MIGRATION AND MOBILITY IN CAMBODIA "The rate of HIV infection in Cambodia is the highest for all of South East Asia at present. Cutting across the country. This includes prevailing economic factors like the meanings and beliefs conditions. or alternatively will enable the team to interpret and understand current As might be expected. sea farers. and migrant workers are increasingly coming into contact with local communities where services are provided at places such as brothels. Economic liberalization. the RAR team will the social meanings of drug use across need to list those contextual factors which different population groups. . and government authorities. 180 Assessment Stage Guide to key questions ● the social and cultural context incorporates those factors at the societal or community level Q1. Interaction among these diverse sectors provides fertile ground for the transmission of HIV/AIDS…Effective intervention to reduce HIV vulnerability with the collaboration of communities. commercial sex workers. and the increase in economic activity surrounding large-scale construction project along transit routes. Mobile populations such as long-distance truck drivers. bars and car parks. and (ii) a This question requires the RAR team to social and cultural context assessment. or social and contextual influence substance use and sexual risk behaviour. The planned reconstruction of two of Cambodia’s major roadways. overlap and interaction patterns of substance use and sexual risk can occur between these two contexts. take into consideration structural factors ● the structural context is often defined as those such as human rights and law factors at the city or country level which can enforcement. construction contractors. gambling places. is vital in preventing the HIV pandemic".

religious and ritualistic patterns of general living conditions) ● questions which focus on specific conditions substance use such as HIV and other infectious disease Chapter 4 Assessment Stage ● communication (e. ● transport links and industries commercial ● types of social relationships including friends family. differences in patterns of which encourage or discourage substance use substance use between social groups. borders with influential ‘norms’ and practices ● questions that assess the social or geographical producing areas. employment transmitted diseases.SEX-RAR Guide EXAMPLES structural factors social and cultural factors question types ● geo-environmental (e. contraception and pregnancy.g. influential ‘settings’ and ‘sites’ transportation) ● private settings such as the home.g. drugs policy. population size. municipal parks to sexual behaviour. long-term. policy) ● questions that compare different social or different social groups and subcultures in regard cultural sub-populations ● education (e. major locations) ● types of sexual relationship including marriage. projections) same sex and opposite sex relationships. ‘shooting ● welfare system (benefits) galleries’ where people inject drugs ● housing (type. structure. existing and new ● economic (e.g. average income. languages spoken. criminal justice system) for men who have sex with men. major industries/centres) ● social meanings of substance use among ● political (e. ● questions that measure the impact structure.g. pre-marital sexual relationships. traditional. level. national and local. location.g. drug using networks ● questions that establish the basic situation 62 Assessment Stage . or public ● law (e. standard. short-term. conditions of access. services. literacy normative patterns of substance use. primary partners.g. and and sexual risk ● health (e. schooling years. legal system. sexually ● questions that look for past.g. casual. transit route for drugs) ● cultural sexual norms in regard to virginity and distribution of a behaviour ● demographics (e. laws relating settings such as sex work areas. socially rates) acceptable and unacceptable patterns of ● questions that seek to understand the factors ● religion (e. range of religions) substance use.g. migration flows. age/sex sexual initiation. condom use trends over time rate. media.g. philosophy.

which contextual factors might obstruct influences. Unstructured individual organisation of health policy and and group interviews should also be intervention initiatives (will condom undertaken to explore social. Observation may prove suspicious of external agencies trying to useful in describing the situations and make contact. Of These are only a guide and the RAR team should also consider additional issues. and making interventions. a similar process will need to or facilitate the development of be followed. are those consequences of public health significance such as HIV Key tasks infection and other sexually transmitted infections (STIs). as well as key informants. Key methods and data sources the RAR team should consider how The Contextual Assessment draws heavily on factors such as the illegality of existing data sources providing descriptions commercial sex work (CSW) can of important structural factors at the country. work amongst behavioural norms related to substance use sex workers if they are not only and sexual behaviour. health consequences associated with substance use and sexual behaviour through Key questions the critical examination of existing data- sources and key-informant interviews (possibly This module addresses three basic questions: also recording details of each data-source as ● what is the extent of HIV infection and AIDS? part of a general ‘data profile’) . but also unwilling to carry settings where substance use and sexual condoms because the police will view behaviours might overlap. cultural and distribution. The Health Consequences The RAR team should prepare for at least four main tasks whilst conducting the module: Assessment assists judgements about the need ● identifying key data-sources as early as and priorities for sexual risk reduction possible in the assessment. greatest importance. interventions? From a structural context perspective. and examining social and cultural community leaders. assessing the potential impact of interventions ● using these sources to identify the adverse for reducing adverse health consequences.4 Health consequences assessment Assessment Stage The aim of health assessment ● what is the extent of sexually transmitted disease and other infections? Health Consequences Assessment aims to ● what is the extent of other adverse sexual assess the extent and nature of adverse health health consequences? consequences associated with sexual behaviours related to substance use. When include key informants. Gathering such data helps inform arrangements to begin accessing this the targeting of interventions among different information. The same principle also applies to groups of substance users.SEX-RAR Guide Assessment Stage Chapter 4 63 Q3. local experts. influence the development and city and regional level. 4 . for example. Useful data sources this as evidence of CSW?).

and an assessment of the validity of the Assessment Stage data from which these are drawn. . which aimed to gain an estimate of the prevalence of different adverse sexual health conditions among cocaine users for the first time in our city. as in statistical reports. 64 Chapter 4 Assessment Stage SEX-RAR Guide EXAMPLE: USING AND PROFILING EXISTING DATA IN THE HEALTH CONSEQUENCES ASSESSMENT The rapid assessment began by analysing existing data. We therefore decided to conduct some exploratory focus groups and key informant interviews. routes. A recent self-report survey among street children involved in prostitution. As with Q1. Cumulative prevalence among the general population in our city is estimated at 24%. this data was inadequate for assessing these health conditions among cocaine users (the main sample group in our rapid assessment). These led to a realisation that some adverse health consequences identified by cocaine users were not included in existing reports. as in newspaper reports. Data also indicates that cumulative prevalence is higher among women than men (29% against 20%). what is the extent of HIV infection and transmitted diseases and other AIDS? infections? The RAR team will need to describe the The RAR team should also focus on broader local situation in regard to HIV sexually transmitted diseases and infection and AIDS. or introducing new responses. Guide to key questions Q2. many of whom use solvents and other drugs. the assessment needs to present the data in ways which will be of practical relevance. the identify the specific links with sexual team should consider how the local behaviours related to substance use. Key informants said that prevalence among adult female sex workers is probably over 50%. trends in HIV infection and AIDS ● cross-checking and supplementing these over time and different population insights using the other assessment modules groups. (with special reference to the Context Assessment and Risk Assessment modules). This was the same time when the surveillance system was established. or anecdotal. what is the extent of sexually Q1. This is between 5-15% higher than in other cities in our country. We therefore added these to our brief survey. context might affect patterns of infectious Particular consideration should be given disease. The Contextual Assessment to an assessment of sexual transmission module will be of use in doing this. We found this useful for estimating the extent of HIV infection. Whether these sources are very detailed. Existing data indicates that about 80% of HIV cases are sexually transmitted. Examples included unplanned pregnancy and sexual violence against women. AIDS. prevalence and incidence data. EXAMPLE: SEXUAL TRANSMISSION OF HIV The first reported case of HIV infection in our city was in 1991. before beginning to infections other than HIV. ● identifying implications for modifying existing of HIV relative to other transmission interventions. However. and STIs. found a point prevalence of almost 30%. It is likely that HIV transmission dates back to the mid-1980s.

parasitic and viral infections ● questions which assess the quality of the data ● genital herpes ● influential structural factors on which judgements and decisions might be made ● chalmydia ● influential social and cultural factors ● questions which assess the social or ● hepatitis B and C geographical distribution of a behaviour ● pelvic inflammatory disease Assessment Stage ● questions that measure the impact ● questions that look for past. fungal. SEX-RAR Guide EXAMPLES HIV. existing and new trends over time ● questions that compare different social or cultural sub-populations ● questions that seek to understand the contextual factors which encourage or Chapter 4 discourage substance use and sexual risk ● questions which focus on specific conditions such as HIV and other infectious disease 65 Assessment Stage . AIDS and STIs other adverse consequences questions ● HIV and AIDS ● unplanned pregnancy ● questions that establish the basic situation ● gonorrhoea ● sexual violence and rape ● questions that seek to measure the total prevalence and incidence of a behaviour or ● syphilis ● tuberculosis condition ● genital warts ● bacterial.

For this reason. and risk taking describe the sexual behaviour of substance behaviour. and the factors which could inhibit or the different individuals and social groups being enable intervention development to reduce assessed using mainly qualitative research any associated adverse health consequences. ● STD reports from health clinics Where there is no existing data. These may include: Module 6. and brief reports surveys. clinical and hospital groups. what is the extent of other adverse National and local policy documents may also sexual health consequences? be useful. also focuses on substance users’ perceptions of the influence The module primarily involves documenting of wider contextual factors and social and substance users’ perceptions. the sexual risk behaviours they engage substance use from the level and perspective of in. structured interviews. The module. as might media reports for Other consequences – such as unplanned identifying health problems not included in pregnancy. Crucially. methods. this involves describing users. for the Health Consequences Assessment is there may be adverse health consequences shown on the next page. as well as triangulating data with Assessment Stage ● HIV and AIDS case reports findings from other Assessment Modules. should also figure in the assessment. The RAR team need to constantly assess the reflecting the local situation. knowledge and cultural influences on their sexual behaviour. and reporting systems with data collection (such as interviews with key information on HIV test reports informants). activity. not reported by existing data (possibly due to time lags in information being collected. or associated sexual violence – surveillance and reporting systems. the ● STD and substance use treatment reports assessment can be conducted using focus ● health agency reports.5 Risk assessment The aim of risk assessment beliefs about the effects of substance use on The Risk Assessment module aims to their sexual desire. 4 . . but also to actively cross-check ● national and local surveillance information through using other methods of ● health information.2). it is The main method for conducting the Health useful to not only be aware of the limitations Consequences Assessment is through the of existing data sources (see: Research collation of existing data. For example. Key methods and data sources analysed and reported on by existing surveillance systems). 66 Chapter 4 Assessment Stage SEX-RAR Guide Q3. quality and validity of the data throughout all A summary of questions and topics relevant of the Assessment Modules. It is important to continually check ● findings from national and local research the validity of existing data against other studies methods and data sources.

We therefore added these to our brief survey. AIDS. The RAR team will need to consider how they Key questions will undertake the following tasks: 1. this data was inadequate for assessing these health conditions among cocaine users (the main sample group in our rapid assessment). . Reported difficulties in reaching orgasm amongst male heroin users has been identified as a possible risk behaviour in that it may lead to prolonged intercourse and greater probability of condom breakage. identify the sexual behaviours and sexual The module addresses five questions central risk behaviours of substance users to the overall assessment: perceptions ● what are the sexual behaviours of substance users? 2. they did not have a reduced interest in sexual behaviour. Another UK study found that although heroin users reported frustration with sexual performance. These led to a realisation that some adverse health consequences identified by cocaine users were not included in existing reports. or anecdotal. Whether these sources are very detailed. begin to compile reasons and factors ● how does substance use influence these explaining why users engage in such behaviours? behaviours ● why do substance users engage in sexual risk behaviour? 4. However. the assessment needs to present the data in ways which will be of practical relevance. EXAMPLE: SEXUAL RISK BEHAVIOUR AND OPIATE USERS. UK Opiates are believed to inhibit sexual response. We found this useful for estimating the extent of HIV infection. A survey of injecting drug users in the UK indicated that 77% had vaginal or anal intercourse during the last six months. use this information to identify the factors ● what factors might inhibit or enable risk that might inhibit or enable risk reduction reduction strategies? strategies EXAMPLE: RAPID ASSESSMENT AND INJECTING DRUG Assessment Stage USERS’ SEXUAL BEHAVIOUR. and STIs. as in newspaper reports. establish how substance use influences ● what are the sexual risk behaviours of substance these behaviours users? 3. which aimed to gain an estimate of the prevalence of different adverse sexual health conditions among cocaine users for the first time in our city. We therefore decided to conduct some exploratory focus groups and key informant interviews. Examples included unplanned pregnancy and sexual violence against women.SEX-RAR Guide Assessment Stage Chapter 4 67 This involves comparison with data collected Key tasks using the Context Assessment Module. COLOMBIA The rapid assessment began by analysing existing data. heroin users in many areas are sexually active and the risks of sexually transmitted HIV and other conditions among users should not be dismissed. as in statistical reports. However.

or targeted surveys). STIs. after perceptions and knowledge about penetration but during intercourse.such as the different well as social and cultural factors like the ways in which ‘condom use’ can be effect of individuals health beliefs. risk understood (e. or at different risk behaviours. The RAR team needs to document which sexual behaviours increase the risk of Q4.often significantly Q5. ejaculation only) . men who use drugs during sex on venues premises. why do substance users engage in HIV. or sexual Q2.g. Guide to the key questions Q3. This question is extremely This requires taking into account important. it is important well as more quantitative data describing to understand how users perceive their the extent and nature of particular consumption as affecting their behaviours (such as through existing relationships. as subtle details . before penetration. and gay men with AIDS who use substance to reduce the physical and psychological effects of HIV infection. how does substance use influence these behaviours? Q1. what factors might inhibit or enable increasing individual risk. Socially. and the wide range of different reasons given for using the substance. The This question requires a ‘typology’ of the pharmacological effects of the drugs sexual behaviours taking place among taken need to be understood by the RAR substance users and the extent of sexual team. other infectious diseases. these include gay men in party circuits. 68 Chapter 4 Assessment Stage SEX-RAR Guide EXAMPLE: SOCIAL MEANINGS OF METHAMPETHAMINE USE AMONG GAY MEN Qualitative research methods have been of great use in understanding the range of gay male sub- cultures that include methamphetamine users. which may need to recognise and target several gay sub- cultures rather than just a single homogenous population. and different methods of drug behaviour. as patterns of sexual structural factors such as the impact of behaviour can differ across different economic factors on patterns of contexts and social groups. with often commercial sex work among users. what are the sexual behaviours of This can be understood in two ways: substance users? pharmacologically and socially. Key issues might involve data. street and public scenes among younger gay men. risk reduction strategies? . what are the sexual risk behaviours of relationships where sex is directly substance users? exchanged for substances. negotiation in relationships. It is important that data are Assessment Stage preparation and combinations should be collected from substance users using documented where possible (as these exploratory qualitative methods such as often aim to increase an individual’s in-depth interviews and focus groups. a transgender/transsexual community of users. This has consequences for the production of educational and information-based interventions. as sexual pleasure). For example. or sexual risk behaviour? other harms.

SEX-RAR Guide
EXAMPLES
sexual behaviour sexual risk behaviour questions
● the effects of substance use on sexual behaviour ● the effects of substance use on sexual risk ● questions that establish the basic situation
and relationships behaviour and condom use
● questions that assess the social or geographical
- pharmacological and physiological distribution of a behaviour
● the extent and nature of sexual risk behaviour
- types of drug
- perceived effects, most important, typology among substance users ● questions that measure the impact
- types of relationship ● questions that look for past, existing and new
● the influence of social norms and settings on
- honesty, negotiation, other trends over time
sexual risk behaviours
● the extent and nature of sexual behaviour among ● questions that compare different social or
- how common notions of substance use
substance users influence negotiation and initiation skills cultural sub-populations
● the influence of social norms and settings on ● questions that seek to understand the factors
● the influence of structural factors on sexual risk
sexual behaviours which encourage or discourage substance use
- knowledge and awareness of risks and risk behaviour
and sexual risk
reduction

Assessment Stage
● the extent and nature of sexual risk reduction ● questions which focus on specific conditions
- health beliefs and risk perceptions
- interpersonal negotiation skills and behaviour change such as HIV and other infectious disease

● the influence of structural factors on sexual ● questions which measure perception, beliefs
behaviour and knowledge

Chapter 4
69
Assessment Stage

70 Chapter 4 Assessment Stage SEX-RAR Guide

As with all Assessment Modules, data perspective of the user. Such methods can also
should be fed from this module into the be used with other key informants (e.g. health
Intervention Assessment, with a focus professionals, brothel maids etc). In addition to
on factors which could facilitate or producing ‘rich’ data and descriptions, such
obstruct behaviour change among methods can also be used to design structured
substance users. interviews and surveys with which to monitor
the extent of sexual risk behaviour within
Key methods and data sources particular sub-groups. Where possible, such
The Risk Assessment module draws heavily on data needs to be interpreted alongside existing
qualitative methods to explore the nature of data on patterns of substance users’ sexual
substance use and sexual behaviour from the risk behaviour.

4 .6 Intervention assessment

The aim of intervention assessment through structured and unstructured
interviews with key informants working in
The Intervention Assessment aims to assess
the sectors of public health and social
the extent, nature and adequacy of existing
Assessment Stage

welfare, as well as through policy
intervention responses targeting sexual risk documentation.
reduction associated with substance use. It
2. profile and describe these interventions. It
attempts to describe the feasibility and
is often useful to either draw on existing
effectiveness of current intervention responses
descriptions (such as annual reports), or
in order to identify the need, and resources
undertake a brief structured survey with
required, for future intervention developments.
agency representatives.
Key questions 3. assess their adequacy and effectiveness as
well as strengths and weaknesses.
This module addresses four key questions:
Previous service evaluations will be useful,
● what existing interventions are there?
as will structured and unstructured
● how feasible and effective are existing interviews and observations. It will also be
interventions? valuable to document the perspective of
● what is the need for future interventions? substance users currently using services,
● what factors influence the feasibility and as well as those not in contact.
effectiveness of interventions?
Guide to key questions
Key tasks
Q1. what existing interventions are there?
The RAR team will need to undertake three Similar to the profile of existing data-
main tasks: sources, the RAR team needs to compile
1. identify and ‘map’ existing interventions in a ‘typology’ of current interventions. This
the study area. This could be achieved should cover factors such as:

SEX-RAR Guide Assessment Stage Chapter 4 71

CASE STUDY: INTERVENTION PROFILE
Between 1988 a survey of outreach projects for psychoactive substance users and commercial
sex workers was conducted in the UK. The survey was sent to all known health education
projects working with psychoactive substance users. They were asked if they knew of outreach
projects targeting psychoactive substance users and commercial sex workers. These projects
were also surveyed. The survey asked a representative from each project to record details on:
history and background; aims and objectives; target groups; intervention methods and
strategies; client contact in the last month; and details of any evaluation materials. In all, 96
outreach projects were identified, and those using ‘indigenous’ outreach workers and ‘cold-
contacting’ methods were found to have higher rates of client contact. The survey also assessed
the extent of outreach services by geographical area.

● their aims and objectives; Q3. what are the needs for future
● target populations or client group; interventions?
● geographic area served; This question requires a systematic
● the types of intervention or service provided; description of the type of new and future
● where possible the data and information held interventions needed. An important
by that agency. consideration here is the overall balance

Assessment Stage
Data from this question serves as a useful between different interventions and the
background description of the current extent to which they integrate to form an
intervention responses targeting the adverse effective strategic response at the local
health consequences associated with sexual level. The RAR team should to consider
risk behaviour related to substance use in a the resources required to ensure
given country, city, community or local area. successful implementation of
intervention developments.
Q2. how feasible and effective are existing
interventions? Q4. what are the factors influencing the
This question aims to provide effectiveness of future interventions?
descriptive data to assess the extent to This question aims to assess the
which existing interventions are feasible potential factors - individual, social,
and effective. This includes an cultural, economic, political - which may
assessment of their accessibility, inhibit or enable the successful
appropriateness and relevance to development and implementation of
substance users. A key consideration is future interventions. It is important to be
the extent to which existing as realistic as possible about potential
interventions succeed or fail to reach influential factors, as this will have a
‘hidden’ populations of substance users bearing on what can be expected in
in need of service contact. Data from terms of intervention outcome and how
this question are important for feeding best interventions can be evaluated.
into later sections of the assessment on Key issues include: potential resistance
the need for future interventions. or support of community and policy

POLICY AND ENVIRONMENTAL CHANGE (structural context) The effectiveness of interventions targeting individual and community change are influenced by the wider policy. and by the capacity they have to make behaviour changes happen. as well as on the and evaluation records . The individual and inter-personal (relationship) factors influencing behaviour are likely to be amenable to change in the short-term. welfare or health institutions.such as monitoring intervention approaches. by their intentions and motivations to change their behaviour. Where there exist punitive drug laws or an absolutist reliance on abstinence from substance use. These factors are also amenable to change. Structured and Key methods and data sources unstructured interviews with selected key Existing data sources can be used to build up a informants and observations at key health picture of the types of interventions which exist service settings can also provide helpful data within an area. for example. 72 Chapter 4 Assessment Stage SEX-RAR Guide EXAMPLE: INTERVENTION AND BEHAVIOUR CHANGE STRATEGIES INDIVIDUAL CHANGE (inter-personal context) Behaviour change is influenced by an individual’s awareness and beliefs about the risks to their health. when collated need for future intervention developments. particularly where there is an emphasis on law enforcement approaches to particular substance Assessment Stage use and sexual practices. Particular interventions may on the adequacy and effectiveness of particular already have existing data . it may be difficult to develop public health responses or risk reduction interventions. for example. will help assess the adequacy of difficulties associated with intervention existing intervention responses. Peer group norms. . They are therefore best viewed as factors which are amenable to change in the long-term.which. These factors are sometimes beyond the immediate control of government. and can be efficacy and outcome. but in the medium-term. and the social settings in which substance use and sexual behaviours occur. there may be greater difficulties in encouraging behaviour change. In addition. used to design brief surveys of interventions within the local area. influence how individuals behave. groups and leaders and potential together. where there are constraints on health resources. legal and structural context. COMMUNITY CHANGE (social and cultural context) Individual attempts at behaviour change are influenced by the views and actions of the social groups to which individuals belong.

2 Step 1: gather key findings 5.6 Step 5: integrate into a wider strategy 5.3 Step 2: identify responses to develop 5.5 Step 4: identify resources and time-scale 5.1 Developing responses 5.4 Step 3: specify goals and objectives 5.8 Consider wider response strategy Response Stage .7 Consider resources.SEX-RAR Guide Response Stage Chapter 5 73 5 RESPONSE STAGE 5. costs and time-scale 5.

Its can begin to translate research findings into a principles can also be applied in planning strategy or action plan for intervention and further assessment. The reduce the adverse health and social end product of this process should be a Response Stage consequences of substance use and simple written plan.this includes where the ● planning locally applicable and appropriate data was collected from.2) funding for an intervention.1 Developing responses This chapter describes how the RAR team associated sexual risk behaviours.4) potential options for intervention and ● identifying the resources and time-scale response development when the RESPONSE3 associated with this (5. or contextual ● understanding the reasons why these problems information about the local area and situations arise ● information source . or as the basis for response development. You may want to . useful. ● integrating a number of separate interventions The time needed to complete the framework into a wider response strategy (5. 74 Chapter 5 Response Stage SEX-RAR Guide 5 .6) will depend on the amount of collected data.2 Step 1: gather key findings The first step is to bring together all of the key Additional information sources can also be findings collected from the rapid assessment. when it was collected.used to indicate the perceived validity identified using the Assessment Modules.this could be a piece of statistical which require action data.3) Investigator. This is achieved by developing funding proposals. it can also The RESPONSE3 framework provides the be completed earlier if the RAR team identify basis for five main activities: a particularly significant research finding. The RAR team may find it useful to Key findings are anything that will be useful to group together these key findings under four the RAR team in: main headings: ● identifying particular problems or situations ● key finding . using the response development framework Whilst the RESPONSE3 framework is normally (RESPONSE3). or ● bringing together all of the key information an opportunity arises to secure resources or from the rapid assessment (5. Completing the ● identifying which responses can be developed framework should be lead by the Principal to reduce harm (5. but should also involve the RAR ● specifying goals and objectives for these team. The CAB should be consulted about the potential responses (5. and accuracy of the finding. an extract from field notes. completed at the end of the RAR. responses and using what method(s) The majority of the key findings will have been ● validity . 5 .5) framework is complete. The RESPONSE3 framework is normally used the problems being addressed and the to plan and develop interventions which will complexity of the planned intervention.

and assessing data validity 2. the RAR team now identify the 3 most important responses from (2). the RAR 6 team discuss potential resources. for each key finding. the RAR team attempt to describe identify key stage the different activities needed to activities make the intervention happen 6. identify responses feasibility and validity are used to to develop reduce the larger list to no more than three to four key responses 4. for each intervention in (5).SEX-RAR Guide Response Stage Chapter 5 75 DEVELOPING AN ACTION PLAN 1 1. simple written response strategy. and strategy how interventions might complement one another The end product of this is a single. the RAR team discuss how a 7 number of interventions might be wider response developed at the same time. relevance. the RAR team gather key findings. resources. costs and noting the original information time-scale source. the RAR team identify in specify goals and detail specific goals and objectives objectives Response Stage 5 5. costs and costs and time-scale time-scale 7. for each of the responses identified 4 in (3). Issues of priority. the RAR team 2 action or interventions might be put describe general into place response 3. . resources.

defining explicit goals and key stages (see: step 5).is important in the successful response. the RAR team should try to identify planning and development of interventions. 5 .5 Step 4: identify resources and time-scale Steps 4-6 aim to turn each of the general needed to clearly communicate to those responses selected in step 4 into more involved what the intervention is seeking to detailed intervention plans. what would it be? intervention plans. it may be ● feasibility . the importance of goals and objectives to Explicitly defined goals and objectives also this process. This is because the aim is to ● general response . 5 .too much information will impede this.this should be left blank until the next step (used to indicate the general provide the RAR team with a clear overview response or action that the RAR team will take) .is the proposed response the identifying which general response correct one? Or could another response be strategies should be developed into detailed more effective? If so. 76 Chapter 5 Response Stage SEX-RAR Guide include information on any other findings which The RAR team should try to keep entries support or contradict it (triangulation). To do this. For each general objectives .3 Step 2: identify responses to develop The second step is to take these key findings resources – the RAR team should produce and discuss the general response to each key brief descriptions that indicate what actions or finding.how accurate is the key finding? Can badly is it needed? Why is it important to act we trust what it is telling us? Or do we need to now rather than later? undertake further assessment to confirm this? 5 .are there any obvious obstacles to its development? Response Stage helpful to consider: ● priority . at least one goal and several objectives.how important is the response? How ● validity . Rather than develop detailed interventions might be put into practice. This is because goals and objectives are Although goals can be fairly general. intervention plans for each key finding – Consideration is not usually given to resources which would use a large amount of time and or time (see: step 3). the RAR . or issues made under these headings short and that require further clarification or assessment concise. Step 4 describes achieve. make it easier to plan concrete activities and This step .4 Step 3: specify goals and objectives The third step of the process involves ● relevance .

Key findings included an indifferent city government attitude to basuco users due to the fact that many were homeless. . for example. At the end of each period the RAR team had to describe their response in a series of bullet-points using phrases such as. It also sorted the key findings into two sections: ● information which indicated the need for action or response ● and data which could be used to plan effective responses and interventions to meet this need Response Stage EXAMPLE: DEVELOPING GENERAL RESPONSE STRATEGIES There were a large number of key findings to discuss from the rapid assessment. We also wrote down operational details of outreach teams currently working with basuco users. To save time we restricted RAR team discussion to five minutes per key item. On the second sheet we wrote down those key findings which were possible contextual factors in causing or heightening these health and social problems. local context and intervention development. On the third sheet we noted any key findings which could assist or obstruct the development of interventions. Categorising the key findings into these three groups made it easier to understand the numerous links between problems. and ‘target younger users (13-16)’. These sheets were then pinned to the walls of the meeting room. factors such as the wide availability and comparatively low cost of basuco. These included. ‘no response currently needed’.SEX-RAR Guide Response Stage Chapter 5 77 EXAMPLE: GATHERING KEY INFORMATION ON BASUCO (COCA PASTE) USE IN COLOMBIA The headings ‘key findings’. included data describing the high frequency of mental health problems amongst coca paste (basuco) users. ‘validity’ and ‘general response’ were written on three large sheets of paper. We also asked the RAR team to summarise each response using one of four symbols: 1 may need to develop a new intervention or response 2 may involve modifying an existing intervention 3 could involve undertaking further assessment 4 continue to monitor the situation (no response at present) These symbols allowed us to look at each completed headings sheet and immediately establish the type of general response suggested by the RAR team. ‘information sources’. for example. for example. This sheet. ‘priority’. On the first sheet we listed all of the key findings which related to particular health problems or specific social situations. and the high levels of homelessness associated with basuco users.

. It is possible to identify the period of brainstorming should produce a key stages. and resources. These can make planning at least one goal and several objectives. This c) The RAR team should put these key stage process involves three sections. and resources. the RAR team should try to identify vague objectives. the RAR as time. 5 . team should try to avoid poorly defined or response. These can make planning main headings: goals and objectives. resources and feasibility do not need team can identify any missing gaps or to be considered at this stage (see: Step 6). Duplicate or similar decisions taken over a period of time. The RAR Although goals can be fairly general. These are the major activities or long list of activities. 78 Chapter 5 Response Stage SEX-RAR Guide DEFINITION: GOALS AND OBJECTIVES ● goal (purpose of intervention) . ‘to reduce levels of street drinking. ‘to provide a drop-in centre for people who drink alcohol on the street’. response is through RAR team discussion.a more detailed statement of what the desired effect(s) of the intervention process will be. even a short simply be too many. A rapid items should be removed. as can irrelevant way to identify the key stages of the general or unrealistic ideas. the RAR team may find it useful to group together team should try to avoid poorly defined or their responses for steps 4-6 under three vague objectives.a general statement about what the intervention will attempt to achieve. activities into a logical sequence. ● objective (outcome of intervention) . This a) The RAR team should ask: how can we sequence should aim to illustrate the order achieve the goals and objectives of the that activities will be carried out to intervention? The team should try to identify implement an intervention in the field. Issues such this order has been established. Once as many activities as possible. team may find it useful to group together Explicitly defined goals and objectives also their responses for steps 4-6 under three make it easier to plan concrete activities and main headings: goals and objectives. surplus activities. to encourage street drinkers to enter residential treatment facilities’. For example.there will together into key stages.6 Step 5: integrate into a wider strategy Response Stage It is not usually possible to produce a detailed b) The second activity involves reducing this plan of all the activities involved in list by grouping or clustering similar items implementing an intervention . For example. to identify larger numbers of young people who drink alcohol on the street. key key stage activities more difficult. key key stages (see: step 5). key stage activities more difficult. For each general stage activities. The RAR stage activities.

Using smaller pieces of coloured paper we then wrote down each key stage activity. we then reviewed the diagram. Although difficult.SEX-RAR Guide Response Stage Chapter 5 79 EXAMPLE: ORGANISING AND IDENTIFYING KEY STAGE ACTIVITIES Through discussion we generated around 15-20 key stage activities. anticipate any events which could cause delays. We then asked two questions: ● What must we do first? ● What should we do next? In response to the first question. cost and time-scale of Geographic resources cover locations in which implementing each general response. On the left-hand side of the paper we wrote a large S (to indicate the start of the intervention implementation process) and on the right-hand side a large F (to denote the finish). distilled water or antiseptic wipes. When we were satisfied. the pieces of paper with the initial key stages were pinned next to the start point. We took a large sheet of paper and pinned it to the wall. we then added arrows to indicate the flow of activity. During this we moved those key stages that were in the wrong place.7 Consider resources. For example. Information resources will be involved or responsible for the can include administrative support or publishing completion of each key stage. the RAR team should include human resources. If a smaller piece of paper did not exist for a stage then we created a new one. We continued the process until all the smaller pieces of paper had been used and the finish point had been reached. costs and time-scale Response Stage The sixth step involves assessing the equipment (for harm reduction leaflets).Time is also often ● what resources might be needed? These can limited. stage of the general response in turn and ask: ● how long will it take? . 5 . The RAR interventions can operate from. We then examined these key stages and identified what the next logical stage would be. As a team. resources. an realistically consider how long each key stage intervention may require skilled outreach will take to complete. costs and time required to will have to be implemented on limited budgets. We took a copy and distributed it for comment. . Medical resources can include sterile syringe These details have to be recorded. This diagram represented all the major elements of work that we needed to do. or people with skills in advocacy work. This involves trying to workers. team could make a note of which individuals Technological resources cover transport and computing equipment. The RAR packs. implement the intervention. and added and removed stages where necessary. team now needs to roughly estimate the ● what costs might be incurred? Most interventions resources. The easiest The RAR team needs to consider how much method of achieving this is to review each key particular resources will cost.

8 Consider wider response strategy At this stage. the action plans can be put into practice. key stage importance of a strategic and integrated activities and resources for each of the approach. The RAR team is now developments may help avert an emerging at the stage where the detailed intervention health problem in the short-term. The wider response strategy. the RAR team should have team should not under-estimate the discussed goals and objectives. Response Stage . While single or specific intervention proposed interventions. effectiveness of such a long-term strategy It is always recommended that interventions depends on how well the selected be developed in direct response to the interventions in the action plan fit together to greatest health and social needs. it may be useful to briefly consider the building a long-term response strategy. 80 Chapter 5 Response Stage SEX-RAR Guide 5 . A wider meet the overall aims of reducing adverse response strategy acknowledges that the RAR consequences at a variety of levels. Before doing plan should also provide the foundations for this.

1 Introduction 6.4 Interviews 6.6 Observations 6.7 Surveys Methods and Tools .SEX-RAR Guide Methods and Tools Chapter 6 81 6 METHODS AND TOOLS 6.5 Focus groups 6.3 Sampling 6.2 Existing data sources 6.

money or physical resources to collect. Rather than re-collecting ● providing an introduction to the method adequate information that is already known. using multiple methods is likely to improve This module briefly summarises the key the validity of the information collected methodological principles underpinning the (triangulation) RAR. the line of enquiry followed in a rapid using: assessment is mainly determined through ● existing data sources (6. over a wide geographic area and over HIV/AIDS Alliance PAR Toolkit. and documentary sources which provide an overview or profile of Module structure the local area such as media commentaries and previous research results. 2. hence also the Research Methods modules) is During the rapid assessment.such as ● identify and describe available data sources surveys . These gaps are then The use of research methods in a RAR (and ‘filled’ using other research methods.4) 4.5) new data it should be halted and ● observation (6.7) (point of saturation) Each Methods Module should be used in ‘Filling gaps’: using existing data conjunction with one or more of the Assessment Modules contained in this guide Existing data includes routinely collected data (advice being given in each of these on the that researchers would not otherwise have the most appropriate data collection methods to time. new data gathering exercises . employ).are typically only undertaken in ● evaluate the utility of these sources in rapid assessments when existing sources of addressing key assessment topics information are inadequate (existing data) ● collect relevant data . the RAR team guided by four main principles: will need to: 1. ● an overview of its use in a RAR rapid assessments aim to use existing data to ● and a list of key tasks for the RAR team describe and understand the local situation and to use this description to identify ‘gaps’ Using the research modules in current knowledge.3) (induction) ● interviews (6. Further guidance on using research This includes HIV/AIDS prevalence data methods is provided in the WHO IDU-RAR collected at set intervals from large numbers of guidelines and also in the International people.2) the critical examination of the data ● sampling (6. 82 Chapter 6 Methods and Tools SEX-RAR Guide 6 .1 Introduction This section contains seven Methods Modules. a long period of time.6) resources should be directed elsewhere ● surveys (6. The Methods Modules all employ a similar The use of existing data is central to any structure: Methods and Tools rapid assessment. and is then followed by modules on 3. when a line of enquiry fails to produce any ● focus groups (6.

when to stop This process of triangulation can help Rapid assessments are intervention oriented. Sometimes such a reliance on particular order. increase the validity and quality of the Data must be collected to allow informed research findings or interventions decisions to be made on a range of developed. or test a number of just one method can provide an inaccurate or predetermined hypotheses in a set way.SEX-RAR Guide Methods and Tools Chapter 6 83 The team can benefit from developing a the amount of confidence that the RAR standard framework for categorising the team have in their findings being accurate available data sources. even biased description. to avoid a situation where the findings of the Little advice is given in this Guide about the rapid assessment are based on a single sequence in which either Assessment or research method. conflicts or consensus The ‘point of saturation’: deciding between data sources. To avoid this. Induction: following a flexible line of Using multiple methods to improve enquiry validity Although triangulation is important. there is While the different methods described in this always a danger in a rapid assessment that guide collect different kinds of data. and to triangulate collection in a rapid assessment is guided by the data from these to improve validity. with a much broader understanding of the This process of critically examining and local situation. a rapid assessment considers and In contrast. rapid assessment. the . it is likely data are collected unsystematically without that the RAR team will want to use a adequate consideration. The aim of triangulation is these conclusions and hypotheses. it differs from some forms of from different sources against one another social science which may adopt a more linear before conclusions are made .makes it or pre-planned approach. a second principle: induction. This framework and reflective of the situation under should be used and updated throughout the investigation. validity is problems. the use of multiple research investigates questions and hypotheses as Methods and Tools methods arguably provides the RAR team they emerge during the collection of data. The continual triangulation of responding to the data collected is ongoing. Using just one research Methods Modules should be used. This involves comparing the data collected and searching for information collected from different methods information that confirms. possible for the RAR team to check for contradictions. data combination of methods. Instead. In a rapid assessment. denies or modifies and data-sources. This is method will only provide a very narrow because rapid assessments do not usually perspective and understanding of the topic aim to answer a series of questions in a under study.comparing findings In this way. Triangulation is the continual process of Induction is the process of drawing collecting and cross-checking information conclusions and developing hypotheses from throughout a RAR. In a rapid assessment. these research methods .

through key behaviour among drug users. 84 Chapter 6 Methods and Tools SEX-RAR Guide USING RESEARCH METHODS IN A RAPID ASSESSMENT: AN EXAMPLE HIV/AIDS data 1 1. working inductively. informant interviews with health professionals (3a). When asked the professionals think 3b. enquiry (gay methamphetamine users). casual partners. sharing paraphernalia . and probably none among private sex lives with regular and substance users. 7 new research area: gay men and methamphetamine 5 cross-check: sex work among cocaine users 6 establish whether 6. and then key informant secondly via some focus groups interviews (3b) with substance users 3 cross-check with 3a. whilst continuing to try and establish whether sex-workers are undertake key injecting cocaine. New line of enquiry begins into the cocaine injectors are safety of cocaine injectors’ drug use. the RAR team therefore attempt to identify gap description on the subject of sexual fill this gap: firstly. The public sex work point of saturation has been reached venues so this line of enquiry finishes. the RAR team respondents as regularly having now begin a new line of research act on data sex in exchange for money. Further observation of focus groups also confirm this. whilst there are some data on HIV transmission among injecting drug 2 users. the RAR team examine a number of existing data sources on infectious existing data review STI data disease with the aim of producing a basic description of the local situation research reports 2. observation and interviews both interviews Methods and Tools indicate that cocaine users seem to be heavily involved in sex work. informant 5. there is little existing data or 3. focus groups including contact with gay men who use methamphetamines. focus group participants mainly that there is little prostitution in the provide descriptions of their own area. A group of cocaine injectors were identified by 4 4. health professionals give some other methods information on sexual behaviour.

the results of previous research studies. For example. policy documents or unproblematic description of what is local clinic registers can all provide valuable happening in a locality. money or physical resources to Using existing data otherwise collect. This can be used to quickly compile a 7. identifying gaps in existing knowledge benefit from media commentaries and 5. . and over a longer 2. the RAR team will need profiles are often collected at set intervals to undertake at least seven key tasks: from larger numbers of people. information that researchers would not have the time. it is time to assessment is no longer providing any new either use a new method or data source.2 Existing data sources Introduction It is not possible. It also includes tasks represent an ongoing cycle of local information available from community activity which will probably continue organisations. accessing. then forgotten. Knowing when to on to a new topic of investigation. political and economic factors which may constrain or facilitate As with the entire rapid assessment. manage ● routinely collected data offers access to and interpret existing materials. to examine Rapid assessments are not solely concerned every item of information available. religious groups or treatment centres which can give researchers a ‘snap- throughout the assessment. covering a 1. select. nor necessary. At this move on to another key area of investigation. HIV/AIDS prevalence data or regional demographic In using existing data. obtaining and checking the data overviews. and to move on to method and data source when it fails to another area of investigation is important. stop using a particular following a line of enquiry. mapping of the data sources available Methods and Tools period of time than would be possible in a rapid assessment alone. provide any new data or information. or to data or information on a particular topic.SEX-RAR Guide Methods and Tools Chapter 6 85 collection of too much data can delay this point. assessing their potential utility and validity ● documentary sources allow the researcher to 4. or to stop In general terms. Existing wise to assume that documents can be information such as routinely collected treated as providing an accurate and government statistics. 3. rather than a shot’ of what is currently happening in the linear set of stages to be completed and local area. When The point of saturation is where the rapid this point of saturation is reached. 6 . these activities and behaviours. interpreting the data profile of social. the development of a ‘data-source profile’ wide geographical area. managing the data NGOs. This module suggests data and insights: how to systematically identify. and the published experiences of 6. Nor is it with the creation of new data. the researcher should consider moving decision-making process. stop using a particular method.

treatment centres and university researchers ● documentary sources such as television news programmes and NGO annual reports. surrounding region. 86 Chapter 6 Methods and Tools SEX-RAR Guide EXISTING INFORMATION: OVERVIEW Existing information allows the researcher to: ● use information that they would not otherwise have the resources to collect ● compile profiles of factors which can obstruct or facilitate activities and behaviours ● use local information to obtain a ‘snap-shot’ of what is currently happening in the area It can include such things as: ● routinely collected data from government bodies. This is useful in understanding the context in which the study is being conducted. religious groups and outreach workers Skills in using existing information are important.to allow materials to be easily located and distributed at a later date The key strengths of using existing information are: ● it is usually cheap and easily obtainable ● it can often provide valuable descriptions of the distribution of behaviours or characteristics in a population ● it can be used to triangulate findings Existing information rarely provides an unproblematic description of the situation: ● documentary sources vary widely in terms of their accuracy ● statistics must always be interpreted carefully by the researcher as they can be biased or inaccurate ● the information is often produced with a particular audience in mind . and local information from community organisations. ● in the early and middle stages it can identify gaps in current knowledge and practice which could be investigated further ● in the later stages it can monitor and cross-check findings from other methods It can be tempting to only collect information that is readily available and not to make any specific efforts to search out information.this will avoid important information being omitted from the study Methods and Tools ● systematically managed . However information should be: ● actively located . and national situation. as: ● in the early stages of a rapid assessment it involves the collection of background data on the local area.

regional STI ● drug treatment statistics data-sets might collate data from different clinics. who is responsible for the data-set? ● who will have to compile the data that we require? Are there any associated costs? 87 Methods and Tools . what data are recorded and ● drug use surveys ● newspaper articles and reports why? ● hospital admissions ● where are the data recorded from (e. SEX-RAR Guide EXAMPLES routine data sources documentary sources questions ● official estimates ● reports of non-governmental organisations working ● does the agency/organisation hold data on ● arrests in the area substance use? If so. ● STD statistics and it will be important to understand which clinics ● do not provide data)? HIV infection data ● over what time period does the data-set cover (current/last three years)? ● what fields/attributes are recorded in this data-set (e. sex etc)? ● what form is the data available in: electronic/paper records.g. easily accessible? Methods and Tools ● are there any problems with the compilation of the data? Or the ways in which cases are defined? ● what estimate would the agency make of the number of individuals held on its database? ● does this data-set record numbers of individual cases or episodes of treatment and care? Does the data-set distinguish between new clients/cases and existing clients/cases? Chapter 6 ● will the agency let us access it? At the agency.g. date of birth. name.

It may also be useful It can be tempting for researchers to collect allocating the responsibility of collecting existing information on an ad-hoc basis. With the study continues. body or individual responsible. Check There is always a danger that a rapid for any references to other possible sources. an invitation to undertake observation. sources contacted. To avoid the material that needs to be collected. 88 Chapter 6 Methods and Tools SEX-RAR Guide Key tasks Prioritising this list may be useful. further sources or advice collected from these contacts. time-efficient way possible. compiled and. Methods and Tools them. assessment will involve large amounts of ● compiling an initial list of possible sources and material being unnecessarily collected. researchers need to actively locate sources contacted. researchers should attempt to . The consultation of existing information will be ● contacting the sources on the list in the most the first step in most rapid assessments. This can save time and money if a identifying data sources in the local area. Explain the purpose of the rapid assessment to a senior person and Initially. government or Consultation is a useful starting point for NGO library. is reviewing any existing information already ● recording the details of any existing collected (which may give references to other information. as this will help researchers identify which material is TASK 1 develop a ‘data source profile’ important or is needed urgently. ● discussing with the rapid assessment team distrust or the burden that such data collation (and key informants) where relevant data and could impose upon the source. Do not be surprised if this early stage in the assessment which other conversation turns into an informal interview or information sources might be available to them. The details of these should be establish whether there is a central reviewed. sources). background data on the local area and region Ask if they can provide any relevant data. further materials will be documentary sources. using the Context Assessment module. this situation. the RAR team has to collect the need for the swift collection of information. It is also research reports or can recommend other likely important that the RAR team understand at an sources. rapid assessment is conducted and the Instead. it can be useful to collected. ● establishing if there is a central distribution point TASK 2 map the data sources available or holding centre from which documents can be Discussion within the RAR team and Initial obtained such as a university. if necessary. this approach can waste This process will vary according to where the time and overlook valuable information. Note the contact details for the validity institute. materials to one or two people on the rapid gathering materials as they come across assessment team. From this. As information available in more detail. the RAR team should compile and prioritise an initial list of sources The collection of existing information is a and contact these sources to describe the continual process in a rapid assessment. materials can be obtained TASK 3 assess their potential utility and ● reviewing any existing information already collected. any distribution point or holding centre. Researchers will find that the information most useful to the rapid certain materials are more difficult to obtain assessment by: than others due to issues of confidentiality. as number of documents are required. However.

consequences of policy immediately checked on receipt (for expected change. people or locations are described? Are these relevant? Are any left out? Is the information Even when existing information has been representative? If not. or might offer descriptions ● needs . summaries and overviews.SEX-RAR Guide Methods and Tools Chapter 6 89 ascertain whether a data-source would be of consulting materials from a number of use in addressing a key research question in the opposing viewpoints.it is usually better to concentrate on the most recent and up to date materials. it is still often difficult to decide could help in obtaining a more comprehensive which materials should be used. organisations who hold important data-sources ● time . if that organisation to improve its understanding of a longer time span needs to be considered try the local situation. making sure to stress that the overall contemporary events and reduce the amount of findings of the rapid assessment will both help information that needs to be consulted. This will in the Initial Consultation or Community Advisory allow the researcher to gain a feel for Body. obtain and check the data Instead. with subsequent benefits for to locate summaries or commentaries. There is little point in collecting key to planning the assessment. researchers should content and accuracy) as this avoids discovering triangulate a number of different viewpoints by problems at much later stages of the RAR. Researchers may have to work unsure which sources are important and in with imperfect existing materials rather than which order they should be examined. detailed statistical information if no-one has the necessary skills or time to interpret this. try to locate alternatives such as Access can often be optimised by including Methods and Tools concise summaries or commentaries. also consider how valid the data-source is. by information being available in a number of TASK 4 identify gaps in existing knowledge different forms such as lists of raw data.different sources of information will from local agencies. rather than negative. Consequently. spend time locating sources which answer all Sometimes. Identifying these ‘gaps’ the questions. data and the information required by the RAR ● constraints . assessment. They may be able to provide Although there is no set protocol for selecting important background detail with which to which materials to use. .only collect materials which will team to answer their research questions is be used. Again.which data reporting systems. government data. For example. this task is made more difficult their questions. or booklets It is unlikely that existing data sources will be produced by advocacy groups. Researchers description? can feel overwhelmed by the mass of ● adequacy .it is easier to select relevant materials which partially answer the RAR team’s when the rapid assessment team can specify research questions. TASK 5 access. topics and issues they want to between the descriptions provided by existing address. it can prove quicker to send reveal different aspects of the topic under a RAR team member to collate or compile the consideration. researchers may find understand data collected using other it useful to consider: research methods. It is vital that any data received is documentation may concentrate on positive. which other sources located. the RAR team should ● coverage . When obtaining data ● audience . analysing its own data. able to address all of the proposed research questions.existing information is usually information that confronts them and can be produced to meet the needs and agendas of other people. Furthermore.

slice etc aspect of the study should be distributed to the ● identify the units or labels . tables. 90 Chapter 6 Methods and Tools SEX-RAR Guide TASK 6 manage the data complexity including raw data.this should ● read the title .this should explain what is being include details of whom and where the described and the coverage of the data. graphs. can be presented in varying forms of The epidemiological definition of terms such as . other sources such as media documents and ● use specific definitions. Once materials have been selected they and summary descriptive statistics (such as should be immediately managed and means). researchers cases.any information collected type of information contained in each cell. This information was obtained coverage may refer to the number of years. unproblematic description of the situation. deliberate bias or required. The nature of these locate or access may be omitted. They are routinely used by government Consequently. row that is important or has bearing on a particular or column. information to interpret the data. ● always consider whether there is sufficient Although this will initially take some organisation. questionnaires or standard forms. For example. and use materials at a later date. Although often appearing very authoritative and persuasive.000 filing system at the beginning of the rapid of the population assessment to avoid becoming overwhelmed by ● consider any accompanying conclusions . the basic principles in interpreting archived. Note any this can make it easier for researchers to locate problems in interpreting the data. form.researchers should identify material is important. interviewer or be willing to report certain However. whilst other types of cases can be included more than once problems often varies depending on the type in totals.start a averages or the number of cases per 100. In This is not the same as the actual number of interpreting such materials. percentages. Statistics are often collected from a Statistics are information in a concentrated large number of people using structured interviews. they are also used in a range of behaviour. It may also be a good idea to keep a these justified? main record or index of the materials collected. not all treatment agencies Methods and Tools should be aware that they can be subject to will report data to a central source as is problems of inaccuracy.summary sheets will allow the researcher to identify why the ● consult any notes . Before something can be NGO annual reports. respondents may not trust the bodies. Researchers should consider: them remain the same: ● tagging and dating the material .are information.the data presented rapid assessment team members may refer to whole numbers. health professionals and economists. which topics or questions how the data were collected and who was it covers and any links to other materials or responsible for doing this assessment modules ● read any headings or keys . certain people or areas difficult to incompleteness. such as drug use. of information collected. Although this information counted and measured it needs to be defined. researchers should always be TASK 7 interpret the data aware that statistics: Existing information rarely provides an ● only describe the reported number of cases.this will outline the ● distributing materials . ● systematically filing the information . the type of agencies or the ethnic groups described ● summarising the key points . ● under-report culturally sensitive or shameful Interpreting statistics behaviours.

media and When using such materials: political documents. Researchers ● note the main findings . and the minutes of public meetings. Researchers should be aware that such newspaper articles. and learning from related arrests have risen that the number of the experience of previous research.attention should be paid to whether collected . it the rapid assessment is taking place in. For example.SEX-RAR Guide Methods and Tools Chapter 6 91 ‘substance misuse’ or ‘risk behaviour’ can differ and the period the research or material refers from the meanings and perspectives of actual to. would be wrong to assume that because drug identifying local behaviours. always subject them to scrutiny. and NGO reports. ● can include ‘hidden’ distortions. drug users actually arrested had also ● consider the conclusion . annual reports. ● often provide biased accounts .scan the written from a particular perspective and will contents page.these are often useful should try to be aware of the context in which in compiling overviews of the context in which the statistics were collected.are any criticisms or increased. any likely interventions or future developments ● are often used to support a particular argument that the researcher was not aware of? or conclusion. In the case of meetings. abstract and executive often cite selected evidence or photographs to summary. Never accept statistics at face ● record any useful references or sources . records of parliamentary materials: debates. useful to note who was present. These include. for example.these value. ● are sometimes based upon incomplete or poor ● identify how and when the information was research . index. This can help in ascertaining why it support their arguments was written and how it is structured. may contain further useful information or may be required in the later stages of the rapid Interpreting documentary sources assessment.note any descriptions of the the methods used to compile the information methods of information collection. coverage were appropriate Methods and Tools . will be ● determine the aim of the document . This could be due to a ‘police recommendations in the material justified? Does it crackdown’ in an area leading to the same raise questions for further research? Does it outline drug users being arrested several times. it may also be drug users or other research bodies.

identify the study population identify a suitable sampling technique. document. which involves marginalized or relatively powerless and selecting a smaller sample of cases which the therefore distrust and try to avoid making RAR team consider will provide useful contact with official agencies. Furthermore. it is not usually possible to Different study populations will require conduct a large or representative sample from different sampling techniques. female users. norms associated with sexual behaviour. These smaller samples are frequently characteristic of the In such cases. agree on procedures for recruitment/data collation Sampling is used when a study population has too many cases for the RAR team to contact. Instead a different approach some countries substance users are often is used: theoretical sampling. Decide on sampling approach and technique The RAR team needs to undertake at least The RAR team should identify whether they five tasks when deciding upon their sampling wish to employ a representative or theoretical strategy. it would be difficult trying to emphasis within rapid assessments on use sampling techniques which relied upon a exploring individuals’ experiences of substance sampling frame. This sampling frame is a set .3 Sampling Introduction 5. If necessary. It is therefore important that the can be employed in a rapid assessment. decide on sampling approach and TASK 3. During this process. Within the study population. information and insights. an agency. identify the sampling frame The RAR team may need to identify a suitable 4. an individual. Using sampling TASK 2. For example. various sub- samples exist such as young and older Sampling techniques substance users. to block samples large a number of sub-populations. if necessary. 92 Chapter 6 Methods and Tools SEX-RAR Guide 6 . sampling approach (see opposite) as well as 1. decide on sample size sampling frame. or documenting the social meanings and users are not a homogenous population. and users who are commercial There are numerous sampling techniques that sex workers. RAR team is clear about which study These range from purposive samples where populations they will investigate during the ‘cases’ (e. identify a sampling technique frame 3. substance use. an event etc) are selected because however. detailed research. a rapid assessment. in a study population. as this Methods and Tools where cases are selected from particular will use valuable time and may prohibit geographical locations or ‘blocks’. 2. Identify the study population a rapid assessment.g. In TASK 1. the RAR team should try not to they match a particular criteria that the RAR commit to undertaking research with too team are interested in. users of different drugs.

93 Methods and Tools . such as when the rapid assessment sexual behaviour are ‘hidden’ from samples are selected on the basis of emerging findings researcher is introduced by one respondent to other people in existing data sources which indicate that new samples are necessary before his or her peer network ● representative samples often require a valid assessment can be made ● block sampling which selects cases specific to particular Methods and Tools large sample sizes. and the use of ● the ‘inductive’ selection of samples means that the geographical locations or ‘blocks’. populations and topics of interest to the RAR team. and for providing ● network samples. and the rapid assessment team is assessment in order to increase the validity and generalisability assessments confident that all sources of potential variation between of findings. which are impractical relationship between substance and sexual behaviour compared against one another given the resources and time has yet to be fully assessed or explained ● quota sampling which controls the type and quantity of the available in conducting rapid ● the findings from different samples are constantly cases selected. comparisons between cocaine users’ unprotected sex in private population. which are also called ‘snowball’ or chain- populations relevant to rapid the data necessary for developing interventions referral’ samples. In rapid assessments. which select cases throughout particular assessments on substance use and ● the selection of samples is ‘inductive’. such as observations undertaken in a particular is insufficient to ensure that samples theoretical and practical relevance for assessing street setting where commercial sex transactions take place are ‘representative’. such as when specific quotas of ‘street’. such as when particular statistical and epidemiological sampling strategy follows up the cases where the street locations of substance use and commercial sex work are methods. and in commercial sexual relationships samples are usually impractical as: The key features of theoretical sampling include: ● opportunistic samples select cases because they are available ● existing data on the study population ● study populations are selected on the basis of their and convenient. aims to relevance for interventions. when no new information is monitor and modify the sampling strategy throughout the rapid Chapter 6 more suitable for use in rapid being collected. and the ‘point of saturation’. An example is when the sampling strategy is altered samples have been explored to include new cases when emerging findings suggest that this is necessary in order to provide an adequate assessment. like theoretical sampling. so that new social networks or groups. SEX-RAR Guide SAMPLING: OVERVIEW representative sampling theoretical sampling sampling techniques A representative sample is one where These samples do not aim to be ‘statistically ● purposive samples inductively select and compare ‘critical the selected cases are ‘statistically representative’ but instead aim to select cases which are cases’ of theoretical and practical relevance. such as representative’ of the larger study theoretically representative of the key types of behaviours. ‘hotel’ assessments compared (as in ‘triangulation’) to check that no new and ‘massage parlour’ workers are selected in a sample of ● other sampling strategies offer samples are necessary commercial sex workers information of greater practical ● the selection of different samples should continue to ● targeted sampling which. and many study substance use and sexual behaviour. such groups.

experiences. 94 Chapter 6 Methods and Tools SEX-RAR Guide of information . 4. The rapid often already compiled by particular agencies assessment team needs to make approximate such as the police force. in a rapid assessment is to simply ask ● facilitate interventions . (including time) and for developing proposals for local rapid assessments. samples using different methods.often a list . The collection of data have local solutions. select target population Interviews also offer the rapid assessment team 2.interviews allow the meanings and definitions that individuals give 5. at Methods and Tools ● provide access to sensitive or hidden information any time. develop an interview or topic guide to events and activities to be explored and 6. undertake the interview . and are particularly effective six tasks: when used as an exploratory method to gather data on topics about which little is known. TASK 4. This is because the The RAR team should discuss any practical strategy is ‘inductive’. Interviews are useful as they: Interviews can take place in any location. situations and knowledge that researchers would not be able to study Using interviews otherwise. 6 . and with different individuals or . This is particularly useful for understanding what individuals think ‘risk’ Often. health clinics or estimates of the potential size of different non-governmental organisations. 1. decide what type of interview to undertake access to experiences and situations that they 3. intervention may face. This is the rapid assessment team can try and create important in planning the rapid assessment their own sampling frame using a number of within the boundaries of existing resources different data sources. Decide on sample size When using a theoretical sampling strategy it TASK 5. decide when to undertake the interview may be unable to capture using other methods.4 Interviews Introduction understood. such as The RAR team will need to undertake at least sexual behaviour.interviews offer indirect access to a range of groups of people. and it is not until issues related to sampling such as subject findings begin to emerge that the rapid recruitment or the procedures for collating assessment team can make judgements existing data. They are appropriate methods to use when investigating sensitive issues.local problems usually someone a question. Talking and listening to through systematically asking questions and local people is important for highlighting the carefully listening to the answers given is constraining and facilitating factors that an called interviewing. Agree on procedures for is sometimes difficult to estimate the size of recruitment/data collation potential samples. the most effective way to collect data behaviours are. Alternatively. organise the interview ● uncover meanings . These lists are sample groups for assessment.about the known about whether to select additional cases or cases in a study population.

These are not the same as focus groups. they may not give details of behaviours they are ashamed or embarrassed about. Alternatively. Respondents may exaggerate about behaviour within a group.informants may give answers that they think the researcher wants to hear rather than their own opinions. facilitation and rapport building skills ● the ability to ask effective questions and use probes and prompts where necessary ● an interview guide. This is a list of the categories. .these are often more suited to collecting in-depth information about sensitive issues ● groups . areas.useful for gathering contextual information. experience and expectations of the researcher can affect an interview ● informant bias . Interviewing skills are needed for ● collecting background data on a topic that a researcher has little knowledge of ● taking advantage of informal or casual conversations that relate to the rapid assessment Interviews can be affected by ● interviewer bias .SEX-RAR Guide Methods and Tools Chapter 6 95 INTERVIEWS: OVERVIEW An interview involves systematically talking and listening to people because they ● already have had the experiences and knowledge that researchers want to study ● already know about local meanings and understandings of risk behaviours and health consequences ● but often wouldn’t be consulted by policy makers and planners Interviews can either try to ● explore this knowledge and understanding through unstructured questioning ● target specific topics and ask particular pre-defined questions through structured interviews Interviews can be useful for ● uncovering the meanings people give to their substance use and sexual behaviours ● obtaining descriptive information about the factors which influence risk behaviour ● investigating sensitive issues ● collecting exploratory data on topics about which little is known Interviews can be held with ● individuals .the interests. Researchers will need ● good communication. topics or questions that a researcher Methods and Tools wishes to investigate.

This often happens when a researcher is conducting an However. available for study. is for the rapid assessment team to reduce TASK 1. However. given the short time used to suggest which informants could be contacted. wide range of key people. 96 Chapter 6 Methods and Tools SEX-RAR Guide Key Tasks identify potential informants. the easier it is to change their mind when they see other EXAMPLE: REDUCING LARGE TOPICS INTO MORE MANAGEABLE ITEMS STAGE 1 (i) what are the economic and structural factors affecting risk behaviour in the target population? (ii) who are the actual population involved in risk behaviours? (iii) which specific risk behaviours take place in the population? Why? Methods and Tools STAGE 2 (i) what are the economic and structural factors affecting risk behaviour in the target population? . One way of doing this.availability of condoms and clean syringes . rather than reflecting the attitudes of only a few marginal Researchers should be aware that interviews individuals or groups. staff at drug treatment and STD clinics? Are condoms of good quality? Do they break during intercourse? Drug users. Are the syringes that are sold at markets new or old syringes that are re-packaged? People purchasing syringes from stall in local market . it may be helpful to consider: relevant to the rapid assessment. Discussion and should not be interviewed during a rapid with colleagues and key informants can be assessment. sex workers. the researcher may suddenly find that ● what information needs to be collected? The more specific a researcher can be about the individuals who previously refused interviews data they want to collect. market stall holders. This can be useful in informants can often suggest and arrange access to individuals and groups that a ensuring that interviews are conducted with a researcher may be able to interview. In such cases. researchers should try to adopt a systematic and pragmatic approach ● are key informants able to help? Key to selecting informants.police and military attitudes towards drug use . people at a family planning centre. more manageable items.public health campaigns and promotions STAGE 3 availability of condoms and clean syringes are condoms and syringes available from local pharmacists. Select a target population larger topic areas (such as risk behaviour) into There are no fixed rules about who should smaller. Similarly. can occur spontaneously. when a researcher will not know conversation with someone interesting or or will be unsure which informants to interview. there will be times during a rapid observation and has a chance or casual assessment.

SEX-RAR Guide Methods and Tools Chapter 6 97 people talking to researchers. ● they require the researcher to have good the researcher will not need to deliberately communication and interviewing skills target or select individuals for interview. Decide what type of interview to Group interviews differ from focus groups. Group interviews may be unstructured and structured approaches to structured or unstructured. or who have specialist access to accounts. Using the topic guide. ● the researcher often has less control over who Key issues to consider about key informant takes part. including broad ‘topic guide’ which helps the rapid sensitive topics assessment researcher focus discussion ● they are amenable to both structured around a number of key areas. This can lead to conflict between interviews are: informants with directly opposing views ● they provide useful data at the beginning of a ● they are not normally useful in tackling delicate rapid assessment on appropriate sample or personal issues groups. There are of individuals a question to which they each individual and group interviews. It is likely that key informants Key issues to consider about group interviews will be used early on as well as throughout are: the rapid assessment. a researcher asks a number rapid assessment simultaneously. generate should not be treated in the same way as individual interviews. In undertake focus groups. In both cases. It is useful to interviewing techniques as well as unstructured use the ‘key questions’ identified in the interviewing techniques (see below) Assessment Modules as a basis for preparing ● they provide essential data for a rapid topic guides. ● they are not practical for providing structured Unstructured interviews are particularly useful or quantitative data on large samples as an exploratory method to investigate areas . sample groups. ● they can provide detailed and descriptive but may also be ‘loosely structured’ by a information about risk behaviour. key questions to Unstructured interviews Methods and Tools ask in interviews and access to other key informants These interviews are generally ‘unstructured’. Because of the Individual interviews with key informants sensitive nature of substance use and sexual These are interviews undertaken with people behaviour. sampling strategies. the assessment which can not be collected via unstructured interview encourages depth other methods description from the key informant. colleagues or clinic patients key informants. In interview each of which may be used in a group interviews. group interviews are more who are able to provide expert or specialist appropriate for asking questions of fact rather information on the specific topics of the than seeking examples based on personal assessment. either in follow-up ● they are easy to organise when informants interviews to comment on new data or as the gather in naturally occurring groups such as rapid assessment team is introduced to new friends. in which individually respond. the aim is to generate group There are a number of different types of discussion (See: Focus Groups below). but the data they interviewing may be employed. Group interviews TASK 2.

Their the concluding stage of a rapid assessment. can prevent the collection of unexpected but relevant or interesting information ● they are flexible enough to allow the interviewer to modify their line of enquiry. interviews may be used during undertaken after some exploratory research the rapid assessment as need arises. analyse and compare and generating data of practical relevance. They may focus Key issues to consider with structured on a particular issue or topic in some depth. They are often been formed. main advantage is that they can provide interviews may be conducted with: comparable data across samples and sites ● targeted individuals or groups . They are therefore useful for researchers to undertake interviews collecting background data in the early stages of a rapid assessment. as well Structured interviews as exploring and describing issues in some Structured interviews are less exploratory depth. This can make the which informants the researcher wishes to interview quite lengthy if the researcher is not assertive enough. 98 Chapter 6 Methods and Tools SEX-RAR Guide about which little is known.interviews are useful for usually asked using exactly the same assessing the possible problems of wording as on the guide. it is important to find an appropriate ● the common format across each interview balance between facilitating depth description makes it easier to code. implementing future interventions . contact and also the content and topics to be ● each interview tends to be unique. when a researcher has ● strict adherence to a structured interview guide little knowledge of a topic. data ● a structured interview guide allows the Key issues to consider with unstructured researcher to decide how long should be spent interviews are: discussing each question or topic ● there are no restrictions on what can be ● structured interviews allow inexperienced discussed. interviews are: However. and can has already been conducted. This can covered in the interview. At researcher wishes to investigate further. data sources. informants follow up interesting responses and investigate may hear and understand the questions in underlying motives different ways. ● inexperienced researchers may introduce bias by using poorly worded questions TASK 3. they can encourage The stage of a rapid assessment at which the respondent to talk about irrelevant and interviews are conducted will depend on unimportant issues. Once a background understanding has Methods and Tools than unstructured interviews. This can affect comparison between respondents. and issues of concern.these on core questions. This allows be particularly useful in identifying the findings from other methods or existing feasibility of potential interventions or actions information sources to identify topics that the recommended by the rapid assessment. They are usually interviews can be used to validate and cross- conducted using an ‘interview guide’ which check findings from other methods consists of a list of questions and which are ● community groups . interviews are important analyse for identifying important population groups. ● although a standard format is used. Decide when to undertake the interview ● without skilled facilitation. At an early stage of sometimes make them difficult to code and a rapid assessment.

own home. Researchers should select topics and questions ● collect contact details from the participant. The researchers should also discuss other areas to researcher should mention how long the include with colleagues and key informants. interview guide. national and regional key informants . It can ● correct any misconceptions that the informant also include instructions on how to respond to may have. and as comfortable as think carefully about the questions they are possible. TASK 4. the quality data.the guide can Methods and Tools be contacted. The location should be accessible. on and Response guides can help do this. or simply ask anyone evaluating and discussing the outcomes of the not involved in an interview to move away or rapid assessment be quiet. If a number of interviews are being going to include in the interview guide. and if necessary. researcher could also give the informant a telephone number or address where they can ● decide on the level of detail . it is often useful to researcher could consider hiring a local discuss the draft with a key informant to school classroom or using a room in a health identify any problems. Develop an interview or topic guide In most cases. reminders. questions and any useful probes and ● assure informants that all the information they prompts. or interview guide: refreshments. Check with key informants what ● identify appropriate topics and questions . the order and wording of who want to ask them questions. Informants may distrust strangers certain answers. This allows interviews to be range from broad topics which act as rearranged if unexpected circumstances arise. topics and issues that a researcher personal benefits to the individual wants to address during the interview. people who could distract or influence the ● draft the questions . relocate from busy town squares large group interviews are often useful for into quieter side-streets.the are appropriate incentives. interviews should be Before undertaking an interview the organised and undertaken as soon as researcher may find it useful to prepare an possible. interview will take. Once an informant is contacted. to specific questions which the researcher must ask in a precise order. If there is time. but what date the interview will take place. provide will be confidential mention any incentives offered to participants to take part.researchers will need to informants responses).interviews normally Researchers could visit informants in their produce better data when questions are . centre. free from interruptions (such as interviewing technique used. An to stimulate the respondent’s interest in the interview or topic guide is a list of all the study by mentioning its importance or the questions. There are five main steps to devising an These may include gifts. money. ● order the questions . This should be whether a structured or unstructured neutral. this partly depends on that facilitates discussion. Structured interviews will the RAR team should: usually require a more detailed or instructive ● explain why they want to talk to them and try guide than unstructured interviews. assessment modules in the Rapid Assessment ● negotiate at what time.SEX-RAR Guide Methods and Tools Chapter 6 99 ● local. The which will help triangulate or fill any ‘gaps’ in existing knowledge. As Interviews should be conducted in a location mentioned above. Organise the interview TASK 5. Badly phrased questions will usually produce poor conducted over the course of a few days.

For example. Although treated like data from individual interviews. Prominent individuals or approach means that the exact order and subgroups can dominate an interview. Since group pressure to express a ‘common’ view the aim of unstructured interviews is to get can stop other views being expressed. 100 Chapter 6 Methods and Tools SEX-RAR Guide grouped into a logical order. This flexible dynamics. they The researcher should be aware that will also encourage a respondent to discuss answers can be influenced by group relevant topics in depth. questions may need to be addressed towards Unstructured interviews therefore require the end of an interview to allow sufficient good communication and facilitation skills. can you ● long or multiple . Additionally. Methods and Tools Unstructured interviews Group interviews When undertaking unstructured interviews the Group interviews can use unstructured and range of topics covered and the responses structured interviewing techniques. or vary from respondent to respondent. data of practical relevance. parts of the question that they can remember. It may also suggest a prostitution around here’ precise wording for questions which the TASK 6.g. researcher must listen carefully to ● list any probes or prompts . rather than jumping from subject to subject. e. the researcher questions or concentrate discussion on a single should encourage the respondent to provide topic.these can confuse informants tell me why you think this makes a and result in participants only responding to the difference?"). The researcher Interview guides should avoid questions may often need to gently guide the which are: conversation to the key questions which the ● complex or technical . "going back to what you were unlikely to be misinterpreted saying a moment ago about alcohol. culturally sensitive as much detail and be as frank as possible. ‘what do you feel about the risks involved Structured interviews in sharing syringes now as opposed to five Structured interviews are used when a years ago?’ researcher wants more control over the topics ● leading .if inexperienced respondents and be aware of any new or interviewers are used then it may be useful to interesting information. wording of questions in each interview will sensitive issues may be suppressed. ‘why These often use a detailed interview guide is there so much prostitution in this area?’ is which outlines areas and questions to cover perhaps better rephrased as ‘is there any and sometimes the order in which they prostitution in this area?’ or ‘tell me about should be asked.use clear and simple rapid assessment needs to address (for language which will be easy to understand and example. A rapport to be built up. e. It is also important to offer instructions on how to encourage concentrate on conversation which generates respondents to give answers. researchers may still cover key topics. researchers may find it useful to ask a series of knowledge and experience. informants to freely offer their opinions. Undertake the interview researcher adheres to.these questions which result in discussed and the format of an interview. participants coming to conclusions that they would not have otherwise considered. .g. given by a respondent are not constrained by Information from group interviews cannot be a detailed interview guide.

or include a question ● PROMPTS Methods and Tools encourages informants to raise issues that have not spontaneously arising ‘so far you’ve told me about how you and your regular boyfriend decide when to use a condom. Now maybe we could think about something you haven’t mentioned: condom use with other more casual partners’ . May be silent. These are normally closed questions.SEX-RAR Guide Methods and Tools Chapter 6 101 TYPES OF INTERVIEW QUESTION ● QUESTIONS OF FACT specify. indicate for the person to continue. confirm or refute a fact. researcher may pause. include encouraging noises or include a question. would this change your behaviour?’ ● ORDERING QUESTIONS allows the researcher to check the importance or significance of certain factors ‘which risk behaviours are most common amongst amphetamine users?’ ● PROBES to encourage a person to provide more information or continue speaking. ‘do you use condoms when you have sex with clients?’ ● OPINION open ended questions which encourage the informant to elicit ideas and beliefs ‘why did you use the syringe that your friend had already used?’ ● CLARIFICATION used to check that the researcher understands or to gain additional information ‘are there any other reasons why you think an outreach project wouldn’t work here’? ● REPRESENTATIVENESS to check whether an event is typical of the persons experience or common to other people in the community ‘do you use condoms with your private regular partner as well as your casual partners’ ● HYPOTHETICAL QUESTIONS allow the researcher to explore situations that the individual has not yet experienced or are perhaps too ‘sensitive’ or ‘shameful’ to directly explore ‘lets say that you were able to obtain free condoms.

Focus-groups usually consist of between six and ten people selected because they share Focus groups have a key role in rapid some common experience or hold a particular assessment. Like interviews. If a tape recorder is used it should have an external micro-phone. interviews. it is often useful to carry health promotion leaflets or the address of local treatment clinics. Introduce people in a non threatening way. translators should be briefed on what is going to happen. always collect demographic information such as age. 4. Focus groups are small and usually consist of no more than 6 .5 Focus groups Methods and Tools Introduction individually. 102 Chapter 6 Methods and Tools SEX-RAR Guide 10 STEPS TO CONDUCTING AN INTERVIEW: 1. be a good listener and ask why and how 8. discussion between participants.10 people. individual and low cost. whereas in They are also useful exploratory methods for group interviews. type of drug use. 5. 2. introduce anyone present to the participant. It is important that the researcher does not give intervention advice that they are not trained to offer. arrive early at the location where the interview is to take place. and status 10. Ask if participants have anything to add or any questions. For this reason. summarise the key issues and opinions when the interview is finished. from a number of people at the same group perceptions of the meanings associated time. and then inviting critical comment 6. and you should have extra batteries and tapes. the aim is for the and data on the contextual factors influencing rapid assessment researcher to generate risk reduction and sexual behaviour change. 6 . they can provide expertise relevant to the assessment. participants answer questions gaining data on topics about which little is . Focus groups are distinct from group with substance use and sexual risk behaviour. check with the respondent that it is acceptable to continue an interview if it looks as though it may last longer than expected 9. Try and ensure that the location is as quiet and as free of interruptions as possible. sensitive subjects can be introduced by asking what ‘other’ people are said to do. at relatively use and sexual behaviours. source of income. 3. reflecting peoples answers back in their own words is a good way of checking that you understand what they are trying to say 7. Allow participants time to think and speak. use clear and simple language when introducing topics or questions. In focus groups. They are descriptive data on the nature of substance useful in obtaining detailed data. ethnicity.

a member of the team who will observe and record significant verbal and non-verbal details Focus groups are good for: ● producing a lot of information quickly ● identifying and exploring shared beliefs. when the focus group data on how participants interact and talk consists of ‘naturally occurring’ groups who about substance use and sexual behaviour.a member of the rapid assessment team who takes part in the focus group and encourages participants to talk about interesting and relevant issues ● a note-taker . . comfortable. already know each other. such as a group of This means that focus groups are not only heroin users who share the same friendship useful in gaining multiple opinions on a topic or social networks. but they can provide prostitutes who work in the same area. whiteboard or paper and pens ● a key informant to help recruit participants Rapid assessment team members may be required to act as ● a moderator . tapes and labels ● a blackboard. attitudes and behaviours The key disadvantages are: ● the researcher has less control than in an interview ● the data cannot tell you about the frequency of beliefs and behaviours ● the group may be dominated by one or two participants who can influence the views of others Methods and Tools known and for assisting with the planning and insights on group perceptions and differences design of interviews and survey questionnaires.SEX-RAR Guide Methods and Tools Chapter 6 103 FOCUS GROUPS: OVERVIEW A focus group is a number of individuals who are interviewed collectively because: ● they have had a common experience ● they come from a similar background ● they have a particular skill These characteristics provide both: ● a focus for discussion ● and help people express individual and shared experiences and beliefs A focus group may require: ● a location that is as neutral. This may be between participants. regarding substance use and sexual Because focus groups encourage discussion behaviour norms and values. they can also provide particularly the case. accessible and free of interruption as possible ● a guide of discussion issues or topic areas ● a tape recorder and extra batteries. or a group of male at the same time.

colleagues or clinic patients sensitive nature of substance use and sexual ● they can produce a lot of information quickly. key consideration needs to be beliefs. and homogenous group.2 Sampling). The first is to explore topics about 2. Select participants homogeneous focus groups include: a group The general rule for selecting participants for a of female heroin users. select participants functions. considerable skill It can sometimes be difficult to get a ● taking good notes is difficult. This ● they are easy to organise when informants follows the principles of ‘purposive sampling’ gather in naturally occurring groups such (See: 6. experience. a focus group on flow of the discussion (compared to the sexual behaviour among women may include individual interview) participants from different religious ● focus groups cannot give the frequency or backgrounds which may influence the scope distribution of beliefs and behaviours and detail of discussion.a common characteristic. opinions. staff from an STD clinic. and behaviours given to the make-up of the group in terms of: ● they are useful for identifying questions for gender. or expertise. For example. Individuals who are similar transcribing from tape recordings is time in some respects have very different consuming and costly backgrounds. individuals who are likely to provide the . religious background later use in individual interviews and nature of substance use. The general rule for selecting focus interviews group participants is that they should be ● facilitating a focus group requires reasonably homogeneous. careful consideration needs to be and at less cost than individual interviews given to the participants of focus groups. Examples of TASK 1. Methods and Tools Using focus groups TASK 2. develop a topic guide Definition: homogenous 5. It is therefore communities important to judge whether differences between The key disadvantages of focus groups are that: the background and opinions of participants will ● the number of questions that can be contribute or detract from the generation of addressed is smaller than in individual useful data. a group of male focus group in a rapid assessment is to select prisoners. This can restrict the range of the ● the researcher has less control over the discussion. With health and ● people usually feel comfortable in focus policy professionals. sexuality. organise the group 4. it is equally important to groups because it is a form of consider how the mix of the group will influence communication found naturally in most the quality of the data produced. attitudes. Decide when to undertake the focus group There are five main tasks: Focus groups may perform three main 1. undertake the focus group Homogenous . decide when to undertake the focus group which little is known. This helps to plan the 3. ethnicity. With ● they are useful for identifying and exploring substance users. 104 Chapter 6 Methods and Tools SEX-RAR Guide The key advantages of focus groups are that: information of most practical relevance. behaviours. Given the potentially as friends.

appropriate body language as bars. as with interviews. the topic that possible interventions. TASK 3. and how many people are to identify cultural obstacles. that existing data do not address. problems and likely to be in the group. ● assure informants that all the information they At an early stage of the rapid assessment a provide will be confidential focus group can be used for: ● mention any incentives offered to participants ● discovering opinions and behaviours that the to take part rapid assessment team may not know much ● negotiate a time and date.SEX-RAR Guide Methods and Tools Chapter 6 105 rapid assessment and the design of other as soon as possible. Key and appropriate and inappropriate customs informants may know relevant individuals and During the middle period of the rapid may recruit participants quickly as well as assessment a focus group may be used for: gain their trust. regional Methods and Tools other methods non-governmental organisation (NGO) lists. tea shops. The second is to validate emerging contacted. the importance of that person’s contribution to the success of the rapid assessment. A focus group could be held in an area Once you have decided who should attend outside of the original study with groups of a similar composition and the results compared. Organise the focus group ● where and when the focus group will take As noted earlier. The third is to check ● correct any misconceptions that the informant the validity of conclusions and judgements may have drawn from other data sources and methods. the focus. mentioning how long about. and truck drivers. Participants can be participant. Once an informant is methods. or the focus group will take issues that had not been considered by the researcher ● collect contact details from the participant ● generating hypotheses and ideas. findings. ● assessing the representativeness of emerging voluntary organisations or patient registers. a street prostitute asked about a particular issue and their responses compared with other data sources. behaviours could be recorded and possibly Informal contacts such as friends and related to wider external factors. focus place. These ● validating and cross-checking findings from include government staff listings. participants should be told: ● judging the reaction of selected groups to ● why they have been recruited. Changes in opinion and attitude about hotel and bar owners. Focus At the concluding stage of the rapid group participants can also be recruited by assessment focus groups may be used for: examining documentary sources. acting as a key informant may not only know ● exploring further what the group feels about a other prostitutes. Participants ● understanding local vocabulary and terms for may normally gather in specific places such particular behaviour. A key informant may also ● validating and cross-checking findings from know more than one type of possible other data and hypotheses. the RAR team should: findings and hypotheses from other data ● explain why they want to talk to them sources and methods. the time participants should arrive and groups should be organised and undertaken how long it will take . but also local taxi drivers. You may also mention issues. identifying It is important to concentrate on how best to key informants and new directions for research recruit focus group participants. colleagues may also be able to help. and public parks. For example. topic. Participants may be able you wish to discuss.

TASK 4. journalism. conducting ad-hoc focus groups. it may be preferable to hold the and meetings. These may topic agenda. it is important to facilitate the Before undertaking a focus group the flow of conversation in focus groups. any location that facilitates discussion and encourages participants to attend (such as a TASK 5. The "why" and "how" questions are EXAMPLE: TOPIC AGENDA FOR EXAMINING SEXUAL BEHAVIOUR AMONG INJECTING DRUG USERS How often does penetrative sexual intercourse occur? Who with? How often does condoms use occur? Who with? Why and why not? How does heroin use influence sexual activity? How easy or difficult is it to change sexual behaviour? . desirable and appropriate. such as when what incentives are acceptable. There will be times when you include gifts. topics and issues that a researcher discussion and then facilitating group Methods and Tools wants to address during the interview. A topic guide is a list of all the researcher introducing a broad topic for questions. members of staff) and comfortable as possible. Topics not directly related to the rapid This could include hiring a local school assessment should be kept to a minimum. The under a tree). ● the location should be as neutral. In these situations quickly concentrate the discussion Although focus groups may be conducted in on one or two key areas of investigation. money. free of focusing and maintaining their attention on interruptions (such as telephone calls. this?". It is discussion on this topic by using ‘prompts’. or just Running a focus group is a skilled task. Undertake the focus group health centre. In accomplished by someone with experience of pursuing topics which may be culturally qualitative research. or asking anyone who Relevant discussion should be encouraged is not involved in the focus group to move away and moderators need to make sure that the or be quiet focus group is not dominated by one or two ● the location should be easily accessible individuals. This is researcher may find it useful to prepare a topic usually achieved by the rapid assessment guide. Develop a topic guide Like interviews. Check will not have a topic guide. classroom. important to remember that a focus group such as "why is that?". 106 Chapter 6 Methods and Tools SEX-RAR Guide ● whether or not there are any incentives offered The research team should be familiar with the to encourage people to take part. or from a background in group in a discrete location. a classroom. facilitating public debates ‘delicate’. careful attention should be moderator will need to be able to control and given to the following: mediate discussion between individuals. other issues relevant to the rapid assessment. a park. or refreshments. or "do you also agree with questions. "can you tell me more guide will only consist of a limited number of about that?". This task may be best ● sometimes the location needs to be private. relocating from a busy town square to a quieter side-street.

You may wish to contact them again. . Stress the fact that anything said is confidential. allow participants to briefly introduce themselves to the group. be a good listener and cultivate the habit of asking ‘why’ and ‘how’ 7. Introduce the first topic slowly and encourage participants to talk. The moderator should sit with the participants.this makes it easier to identify and locate tapes at a later date. arrange the location so that the group will sit in a loose circle. 5. tapes and labels. They may pick up on information . at the end. Explain why the focus group is taking place. Materials should be kept that the moderator could overlook. when the focus group is finished. Reassure members why people are taking notes and (if used) ask for their consent to tape record the discussion. each focus issues to consider after the focus group are: group may only consist of four or five broad ● summarise the key points made in the group topics to be addressed (for example. missed? It is useful to have an additional note-taker or ● if a recording was made. Tape- in a safe place to ensure confidentiality. 4. 3. summarise the key issues and opinions and ask if anyone has anything they want to add 10. You will also need extra batteries. refreshments and breaks may be required in longer focus groups. take down any contact details. collectively significance. Key between participants on a topic.SEX-RAR Guide Methods and Tools Chapter 6 107 extremely important in focus groups. ensure that the location is as quiet and as free of interruptions as possible. The proceedings will still be fresh of the main points discussed TEN STEPS TO CONDUCTING A FOCUS GROUP: 1. This allows everyone to see and hear what is going on. If other researchers participants. Find out what is appropriate. thank participants and if you have not already done so. 8. but note takers and any observers can sit anywhere outside the circle where they can hear and observe. record the discussion if this is acceptable to ● play back the recording. arrive early at the location where the focus group is to take place 2. ● were there any weaknesses in the way the "perceptions of risk". 9. You may wish to do this on a large piece of paper so everyone can remember the points already covered. "views focus group was carried out? Were any topics of health services"). and you may Methods and Tools need to say what is expected. welcome participants warmly and introduce yourself and any assistants. This may be a good opportunity to test if the tape recorder is working. summarise the discussion at appropriate points. 6. debrief the team or individually reflect on the ● ensure that the note-taker writes a description discussion. "condom use". Participants may never have been to a focus group before. are involved compare notes and discuss their Immediately after the focus group. If a tape recorder is used it should ideally have an external microphone to pick up individual voices. tag and date the tape observer. Given in your mind and you may have observations that focus groups aim to generate discussion that you wish to discuss with colleagues.

experience and expectations of the researcher can all affect what is being observed ● selective interpretation . and The most natural and obvious way for a contexts. by seeing what people do. Observation is unlike other methods which The use of ‘mapping’ techniques. the less likely these are to be accurate and perceptive Methods and Tools ● ‘observer’ effects . also complement other research methods. relationships. are ashamed of their behaviour. the rely on self-reported behaviour or secondary generation of theories and ideas for further data sources. and by listen. . or are just hostile to strangers Although useful in producing rich and varied data. data sources and hypotheses There are two types of observation ● unstructured observations are useful in collecting background data on the local area and behaviours ● structured observations use pre-selected categories to determine what needs to be observed The key advantage of observation is ● directness . and the validation of existing to gain first-hand experience of human findings can all be aided by observation. 108 Chapter 6 Methods and Tools SEX-RAR Guide 6 . and contexts ● to systematically describe these Observation can be useful for ● producing detailed maps identifying the key locations and individuals in an area ● highlighting areas and topics for further research ● validating and cross-checking findings from other methods.the interests. meanings. relationships. and record what is happening around listening to what they say.this avoids people giving misleading information which can happen if they want to be seen in a favourable light.the longer a researcher waits until writing up notes. meanings. present. Observation can him or her. Instead. The observer learns by being researcher to collect data is to simply watch. observation can be affected by ● selective attention . it allows the researcher research.being watched may lead to individuals changing their normal pattern of behaviour Introduction behaviour.the researcher jumping to conclusions ● selective memory .6 Observations OBSERVATION: OVERVIEW Observation allows the researcher ● to gain first-hand experience of human behaviour.

sold and used. important activities or behaviours being for example. process factors influencing the These can also be used in sorting out notes Methods and Tools implementation and feasibility of existing made during an observation. Notes can be interventions. It is usually ● want to produce a descriptive account of the unlikely that observations will be able to identify situation for contextual background specific sexual risk behaviours themselves. Normally. observations can assist in identifying the key actually of interest. in health agencies. as well as identify and describe the following aspects in their observations. the researcher findings from other data sources and may wish to include one or more of the methods. because they are worried that they will miss something important or are unsure what is In the early stages of the assessment.this is normally done when 3. Not all of these aspects can or should be Using observation observed at one time. undertaking observations at displayed. To assist in the collection of data this does not mean that researchers should using multiple methods and data sources. They may do this an interviewee’s place of residence). as well as gain an observations on specific aspects of a understanding of the local context of substance situation. but can also take place in the settings where interviews and focus groups are Almost anything can be observed. begin the observation end at any moment . or detail of a situation. ● want to explicitly determine what should and During and towards the end of the rapid should not be observed. assessment. observations can be used to To help ensure that observations are assess the generalisability and validity of undertaken systematically. locations where researchers: substances are bought. they should: 1. the RAR team will feels that there are a large number of need to undertake at least five key tasks: aspects that could be observed. decide what is to be observed assessment. decide what is to be observed ● prioritise each aspect in terms of its 2. However.SEX-RAR Guide Methods and Tools Chapter 6 109 Observations may take place as separately Key tasks organised activities as part of the rapid TASK 1. and ● are not sure which aspects are important commercial sex work settings. areas or settings of potential interest for the Researchers should concentrate their rapid assessment. these should be the most use and sexual behaviours. decide how this data will be collected importance to the rapid assessment and deal with these in turn . An often a good idea for interviews to be arranged inexperienced researcher may make the in settings where useful observations can also mistake of trying to record or remember every be made (for example. or could 4. particularly useful. there will be times when selected drinking venues. This might involve. However. organise the observation a situation is unlikely to be repeated. Where a researcher In undertaking observation. Undertaking observations in coded according to themes (thematic health service settings and in the locations coding) which will help in the analysis of where interventions are delivered may prove what is observed. it is unsystematically observe everything. arranged.

These observations can then be classified and coded after the event according Methods and Tools If a colleague can assist. ● useful for highlighting behaviours which either the researcher or the participants were TASK 2. one aspect. such observations repeat the observation at a later date. This can should not exclude any prominent features. Also. be useful where a situation is frequently repeated such as interactions at a daily but should also avoid concentrating on any treatment service. There are two main methods of conducting unstructured observation can still be subject to an observation in a rapid assessment: certain observational biases. The where the situation under observation would researcher notes a range of aspects of a not be disturbed or interrupted by this situation to gain a general understanding of ● observe a limited number of aspects and try to what is going on. These background data on the local area and decisions are normally taken after initial . validity through comparisons between observers’ findings and interpretations. this could improve to relevant themes. unstructured and structured observations. Initially. 110 Chapter 6 Methods and Tools SEX-RAR Guide EXAMPLE: ASPECTS OF OBSERVATION Settings where does the observation take place? When? What is the physical layout? What kind of objects are present? People who is present? What type of person are they? How old are they? Why are they here? Activities what is going on? What activities are the people involved in? Signs are there any ‘clues’ which provide evidence about meanings and behaviours? Acts what are people doing? Events is this a regular occurrence? Or is it a special event such as a meeting or a disagreement? Time in what order do things happen? Is there a reason for this? Goals what are people trying to accomplish? Connections how do the people present know one another? Is their relationship social or organised on a commercial basis? Does the relationship change over time? ● ask colleagues to help .this is only possible behaviours are being collected. decide how this data will be unaware of collected ● can require skilled observers. Structured observations Unstructured observations Structured observations are undertaken when Unstructured observations are useful in the the team have decided what data are most early stages of a rapid assessment when relevant for the rapid assessment.

the information is useful for validating certain There are three different types of structured information from interviews. descriptions of what they have observed. the researcher notes specific instructions on how to do this. what was discussed. conducted continuously. in certain places. for 10 minutes every three occurs. or twice a day for a week. and unannounced at a particular site. For example. use in the location. Note that untrained researchers are used. Collecting data requires made continually and written down either in the observation of specific behaviours or note form or entered onto a record sheet or field notes. they came on foot or by private vehicle or taxi. for example.that are evidence of substance those being observed. observations should be researchers will only observe certain types of .sometimes. video-recordings. present. and record sheets. structured information. ● in the early stages of a rapid assessment .these attempt to ● an observational guide is useful for stating monitor behaviour over a period of time. as long as this is acceptable to intoxicated . time point even to make sure that researchers are using a observations and spot-checks: method correctly. This Research rarely follows a predictable or can. if participants do not object. precise tasks. However. syringes or the photographs can provide useful records of numbers of people leaving a club who are observations. The researcher could note the the current stage of the rapid assessment and types of people seen. areas and meeting between local police and doctors from behaviours for observation.(i) how long they stayed. and at certain are that this can produce rich and detailed times. ● extended observations . Such spot checks are useful after. or recording the details of a lengthy information on key people. documents or observation: extended observation. observation may take place for 60 seconds ● a record sheet records a behaviour and when it every 10 minutes. Furthermore. what should and should not be observed. It these can be useful when new or hours. how this was the team could allocate specialised duties to received and any conflicts could be noted. if the method of observation used. (ii) if it appears that a treatment clinic. For example observer’s mind. organise the observation researcher will want to make ongoing Methods and Tools observations of a particular event or site. These However. make the written up in more detail as soon as possible check and leave. However.SEX-RAR Guide Methods and Tools Chapter 6 111 exploratory research.these are normally one-off notes may sometimes be made in research observations. This preparation will depend on 24 hour period. rather than observation being may include reminders of what to observe. drugs packaging. or activities at pre-defined periods. Brief ● spot checks . behaviours and interactions of people that a researcher cannot systematically prepare who visit a known drug dealing point during a for observation. it can be very tiring and observations can employ observational guides may only be maintained for a short period. The details of who was a large number of observations are required. Usually the researcher will arrive settings. This means that During this process. if people return more than once. To help researchers. and what behaviours mapping can prove useful for preparing basic occurred. different researchers. observing items . a TASK 3. which direction they came from. this does not mean types. ● time point observations . be used in monitoring the uneventful path. and containers.such as discarded drinks ● tape-recordings. while events are still fresh in the in observing signs of behaviour. The advantage of such observations activities. activities may be different at different times of ● field notes are the researcher’s written day or days in the week.

Although they are rarely used as simple to analyse. If the researcher unconnected observations.researchers should attempt to fill in ‘missing observations’ with demonstrations amount of notes this could mean that they have made unsystematic observations of everything TASK 4. surveys are used to have taken place. in the context of rapid baseline data for future evaluation of assessment.researchers should try rather than briefly undertaking a number of and keep an ‘open mind’. This allows the researcher to build up is extremely significant.this could make it difficult to observations be repeated? recall later what has been observed ● at the concluding stages of a rapid assessment ● too many notes . ● in the middle stages of a rapid assessment - ● the ‘observer’ effect . 6 .7 Surveys Methods and Tools Introduction Surveys are most likely to be conducted once initial interviews. (iii) researchers jumps to conclusions too early. . should be brief and relatively interventions.if a researcher produces a large . researchers should be clear and precise notes then this could create aware that they can encounter the following problems during analysis difficulties: After observation During observation ● selective memory . ● selective interpretation .an observer should not ● selective attention . it is important to remember that the screen target groups for purposes of sampling main purpose of the rapid assessment is to for other data gathering techniques. gather data which is of practical relevance for depth interviews and focus group discussions. such as in. begin the observation ● poor notes . that occur later. to validate the data other methods should be used to design survey gained from other methods and to provide instruments which. The and expectations of the researcher can all longer a researcher waits until writing up affect what is being observed. Researchers notes.the effect of being structured observation guides and if necessary record sheets should be prepared. this may lead to should try to arrange initial field visits with selective attention and miss important activities key informants. the less likely these are to be accurate should try and make a conscious effort not to and perceptive. developing interventions. When designing or using exploratory methods.if a researcher does not produce During observation. they may also serve to surveys. The rapid watched may lead to individuals changing their assessment team will need to decide: who and normal pattern of behaviour what should be observed? Where and when Whilst recording data should this take place? How often should ● too few notes . focus groups and observations In a rapid assessment. expertise and rapport with local informants.the interests. 112 Chapter 6 Methods and Tools SEX-RAR Guide behaviour or will work in specific geographical dwell on any one aspect of a situation unless it areas. The descriptive data from complement data gathering. experience rely on simply having a good memory.

rapid assessment surveys are commonly used to complement data gathering. agree on the data collection techniques 4. the RAR team should consider how the survey will be distributed to respondents ● the team will also need to address the return and monitoring of the survey ● interviewers will need to be trained.SEX-RAR Guide Methods and Tools Chapter 6 113 SURVEYS: OVERVIEW Surveys in a RAR ● support other data collection methods . taken from the community) Methods and Tools ● the RAR will also need to consider any additional resources that are required Role of the interviewer Interviewers should: ● be familiar with the survey ● follow question wording exactly record responses exactly ● record responses exactly Data can be managed using two methods ● tally sheets which allow the rapid assessment team to produce a clear overview of the answers ● computer software packages that facilitate data entry and analysis .to measure change over a given time period Surveys in a RAR may differ from conventional survey research as they ● typically focus on a limited number of questions ● avoid representative sampling procedures ● use simple analytical techniques and focus on simpler quantitative description There are six steps in preparing a survey: 1. agree on the sample 3. identify the research aim(s) and sub-topics 2. determine the format and wording of questions 5. particularly when using indigenous interviewers (i.e. determine the order of the questions and survey layout 6.to target particular groups or populations and quickly determine whether a respondent is eligible to take part ● produce baseline data for evaluation purposes . or to validate data collected by other methods ● screen respondents . evaluate the survey and prepare final version Organising surveys ● at an early stage.

and Intervention Using surveys Assessments (See: 4. determine the format and wording of risk behaviour. In rapid assessments. the basis of findings from other methods in ● use simple analytical techniques . This is because RAR surveys tend to: aims or questions to guide the development ● be shorter – RAR surveys typically focus on a of the survey.6). among substance between variables over time. determine the order of the questions and proportion of the sample engaging in risk survey layout behaviours. Rapid data gained from interviews. agree on the data collection techniques nature of interventions. 114 Chapter 6 Methods and Tools SEX-RAR Guide Surveys alone usually provide inadequate ● avoid representative sampling procedures . focus groups assessment surveys will emphasise and observations. data management. evaluate the survey and prepare final version Methods and Tools the number of times risk behaviours occur. for example. 6. the extent and nature of associated adverse 2. these are then broken down into a of printed copies). the number of people risk behaviours are Task 1 identify the research aim(s) and engaged with and the key behavioural sub-topics differences within the sample. agree on the sample health consequences.the data for the development of appropriate ‘hidden’ nature of drug user and sex worker populations. preparation questions. The rapid assessment team translates the The use of surveys in RAR differs slightly from general topic of interest (such as alcohol use conventional social science or medical among sex workers) into specific research research. This is only the first step of the limited number of questions. 4. it is more users in a particular setting). This is because process. 4. and the extent and 3. population (for example. when undertaking the Health Consequences. They are likely to be most opportunistic and convenience samples of a effectively applied when they are designed on manageable size. quantitative or questions questionnaire data may be collected on: the 5. Once the rapid assessment team shorter surveys place less demands on the have determined a number of specific aims or resources of the rapid assessment team (for data collection. among clients of a Although the team may wish to undertake more complicated analyses of statistical associations particular health service. Risk Assessment. the 1. important that the identified research aims .it is the assessment and when they are conducted important that data from the survey can be among targeted samples of the study quickly fed back into the rapid assessment. combined with the short amount of interventions. identify the research aims and sub-topics extent and nature of sexual risk behaviour. and are easier to administer more detailed list of sub-questions. surveys time and smaller sample sizes used. They In using surveys. practical for the rapid assessment to focus on Surveys are likely to be of most relevance simpler quantitative descriptions.4. the RAR team will need to provide data on: the extent and nature of undertake at least six key tasks: substance use and sexual behaviours. It is in the field. precludes are most likely to be used to supplement the representative and random sampling. the frequency of risk behaviours.5. In surveys of sexual 4.

you may decide the survey. For example. Task 2 agree on the sample Task 3 agree on the data collection Sampling is the selection of cases from a techniques defined study population.3 Surveys can be administered in two main contains further discussion of sampling. you may want methods. The survey should also aim to can indicate which sampling approach is incorporate findings and results from other most appropriate. people who use a combination of Questionnaires which respondents complete alcohol and codeine. age. in a RAR it is useful to insist on Methods and Tools population (for example. you now need governmental organisations (NGOs) who work to draw up a preliminary list of potential sub. if there are five survey fieldworkers. to use this opportunity to distribute a survey. and You will need to consider how representative respondents sometimes fail to return surveys this sample can be of the wider study if taken away. It is therefore useful to think about limitations are: that there is no opportunity for target sample sizes. community. The advantages of geographical representation). self-completion surveys are: they are less ● what size sample will be taken – surveys in open to problems of interviewer bias. surveys are likely to be short. Researcher-completed survey interviews are ● the best way to do this with current resources . As the workers out of a brothel of 100 sex workers). where face-to-face interviews are completed . You may find it depend on the human and material resources available. they are unsuitable for those with of them and how long sampling might take.this could be a which are used to structure and record data proportion of the street children in the local collection during a face-to-face interview. These can give the researchers to probe or clarify a response if it research team a clear idea of what is expected is not clear. immediate completion. Module 6. This list will be used later to help planning meeting for all regional NGOs is to formulate and word questions for inclusion in take place later that month. gender. each of whom aim require clear instructions to be given on how to recruit four cocaine users a day over seven to complete the survey. this can give a target sample size of 140. For difficulties in reading or writing.the sample is a selection of cases distribution. with child sex-workers.SEX-RAR Guide Methods and Tools Chapter 6 115 are not too ambitious or do not try to cover the design and implementation of a survey will more than two or three topics. and they example. days. The methods. If you find out that a topics. in a survey of cocaine users. exploratory research prior to the survey this. ten sex take away and return at a later date. themselves come in two forms: those that are completed (usually immediately) at the time of ● how representative the sample will be of this population . Once you have clarified the to use a survey with regional non- research aim(s) for the survey. or all of the sex workers in a particular brothel. and RAR seek to provide a quick and cheap way of collecting information from a larger number of they can be quicker and use less resources respondents than is possible using qualitative than researcher-completed interviews. and questionnaires ● who the study population is . The ways: questionnaires which respondents rapid assessment team will need to consider: complete themselves. and those that respondents can from the study population (for example. helpful to use the assessment modules in the rapid assessment and response guide to do Often.

the time researchers require to code participant to list only the positive aspects of this answer. This can result in misleading literacy. and they are useful when interpreted in a different way from the way working with people with low levels of you intended. This question questions. avoid leading questions. There are three alcohol availability and to consider the situation main types of question format: open questions five years ago. . The advantages First. Use of such surveys are that: the researcher can language which is specific and clear. These occur By this stage. you now need to word the questions to or over estimates. disagree. The table opposite lists several heroin?’ may provide a more balanced answer. this can lead to the unconstrained way. These are disagree strongly’). avoid mentally taxing questions. ‘What do you list of sub-topics. often using as many question being misinterpreted. The format a question questions which encourage a respondent to takes is not simply an issue of presentation. ‘Why will affect the length and type of answer do you like heroin?’ could encourage a provided. "how many alcoholic beverages did Using the rough list of sub-topics drawn up you drink last year" may result in large under earlier. Before you move on to feel about the availability of alcohol compared translating these sub-topics into actual to the situation five years ago?’. and then to draw a comparison. ‘What do you think about analysis. you should have identified the where two different questions are asked in a research aims and produced a more detailed single statement. you should consider the different is asking the respondent to think about current question formats available. example. question it could lead to very long answers. Here. 116 Chapter 6 Methods and Tools SEX-RAR Guide using a questionnaire. neither agree nor disagree. If you ask for clarification or probe if a respondent’s use vague language then the question may be answer is unclear. questions Third. Each question should normally reads the questions out in the order be clear and easy for the respondent to in which they are listed on the survey and understand.allows respondent to answer in an In a closed question. For their relative advantages and disadvantages. However.uses a alcohol?’. or Fourth. Use simple and forms of survey. For example. records any answers in full. For example. scaled questions . agree. it may be better to . ‘how does the situation answers (for example ‘agree strongly. ‘what was the availability of alcohol Methods and Tools scale or range to measure respondent’s like five years ago?’. whilst in an open words as they like. and the complexity of the data the drug. closed questions . technical or unusual term (such as perinatal Task 4 determine the format and wording of transmission) then explain what it is. avoid double questions. It is provides two or more alternatives from which easier to ask a series of shorter questions: the respondents select the choice closest to ‘what do you feel about the availability of their own thinking. If you need to use a of interviewer bias. the researcher be used in the survey. and introduce the possibility ordinary language. sometimes take longer to complete than other Second. It answer in a particular way. Instead. five years ago compare with today?’. it is important to avoid ambiguity. different types of question format and outlines Fifth. The disadvantages are that they: can and inaccurate data. avoid complexity.

and sampling strategies which allow access to comparable samples of the study population. intervention development and implementation has been established. Such monitoring requires that the survey collects data which is suitable for measuring the extent of risk behaviour at a given time. once an ongoing process of situation assessment. However. These are ‘longitudinal surveys’ and ‘cross-sectional’ surveys. Given the resources and time available in a rapid assessment. This is important to bear in mind in the assessment. as well as the determinants or ‘causes’ of behavioural outcomes. and brief research instruments. they provide data on the statistical associations between behaviour and outcome. Through comparing behaviour change between exposed groups and non-exposed groups behaviour change due to specific interventions can be distinguished from other factors influencing behaviour change. it is suggested that surveys are used with targeted samples. Here condom is to have a ‘concept’ (such as condom strength could be equally represented by strength in the following example) which is durability. For example: had in the last week or month. A common strategy for evaluation is to draw two samples at a time of which only one is exposed to a certain intervention at a later stage. avoid unbalanced questions. the most important to you when buying Sixth. such time does not exist. It will only demonstrate that the use of alcohol is in some way associated with unprotected sex. In the initial phase of rapid assessment. surveys will not be able to provide the data necessary to assess whether or not alcohol ‘causes’ unprotected sex. they are unable to measure the precise direction of the relationship between cause and effect. can provide data of practical relevance for the development of interventions. In a condoms? (a) cost. LONGITUDINAL SURVEYS Longitudinal surveys are conducted with the same group of people over time. This enables them to assess the extent and nature of change. multiple choice question. (b) durability. For example. They are unable to provide conclusive data on causal associations. CROSS-SECTIONAL SURVEYS Cross-sectional surveys examine a ‘cross-section’ of a study population at a particular point in time. (c) thickness. ask the respondent the number of drinks they represented more than once. at different points in time. thickness or strength. sample sizes which are not too large to manage. such as mass media campaigns. the re-administration of a questionnaire provides a useful tool to monitor the ongoing impact of interventions. one questionnaire can be suitable for both types of survey. and multiply "Which one of these things would you say is this figure by 52 or 12. in combination with other methods. However.SEX-RAR Guide Methods and Tools Chapter 6 117 TYPES OF SURVEY There are two main types of survey design. They require a sufficient period of time to have elapsed between each time the survey is administered in order to measure behaviour change. They provide one-off studies. . Because they lack a time or ‘critical incidence’ dimension. The use of cross-sectional surveys in the rapid assessment should be judged by the extent to Methods and Tools which they. Instead. a common mistake (d) flavour. or (e) strength".

However. and the name of should aim to make the respondent interested the organisation conducting it in completing the rest of the survey.it is often better to place simpler ● specific instructions if a particular question questions earlier in the survey. These instructions can either be issues which could lead to refusal or bias. It is usually better to place questions space is needed. complex . important that the questions follow a logical When designing the questionnaire’s layout. ● clear . either refuse to continue. use large and clear type. These are key informants. it ● general instructions on how the survey should should not address controversial or sensitive be completed. that a separate piece of paper regarding socio-demographic characteristics should be used). you should test the survey before respondent or the interviewer. For example. directed at respondents or the interviewer ● asked questions which become gradually more conducting the survey. you ● numbered . where possible. Similarly. leave enough space for again. general issue at the beginning of the survey Questions in the survey should be: before returning to it in more depth later. or could quickly The layout of the survey should be: provide answers to the following questions without giving them due thought. if a requires an unusual method of completion. if you wish to ask truck drivers to included early. For question requiring extensive memory recall is example. Consequently. it is often useful to include commentary within ● complete . They are often used review some of the pointers given in steps when a question has a number of different one to five of this module. Instead. or looking at a Task 6 test the survey and prepare final different topic. this similar effort and time. Your primary aim should be to instructions printed on the survey which tell evaluate whether the survey will provide the the interviewer which question or action information you need. the respondent may think that draw a map of the route they take (to see if this all of the proceeding questions will require coincides with the location of sex workers). Or. towards the end. . 118 Chapter 6 Methods and Tools SEX-RAR Guide Task 5 determine the order of the questions possible answers. ● readable .this will avoid questions being may want to introduce a number of different omitted or missed. It is in further depth. you may wish to address a surveys.try to avoid splitting a question or the survey which explains why you are returning its response across different pages to an issue in more depth. and the researcher is The order in which questions are asked can interested in exploring one or some of these be as important as their wording.try to avoid putting too much information onto a single page. they may may require specific instructions. any question sub- Methods and Tools topics within a single survey. parts should be lettered to prevent this.the first question ● including the title of the study. hand written In longer surveys. If you use ● not asked for personal information too soon - open-ended questions. It may be useful to should be taken next. This should involve reviewing the An additional factor associated with question survey with the rapid assessment team and order in a longer survey are skips. progression so that the respondent is: the RAR team will need to consider: ● immediately engaged . this is on the basis of respondent a lengthy answer (and indicate that if more refusal. This commentary is printed in the version survey and can either be read by the If possible. In such situations.avoid. using it.

the interviewer have to be returned from each of the different should record the answer exactly how it is groupings being studied). It is therefore the population under consideration). Given the short length of spend too much time moving from question to the survey. At an early stage. if this is not impression to the respondent. undertake interviews with one another. a group reading of the survey the survey. However. This is not a problem to monitor the number returned by each when using closed questions. you will need to consider ensuring that spare copies of the survey are how the survey will be distributed to available. or using they do not have research experience. help boost the return rate of surveys. important that they should: You will also need to consider the how the ● be familiar with the survey . you will also need given by the respondent. This can be used to pick up practice exercises where interviewers on poorly designed or worded questions. This is where respondents from the where the trainer explains each question and study population complete the survey as they interviewer’s questions are answered. population is known to gather such as a treatment centre or known drug dealing point - Role of the interviewer although caution should be exercised). misunderstandings or sub-topics which may Finally. These can include: distributing pens or pencils to respondents/interviewers. or through indigenous Interviewers can have a significant influence interviewers (individuals who are normally from on the completion of a survey. or arranging the use of a computer respondents. if interviewers where surveys can be returned. This is particularly important if Data can be managed using two methods: you are using indigenous interviewers and tally sheets or pre-formatted tables. Tally sheets allow the rapid Training should include: an explanation of the assessment team to produce a clear overview . this comparability is reduced. a computer. analysis and doing this including: at a point where the rapid dissemination. before conducting the survey. If you are using interviewers they will need to Managing data from surveys be trained. or section to section. Some researchers argue that offering questions summarising may influence a small incentives such as food or drink can respondent’s answer. and give a poor almost immediately. and survey length. and would in the field. One method advantages of a survey is that it can produce of doing this is arranging a time or place comparable data. it is normal to complete them question.one of the respondents to return the survey. rapid assessment team will also need to consider any additional resources that are Organising surveys required. sampling where a specific number of surveys ● record responses exactly . However. but with open group. possible. the need to be included.SEX-RAR Guide Methods and Tools Chapter 6 119 Sometimes it may also be worthwhile pre-testing survey’s aims. survey is returned. make it as easy as possible for ● follow question wording exactly .without this the interviewer is more likely to: make mistakes. When using rephrase questions or offer their own Methods and Tools certain sampling methods (such as quota interpretations to respondents. There are a number of ways of to improve data management. through key informants.

Each question in the survey is ticks or the actual data collected can be allocated a sheet on which the range of inserted. such as Epi-Info and Excel. Methods and Tools . As each survey is examined. A similar approach can also be different responses for that questions are adopted when using computer software printed. marks. 120 Chapter 6 Methods and Tools SEX-RAR Guide of the answers. packages.

SEX-RAR Guide References 121 REFERENCES References .

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SEX-RAR Guide Appendices 131 APPENDIX 1 ASSESSMENT FRAMEWORKS APPENDICES .

4. appropriate and effective? Appendices Intervention Assessment.5 What are the resources and actions required to develop and implement locally appropriate interventions to reduce the adverse health consequences associated with sexual 132 behaviour related to substance use? APPENDICES . and which interventions are likely to be feasible. 4.4 What is the extent and nature of the relationships between substance use and sexual behaviour? And sexual risk behaviour? Intervention Assessment.SEX-RAR Guide Example Assessment Planning Matrix FIELD1 Assessment Modules Key Questions? Key data sources? Key methods? Key tasks? Importance (1-5) Context Assessment. 4. 4.2 What contextual factors influence: patterns of substance use? sexual behaviour and risk? adverse health consequences? feasibility of response development? Health Consequences Assessment.5 What are the needs for intervention responses.3 What is the extent and nature of adverse health consequences associated with sexual risk behaviours related to substance use? Risk Assessment. 4.

policy and Community level political situation influences Social and economic situation Other structural factors Substance use Structural level norms influences Sexual norms Setting Appendices Risk behaviours Individual level influences Levels of knowledge Personal attitudes 133 APPENDICES . SEX-RAR Guide Example Data management DATA2 Description Source/Rationale Action Importance Validity (1-5) (1-5) Key finding Legal.

SEX-RAR Guide Example Planning responses RESPONSE 3 Important Feasible Urgent General response Opportunities Constraints (1-5) (1-5) (1-5) Key finding Legal. 134 concerns APPENDICES . policy and Goals and objectives Community level political situation influences Social and economic situation Other structural factors Substance use Structural level norms influences Activities Sexual norms Setting Appendices Risk behaviours (human/financial/time) Individual level influences Resources Levels of knowledge Personal attitudes.

SEX-RAR Guide Appendices 135 APPENDIX 2 EXAMPLE REPORT STRUCTURE APPENDICES .

● Community Advisory Body. and how population groups.SEX-RAR Guide SECTION CONTENT DESCRIPTION CONTENTS EXECUTIVE SUMMARY ● Key findings of RAR The Executive Summary should provide the reader with a clear idea of: (a) ● Recommendations what the most important results of the RAR were. agencies and organisations involved in the RAR. (c) an indication of the problems encountered. Include information on training provided as part of the ● Training RAR. TIMETABLE + PROCESS ● Timetable It is crucial that you provide: (a) timetable of the events and activities involved in ● Description of process the rapid assessment. Please state any external events/factors which affected the RAR. Objectives are the activities that ● Rationale for selection were required to meet these aims. population method was used with. injecting in study location STUDY DESIGN AIMS AND OBJECTIVES ● Aims and objectives Aims are what the RAR intended to achieve. start/finish The Introduction provides an important description of the context in which the date. and other community Description of participation in RAR of the Community Advisory Body. (b) a short written description of these events. and sample sizes these methods were used. and (c) what action needs to be taken. Be sure to describe which population groups each Appendices ● Rationale for selection of these methods. It is important to describe why these aims and objectives were selected (the ‘rationale’). and other participation community organisations. injecting (Background #1). 136 ● Problems and successes APPENDICES . and the successes achieved. and HIV/other infectious conditions related to #2). METHODS ● Methodology #1: methods used in the RAR. a focus group groups. INTRODUCTION ● Background #1: description of location. RAR team and additional fieldworkers A description of the individuals.g. target It is important that you describe what methods were used in the RAR. It should contain a brief description of the study background ● Background #2: brief history of drug use. and the number of people involved (e. and also the area in which the RAR took place (Background drug use. and sample sizes with 10 street children living in the Walthamstow district of London). and population target groups RAR took place. or has already taken place. TEAM ● PI. (b) how these results ● Action plan were obtained.

religious beliefs. Appendices 137 APPENDICES . conditions. It should provide a description of (a) ● Unmet need. use in the study location HEALTH AND SOCIAL ● Description of health and social consequences related For example. education. laws) use and sexual behaviour. This means using findings from the RAR to support your recommendations. health and living where drug use takes place. Where known. The interventions section is critical. and (c) whether new interventions are needed. HBV. data on STIs can also be included. demographics. HIV among substance users are already provided (existing provision). migration. and if so. ● Description study sites. the study location populations involved. location INTERVENTIONS ● Existing provision. and the possible reasons for this behaviour. and HCV.g. This includes. The cultural context can also have an impact. literacy levels or geographical areas situation. for example. SEX-RAR Guide FINDINGS CONTEXT ASSESSMENT ● Structural and cultural features of existing situation The structural context can affect patterns and consequences of substance which facilitate/obstruct HIV prevention activity (e. this context can include laws. health consequences relate to infectious diseases such as CONSEQUENCES to substance use and sexual behaviour in the study HIV. Plans to meet this. which type? Remember that it is important that you state the basis for your claim. police and justice. For example. Such ● Profile of sexual risk behaviours liked to injecting drug descriptions can help HIV prevention efforts. which interventions for preventing the spread of infectious conditions such as ● Reference to data which support these actions. RISK BEHAVIOUR ● Profile of risk behaviours linked to substance use in the It is important to provide detailed descriptions of risk behaviours. (b) whether these existing interventions need to be improved and how. economic and political policing activity. community or group beliefs about the risks of sharing needles and other drug injecting paraphernalia.

● Training slides ● Photographs Appendices 138 APPENDICES . APPENDICES APPENDICES 1 – x ● Key documents It is important that each site includes key documents. likely assistance above are realised. It can also include recommendations for further research or surveillance. research instruments. community and individual levels among substance users in your study area. ACTION PLAN ● List of activities and responsibilities This section should describe what practical steps are being taken in the study ● Timetable. acceptability area to make sure that the recommendations and interventions described ● Likely obstacles. RECOMMENDATIONS AND ACTION PLAN RECOMMENDATIONS ● Recommendations This section should indicate what activities are needed to reduce harms ● Structural.SEX-RAR Guide FINDINGS continued INTERVENTIONS. feasibility. ● Research instruments training slides or photographs as an appendix.

SEX-RAR Guide Appendices 139 APPENDICES .