PST06210: OPERATIONAL RESEARCH

Handout 8.1: Research Problem Identification

 Problem Identification
o Finding a problem is not difficult but identifying one for the purpose of research is not
always easy.
o Identifying a problem situation is the first essential step in designing a research proposal,
but it must then be followed by a process of problem definition.
o The research problem identified must be defined in terms of its occurrence, intensity,
distribution, and other measures for which data are already available.
o The aim is to determine all that is currently known about the problem and the reason
it exists.
o All research is set in motion by the existence of a problem.
o A problem is a perceived difficulty, a feeling of discomfort about the way things are, or a
discrepancy between what someone believes should be the situation and what the
situation is in reality.
o While problems are the initiating force behind research, not all problems require research.
o A potential research situation arises when three conditions exist:
 A perceived discrepancy exists between what is and what should be.
 A question exists about why there is a discrepancy.
 At least two possible and plausible answers exist to the question.
 If there is only one possible and plausible answer to the question about the
discrepancy, then a research situation does not exist.
 Problem Justification
o After the problem is identified, it is necessary next to justify the importance of the
problem. Research often is expensive and time consuming.
o Find out why the problem you wish to study is important.
Ask yourself the following questions: Can you justify your selection of the research
problem? Can you convince others that the problem is important?
 What to Do: Justifying the Selection of a Research Problem
o In justifying the importance of a research problem, it is helpful to ask yourself a series of
questions and then try to answer each of them.
 Is the problem you wish to study a current and timely one?
 Does the problem exist now? How widespread is the problem? Are many areas and
many people affected by the problem?
 Does the problem affect key populations, such as youth, people living with
HIV/AIDS (PLHA), mothers, or children?
 Does the problem relate to ongoing program activities?
 Does the problem relate to broad social, economic, and health issues, such as
 unemployment, income distribution, poverty, the status of women, or education?
 Who else is concerned about the problem? Are top government officials concerned?
Are medical doctors or other professionals concerned?
o Review your answers to these questions, and arrange them into one or two paragraphs
that justify the importance of the research problem.
o Start by discussing the broad issues that justify the problem and then begin to focus on
the more specific issues related to a particular population group or geographical setting.
 Sample Research Problem Justification
o Over time, millions of HIV-infected people in Africa and elsewhere in the world are
developing HIV-related illnesses. In most African countries, hospitals, clinics, and other
formal health care institutions simply cannot cope with the large numbers of people in
need of physical care and social and psychological support.
o In some hospitals, well over half of the beds are already occupied by AIDS patients. In
some countries the figure is as high as 70 percent of all hospital beds. This is a problem
of great concern to health care planners, as well as to the Ministry of Finance, which
simply does not have the resources to build new facilities or train large numbers of new
providers.
o The problem of providing care and support for PLHA is particularly challenging in rural
areas because there are relatively few health facilities or adequately trained providers
available. In this situation, an alternative is to provide care, support, and treatment in the
homes of those with AIDS. How to do this in a cost-effective manner while
simultaneously providing high-quality services is a challenge.
o New models of delivering care and support services in rural areas need to be developed
and tested to improve the quality of life for PLHA.
o Without effective new approaches, large numbers of people with AIDS will suffer
physical and psychological pain that might otherwise be avoided or at least lessened.
 Comments on the Sample Justification:
o The first paragraph establishes the dimensions of the problem. The large number of
people with AIDS cannot be adequately treated or supported by the formal health care
system, which is already overwhelmed in many countries.
o The second paragraph notes that the problem is particularly acute in rural areas, where
health facilities and providers are relatively few in number. An alternative is to provide
services to PLHA in their homes. The important question is how to do this.
o The paragraph ends by saying that without the development of new approaches to care
and support, large numbers of PLHA will needlessly suffer.
Handout 8.2: Examples of Research and Non-Research Problems
Example of a Non-Research Problem
 Problem Situation
o A recent situation analysis assessment of a hospital in District A found that 125 HIV
positive adults were coming to the hospital every day as part of a DOTS program to take
medication for tuberculosis (TB). But last month’s service statistics from the
hospital’s DOTS program revealed that for one entire week, none of the 125 patients
received any medication.
o Discrepancy
All 125 patients should be receiving a daily treatment for TB, but all 125 did not
receive a single treatment for an entire week last month.
o Problem Question
What factor or factors are responsible for 125 patients’ failing to receive any
treatment for their TB for an entire week?
o Answer
 During the week when the patients did not receive daily TB treatments, a very heavy
rainstorm caused flooding that washed out several roads and destroyed a major bridge
that is used to bring supplies to the district hospital. Because of the flooding and the
destroyed bridge, the hospital ran out of TB medication, and a resupply truck could
not reach the hospital for one week while the bridge was being repaired.
 In this example, a problem situation exists, but the reason for the problem is already
known. Therefore, assuming that all the facts are correct, there is no reason to
conduct research on the factors associated with the break in the supply of daily TB
medication for 125 patients.
 Nonetheless, there may very well be a need to conduct research on the question of
why the supply logistics system is incapable of providing medication during the rainy
season, when it is known that roads and bridges are frequently damaged.

 Problem Situation
o A recent provincial study revealed great differences among villages in the prevalence
of HIV-positive persons. Despite the fact that all villages receive the same level of
health education and services from the Ministry of Health, some villages have an HIV
prevalence rate as high as 32 percent among adults from 15 to 49 years old, while
other villages have a rate as low as 6 percent.

o Discrepancy
 In a relatively small geographic area, you would expect that all villages should have
approximately the same sero-prevalence rate but, in fact, there is great variation
among villages.

o Problem Question
Which factors are responsible for the geographic variation in HIV prevalence among
villages?

o Possible Answers
 Villages differ in their socioeconomic environments, and these differences
influence the context within which HIV is transmitted.
 Some are stable agricultural villages, while some are mobile fishing communities.
 Some villages are located on major roads and have easy access to market towns;
others are more remote with very difficult access to market centers. Some villages
 have schools, health clinics, electricity, and a good water supply, while others do
not have these advantages.
 These and many other social, economic, and cultural differences affect the
context within which sexual relations take place and HIV is transmitted.
 Villages differ in individual and institutional support for HIV/AIDS
prevention, care and support programs.
 In some villages, influential local leaders strongly support sexual behavior
change and condom distribution programs.
 In other villages, people are resistant to these programs, and there is
substantial stigma and discrimination associated with HIV/AIDS.
 In some villages, there are very active anti-AIDS clubs for youth, strong
PLHA organizations, and effective orphan care NGOs.
 In other villages these institutions are absent. These differences in individual
commitment to and institutional support for HIV/AIDS programs affect the sexual
behavior of individuals, the use of condoms, the level of stigma and
discrimination, and the transmission of HIV.
o While the problem situation presented above is clear, the possible and plausible
reasons for the problem are complex. Several of these reasons have been described,
but it is very likely there are many more.
o In situations such as this one, the researcher must devote considerable time and
attention to identifying and clearly defining the problem situation before any potential
solutions to the problem can be tested experimentally through a longitudinal
operations research study.
o The aim of clearly identifying and defining a problem situation is to focus the
research on the most important aspects of a problem that can be changed through a
program intervention.
Handout 8.3: Prioritizing Health Problems for Operational Research

 Relevance
o The topic you choose should be a priority problem.
o Questions to be asked include:
 How large or widespread is the problem?
 Who is affected?
 How severe is the problem?
o If you do not consider a topic relevant, it is not worthwhile to continue rating it. In that
case you should drop it from your list.
o Try to think of serious health problems that affect a great number of people or of the most
serious problems that are faced by clinicians in the area of your work.
o Also, consider the question of who perceives the problem as important. Health managers,
health staff and community members may each look at the same problem from different
perspectives.
o Community members, for example, may give a higher priority to economic concerns than
to certain public health problems.
o To ensure full participation of all parties concerned, it is advisable to define the problem
in such a way that all have an interest in solving it. Even within villages, opinions may
differ on how important a problem is.
o It is therefore obligatory to discuss the problem with community leaders, as well as
peripheral villagers, males as well as females, rich and poor, exploring their perceptions
of the problem.

 Avoidance of Duplication
o Before you decide to carry out a study, it is important that you find out whether the
suggested topic has been investigated before, either within the proposed study area or in
another area with similar conditions.
o If the topic has been researched, the results should be reviewed to explore whether major
questions that deserve further investigation remain unanswered. If not, another topic
should be chosen.
o Also, consider carefully whether you can find answers to the problem in already
available, unpublished information or just by using your common sense. If so, you should
drop the topic from your list.

 Urgency of Required Solution (Timeliness)

 o How urgently are the results needed for making a decision or developing interventions at
various levels (from community to policy)? Consider which research should be done first
and which can be done later.
 Political Acceptability
o In general, it is advisable to research a topic which has the interest and support of the
Local/national authorities. This will increase the chance that the results of the study will
be implemented.

o Under certain circumstances, however, you may feel that a study is required to show that
the government's policy needs adjustment. If so, you should make an extra effort to
involve the policy-makers concerned at an early stage, in order to limit the chances for
confrontation later.

 Feasibility
o Look at the complexity of the problem and the resources you will require to carry out
your study and time required for intervention. Thought should be given first to
manpower, time, equipment and money that are locally available.

o In situations where the local resources necessary to carry out the processes are not
sufficient, you might consider resources available at the national level. Finally, explore
the possibility of obtaining technical and financial assistance from external sources.
 Applicability of Possible Results/Recommendations
o Is it likely that the recommendations from the study will be applied? This will depend
not only on the management capability within the team and the blessing of the
authorities but also on the availability of resources for implementing the
recommendations.
o Likewise, the opinion of the potential clients and of responsible staff will influence the
implementation of recommendations.

 Ethical Acceptability
o We should always consider the possibility that we may inflict harm on others while
carrying out research or any intervention.
o Therefore, consider important ethical issues such as:
 How Cultural sensitivity must be given careful consideration.
 Informed consent be obtained from the research subjects.
 Will the condition of the subjects be taken into account? For example, if individuals
are identified during the study who require treatment, will this treatment be given?
 What if such treatment interferes with your study results?
• Will the results be shared with those who are being studied?
• Will the results be helpful in improving the lives or health of those studied?
 Scales for rating research topics
These criteria can be measured by the following rating scales:
o Relevance
1. = Not relevant
2. = Relevant
3. = Very relevant
o Avoidance of duplication
1. = Sufficient information already available
2. = Some information available but major issues not covered

3. = No sound information available on which to base problem-solving

o Urgency
1. = Information not urgently needed
2. = Information could be used right away but delay of some months would be
acceptable
3. = Data very urgently needed for decision-making
o Political Acceptability
1. = Topic not acceptable to high level policymakers
2. = Topic more or less acceptable
3. = Topic fully acceptable
o Feasibility
1. = Study not feasible, considering available resources
2. = Study feasible, considering available resources
3. = Study very feasible, considering available resources
o Applicability
1. = No chance of recommendations being implemented
2. = Some chance of recommendations being implemented
3. = Good chance of recommendations being implemented
o Ethical acceptability
1. = Major ethical problems
2. = Minor ethical problems
3. = No ethical problems
 Handout 9.1 Formulating the problem Statement
 Importance of a Well-Defined Problem
o A poorly defined research problem leads to confusion.
o A well-defined research problem statement leads to:
 Statement of research objectives
 Hypotheses
 Definition of key variables
 Selection of a methodology for measuring the variables
 Foundation for the further development of the research proposal
 Ease in finding find information and reports of similar studies from which your own
study design can benefit
 Systematic justification for undertaking the proposed research, and what the
 researcher he/she hope to achieve with the study results
 This is important to highlight when you present your project to community members,
health staff, relevant ministries and donor agencies who need to support your study or
give their consent.
 Statement of the Problem Includes:
o Identification, definition, and justification of the research problem
o One of the most important first tasks of research is to identify and clearly define the
problem you wish to study.
o If you are uncertain about the research problem or if you are not clear in your own mind
about what you want to study, others who read your proposal will also be uncertain.
o Problem Identification and definition
o While it is always possible to guess why a problem exists, guesses are often wrong and
usually do not provide a firm basis for designing a research study.
o A far better way to define a problem situation is to review relevant literature, examine
current service statistics, seek educated opinions from persons concerned about the
problem, and obtain probable reasons for the problem from social, economic, or health
theory.
o Follow this general procedure when identifying and defining a problem situation:
 Start with a simple statement of the problem situation.
 Add details as you review the literature, review theoretical concepts, and investigate
the problem in greater depth.
 Simplify the focus by identifying the most important aspects of the problem that are
researchable.
 Make a first attempt at identifying the problem situation by using the following format:
o Problem Situation: Write a small, simple paragraph that identifies the problem.
o Discrepancy: State the discrepancy between what is and what should be.
o Problem Question: Write down the central problem question.
o Possible Answers: Write two or more plausible answers to the problem question.
 From the available research literature, health and behavioral theory, current service
 statistics, educated opinions and other sources of information, try to add details to the
problem situation you have just identified. Look for theoretical concepts and operational
variables that you may have missed. List these concepts and variables on a piece of paper as
you come across them. Try to answer
 the following questions:
o What are the incidence and prevalence of the problem?
o Which geographic areas are affected by the problem? Which population groups are
affected by the problem?
o What are the findings of other research studies?
o What has been done to overcome the problem in the past?
o How successful were past efforts to overcome the problem?
o What seem to be major unanswered questions about the problem?
 With the information you have collected from a literature review and other sources, rewrite
your statement identifying and defining the problem. Use the format described above:
o Problem Situation, Discrepancy, Problem Question, and Possible Answers
o Add details that help to define the problem but organize the information. Try to establish
the boundaries of the problem.
o Focus your attention on the most important, researchable aspects of the problem.
 Have one or more colleagues read your final statement identifying and defining the problem
situation. If they are unclear about the problem situation or cannot describe the discrepancy
between what is and what should be, then go back to the beginning and start all over again.
Handout 9.2: Sample Problem Diagram

Figure below shows the initial problem diagram on Irrational drug use

Abuse Polypharmacy misuse

Irrational drug
use

Adverse effects Drug dependency Waste of resources

Handout 11.2: Examples of Broad and Specific Objectives
First Example
 A study into the cost and quality of home-based care for HIV/AIDS patients and their
communities in Tanzania, was developed. It had its general
objective:
o To explore to what extent Community Home-Based Care (CHBC) projects in Tanzania
provide adequate, affordable and sustainable care of good quality to people with
HIV/AIDS, and to identify ways in which these services can be improved.

o It was split up in the following specific objectives:

 To identify economic, psychosocial and other needs of patients and their families
affected by AIDS.
 To determine the extent to which formal and informal support systems address these
needs from the viewpoint of service providers as well as patients.
 To determine the economic costs of CHBC to the patient and family as well as to the
formal CHBC programme.
 To relate the calculated costs to the quality of care provided to the patient by the
family and to the family/patient by the CHBC programme.
 To determine how improved CHBC and informal support networks can contribute to
the needs of persons with AIDS and other chronically and terminally ill patients.
 To use the findings to make recommendations on the improvement of CHBC to home
care providers, donors and other concerned organisations, including government.
 In the example given above, the needs of AIDS patients and their relatives for care and
support have been defined in the first objective. The objectives which follow concentrate on
adequacy, cost and quality of care provided whereas the last two objectives specify possible
improvements with respect to CHBC, and to whom the results and recommendations of the
study will be fed back
Handout 13.1: Types of sampling and when to use it
Handout 16.1: Overview of Data Collection Techniques
 Data collection techniques refer to a variety of methods which are used to gather
information for the study.
 Data collection techniques allow to systematically collect information about the objects of
study (people, objects, phenomena) and about the settings in which they occur.
 In the collection of data, we have to be systematic.
 If data are collected haphazardly then it will be difficult to answer research questions
in a conclusive way.
 Common Data Collection Techniques in Use
o Reviewing documents
o Observing/observation
o Interviewing (face-to-face)
o Administering written questionnaires
o Focus group discussions
 Reviewing Documents
o Documents to be reviewed can be obtained from dispensary, health center, and hospital
records.
 For example, analysis of the information routinely collected by health facilities can be
very useful for identifying problems such as flows of drug supply or increases in the
incidence of certain diseases.
o Other sources of data may be Health Information Management System, census,
unpublished reports and publications in archives and libraries or in offices, newspapers
and published case histories
 Limitations of Reviewing Documents
o Data are not always easily accessible.
o Ethical issues concerning confidentiality may arise.
o Information may be inaccurate or incomplete.
 Observation Technique
o Observation is a technique that involves systematically selecting, watching and recording
behavior and characteristics of living beings, objects or phenomena.
o Observation of human behavior is a much-used data collection technique.
It can be undertaken in different ways:
 Participant observation: The observer takes part in the situation he or she observes.
• For example, a doctor hospitalized with a broken hip, who now observes hospital
procedures from within.
o Non-participant observation: The observer watches the situation, openly or concealed,
but does not participate.
 Observation becomes a scientific tool and method of data collection for the researcher,
 when:
o It serves a formulated research purpose.
o Is systematically planned and recorded.
o Is subjected to checks and controls on validity and reliability.
 Advantages of Observation Method
o Subjective bias is eliminated, if observation is accurately done.
o The information relates to what is currently happening.
o Not complicated by either past behavior or future intentions or attitudes.
o Independent of respondent’s willingness to respond and hence less demanding on active
cooperation on the part of the respondents.
o Suitable in studies which deal with subjects who are not capable of giving verbal reports
of their feelings for one reason or the other.
 Limitations of Observation Method
o It is an expensive method
o Information provided by this method is very limited
o Sometimes unforeseen events may interfere with the observational task
o Some subjects are rarely accessible to direct observation
o If subjects know that they are being observed, they may change their behaviour
 Interviewing Technique
o An interview is a data-collection technique that involves oral questioning of respondents,
either individually or as a group.
o Requires a person known as the interviewer asking questions in a face-to-face contact to
the interviewee or through other means of communication like telephone.
 Limitations of Reviewing Documents
o Data are not always easily accessible.
o Ethical issues concerning confidentiality may arise.
o Information may be inaccurate or incomplete.
 Observation Technique
o Observation is a technique that involves systematically selecting, watching and recording
behavior and characteristics of living beings, objects or phenomena.
o Observation of human behavior is a much-used data collection technique.
o It can be undertaken in different ways:
 Participant observation: The observer takes part in the situation he or she observes.
• For example, a doctor hospitalized with a broken hip, who now observes hospital
procedures from within.
o Non-participant observation: The observer watches the situation, openly or
concealed, but does not participate.
 Observation becomes a scientific tool and method of data collection for the researcher,
 when:
o It serves a formulated research purpose.
o Is systematically planned and recorded.
o Is subjected to checks and controls on validity and reliability.
 Advantages of Observation Method
o Subjective bias is eliminated, if observation is accurately done.
o The information relates to what is currently happening.
o Not complicated by either past behavior or future intentions or attitudes.
o Independent of respondent’s willingness to respond and hence less demanding on active
cooperation on the part of the respondents.
o Suitable in studies which deal with subjects who are not capable of giving verbal reports
of their feelings for one reason or the other.
 Limitations of Observation Method
o It is an expensive method
o Information provided by this method is very limited
o Sometimes unforeseen events may interfere with the observational task
o Some subjects are rarely accessible to direct observation
o If subjects know that they are being observed, they may change their behavior
 Interviewing Technique
o An interview is a data-collection technique that involves oral questioning of respondents,
either individually or as a group.
o Requires a person known as the interviewer asking questions in a face-to-face contact to
the interviewee or through other means of communication like telephone.
o Answers to the questions posed during an interview can be recorded by writing them
down (either during the interview itself or immediately after the interview) or by tape-
recording the responses, or by a combination of both.
 Advantages of the Interview Method
o Detailed information can be obtained.
o Interviewer could overcome resistance of the respondent, if any.
o Provides flexibility to the interviewer to restructure, clarify, or add probe questions.
o Observation can also be applied during interview.
o Is suitable for use with both literates and illiterates.
o Has higher response rate than written questionnaires.
o The interviewer can collect supplementary information about the respondent’s personal
characteristics and environment.
 Limitations of Interview
o It is very expensive and time consuming especially when the sample is large.
o Chances of Interviewer as well as interviewee’s bias are high.
 o People with certain high level positions like officials or executives may not be easily.
approachable under this method and to that extent the data may prove inadequate.
o Creating effective rapport with the interviewee may be a difficult.
o Some subjects may demand incentives during data collection process.
o There may be a language barrier between an interviewer and interviewee.
 Pre-Requisites and Basic Tenets of Interviewing
o Interviewers should be carefully selected and trained
o They must possess technical competence (interviewing and interpersonal skills)
o They should be able to create an atmosphere of trust and confidence
 Written Questionnaires
o A written questionnaire (also referred to as self-administered questionnaire) is a data
o collection method in which written questions are presented that are to be answered by the
respondents in written form. The questions can be either open-ended or closed (with pre
categorized answers).
o A written questionnaire can be administered in different ways, such as by:
 Sending questionnaires by mail with clear instructions on how to answer the
questions and asking for mailed responses;
 Gathering all or part of the respondents in one place at one time, giving oral or
written instructions, and letting the respondents fill out the questionnaires; or
 Hand-delivering questionnaires to respondents and collecting them later.
 Advantages of Questionnaires
o Low cost when study is large
o Free from interviewer bias
o Respondents have adequate time to give out their answers
o Respondents, who are not easily approachable, can be reached
o Used in large studies
o Permits anonymity and may result in more honest responses.
 Limitations of Questionnaires
o Low rate of return of the duly filled in questionnaires
o Bias due to non-response is undetermined
o Used only when respondents are educated and cooperating
o Control over questionnaire may be lost
o Not flexible once the questionnaire has been dispatched out
o Ambiguous replies or omissions creating difficult in interpretation
o Slowest method of all when mailing is used
 Focus Group Discussions (FGD)
 o FGD allows a group of 6 - 12 informants to freely discuss a certain subject with the
guidance of a facilitator or reporter during which group members talk freely and
spontaneously about a certain topic.
 Characteristics and Uses of Focus Group Discussions
o A FGD is a qualitative method.
o A FGD aims to be more than a question-answer interaction.
o The idea is that group members discuss the topic among themselves, with guidance from
the facilitator.
o FGD techniques can be used to:
 Focus research and develop relevant research hypotheses by exploring in greater
depth the problem to be investigated and its possible causes.
 Formulate appropriate questions for more structured, larger scale surveys.
 Help understand and solve unexpected problems in interventions.
 Develop appropriate messages for health education programmes and later evaluate the
messages for clarity.
 Explore controversial topics. For example: Sexual behavior is a controversial topic in
the sense that males and females judge sexual relations and sexuality often from very
different perspectives.
 Advantages of FGD
o The researcher can interact with the participants, pose, follow up questions or ask
questions that probe more deeply.
o Results can be easier to understand than complicated statistical data.
o The researcher can get information from non-verbal responses such as facial expressions
or body language.
o Information is provided more quickly than if people were interviewed separately.
 Limitations of FGD
o The small sample size means the groups might not be a good representation of the larger
population
o Group discussions can be difficult to steer and control, so time can be lost to irrelevant
topics
o Respondents can feel peer pressure to give similar answers to the moderators’ questions
o The moderators skills in phrasing questions along with setting can affect responses and
skew results

 Advantage of using Available Information Usually there is a large amount of data that has
already been collected by others, although it may not necessarily have been analyzed or
published. Locating these sources and retrieving the information is a good starting point in
any data collection effort. For example,
 o Analysis of the information routinely collected by health facilities can be very useful for
identifying problems in certain interventions or in flows of drug supply, or for identifying
increases in the incidence of certain diseases.
o Analysis of health information system data, census data, unpublished reports and
publications in archives and libraries or in offices at the various levels of health and
health-related services, this may be a study in itself. Usually, however, it forms part of a
study in which other data collection techniques are also used.
o The use of key informants is another important technique to gain access to available
information. Key informants could be knowledgeable community leaders or health staff
at various levels and one or two informative members of the target group (e.g.,
adolescents on their sexual behavior). They can be involved in various stages of the
research, from the statement of the problem to analysis of the data and development of
recommendations.
o Other sources of available data are newspapers and published case histories, e.g., patients
suffering from serious diseases, or their relatives, telling their experiences and how they
cope.
o The advantage of using existing data is that: Collection is inexpensive. However, it is
sometimes difficult to gain access to the records or reports required, and the data may not
always be complete and precise enough, or too disorganized.
Note:
 In order to retrieve the data from available sources, the researcher will have to design
an instrument such as a checklist or compilation sheet.
 In designing such instruments, it is important to inspect the layout of the source
documents from which the data is to be extracted.
 For health information system (HIS) data, for example, the data compilation sheet
should be designed in such a way that the items of data can be transferred in the order
in which the items appear in the source document. This will save time and reduce
error.
 Interviewing
o An interview is a data-collection technique that involves oral questioning of respondents,
either individually or as a group. Answers to the questions posed during an interview can
be recorded by writing them down (either during the interview itself or immediately after
the interview) or by tape-recording the responses, or by a combination of both.
o Interviews can be conducted with varying degrees of flexibility. The two extremes, high
and low degree of flexibility, are described below:
 High degree of flexibility:
• For example: When studying sensitive issues such as teenage pregnancy and
abortions, the investigator may use a list of topics rather than fixed questions.
• These may, e.g., include how teenagers started sexual intercourse, the
 responsibilities girls and their partners take to prevent pregnancy (if at all), and
the actions they take in the event of unwanted pregnancies.
• The investigator should have an additional list of topics ready when the
respondent falls silent, (e.g., when asked about abortion methods used, who made
the decision and who paid).
• The sequence of topics should be determined by the flow of discussion. It is often
possible to come back to a topic discussed earlier in a later stage of the interview.
• The unstructured or loosely structured method of asking questions can be used for
interviewing individuals as well as groups of key informants.
• A flexible method of interviewing is useful if a researcher has as yet little
understanding of the problem or situation he is investigating, or if the topic is
sensitive. It is frequently applied in exploratory studies.
• The instrument used may be called an interview guide or interview schedule.*
• Low degree of flexibility:
o Less flexible methods of interviewing are useful when the researcher is
relatively knowledgeable about expected answers or when the number of
respondents being interviewed is relatively large.
o Then questionnaires may be used with a fixed list of questions in a standard
sequence, which have mainly fixed or pre-categorized answers.
o For example: After a number of observations on the (hygienic) behavior of
women drawing water at a well and some key informant interviews on the use
and maintenance of the wells, one may conduct a larger survey on water use
and satisfaction with the quantity and quality of the water.
 Administering Written Questionnaires
o A written questionnaire (also referred to as self-administered questionnaire) is a data
collection tool in which written questions are presented that are to be answered by the
respondents in written form. A written questionnaire can be administered in different
ways, such as by:
o Sending questionnaires by mail with clear instructions on how to answer the questions
and asking for mailed responses;
o Gathering all or part of the respondents in one place at one time, giving oral or written
instructions, and letting the respondents fill out the questionnaires; or hand-delivering
questionnaires to respondents and collecting them later.
o The questions can be either open-ended or closed (with pre-categorized answers).
 Projective Techniques
o When a researcher uses projective techniques, she/he asks an informant to react to some
kind of visual or verbal stimulus. For example:
 An informant may be provided with a rough outline of the body and be asked to draw
her or his perception of the conception or onset of an illness.
  Another example of a projective technique is the presentation of a hypothetical
question or an incomplete sentence or case/study to an informant (‘story with a gap’).
o A researcher may ask the informant to complete in writing sentences such as:
 If I were to discover that my neighbor had TB, I would ...;
 If my wife were to propose that I use condoms, I would...
 Or (s) he may ask the informant: Suppose your child suffered from diarrhea, what
would you do?
o Such techniques can easily be combined with semi-structured interviews or written
questionnaires. They are also very useful in FGDs to get people’s opinion on sensitive
issues.
o Mapping and Scaling
 Mapping is a valuable technique for visually displaying relationships and resources.
 In a water supply project for example:
• Mapping is invaluable. It can be used to present the placement of wells,
distance of the homes from the wells, other water systems, etc. It gives
researchers a good overview of the physical situation and may help to highlight
relationships hitherto unrecognized.
• Mapping a community is also very useful and often indispensable as a pre-stage
to sampling.
• Scaling is a technique that allows researchers through their respondents to
categorize certain variables that they would not be able to rank themselves.
• For example, they may ask their informant(s) to bring certain types of herbal
medicine and ask them to arrange these into piles according to their usefulness.
The informants would then be asked to explain the logic of their ranking.
 Mapping and scaling may be used as participatory techniques in rapid appraisals or
situation analyses. Rapid appraisal techniques and participatory research are
approaches often used in health systems research.
Handout 16.2: Advantages and disadvantages of using various data collection
tools
Table for advantages and disadvantages of using various data collection tools
 Corlien, Pathmanathan, & Brownlee. (2003).

Handout 16.3: Focus group discussions

 Uses of Focus Group Discussions
o Help understand and solve unexpected problems in interventions. For example:
  In District X, the recent national (polio) immunization days (NID) showed widely
different coverage’s per village (50-90%) and in a number of villages a marked
decrease in coverage was observed compared to last year.
 Eight FGD decrease were held with villages’ mothers, two in town, three in rural with
a marked in NID coverage and three in villages with a high coverage throughout.
 It appeared that overall; the concept NID had raised confusion.
 Most people believed that this mass campaign strengthened the children’s immunity
 Against any (childhood) disease, including Malaria and Respiratory Tract
Infections.
 In the villages with a low NID coverage there had been a high incidence of malaria in
 Children immediately after the previous NID campaign and several children died.
 Mothers therefore believed that the NID campaign was useless.
 Develop appropriate messages for health education programmes and later evaluate the
messages for clarity.
 For example: A rural health clinic wanted to develop a health education programme
focused on weaning problems most often encountered by mothers in the surrounding
villages and what to do about them.
 The focus group discussion could be used for exploring relevant local concepts as
well as for testing drafts when developing the messages.
 The messages should be developed and tested in different socio-economic groups of
mothers, as weaning practices may differ with income, means of subsistence and
education of the mothers. Also ethnic differences may have to be taken into account.
o Explore controversial topics.
 For example: Sexual behavior is a controversial topic in the sense that males and
females judge sexual relations and sexuality often from very different perspectives.
 Sexual education has to take this difference into account.
 Through FGDs, first with females, then with males, and then with a mixed group to
confront both sexes with the different outcomes of the separate discussions (listed on
flip charts) it becomes easier to bring these differences in the open. Especially for
teenagers, who may have many stereotypes about the other sex or be reluctant to
discuss the topic openly (particularly girls), such a ‘multi-stage’ approach is useful.
 Strengths and Limitations of FDG
o Implementation of FGDs is an iterative process; each focus group discussion builds
on the previous one, with a slightly elaborated or better-focused set of themes for
discussion.
o Provided the groups have been well chosen, in terms of composition and number (see
o below), FGDs can be a powerful research tool which provides valuable spontaneous
information in a short period of time and at relatively low cost.
o FGD should not be used for quantitative purposes, such as the testing of hypotheses or
the generalization of findings for larger areas, which would require more elaborate
 surveys.
o However, FGDs can profitably complement such surveys or other, qualitative
techniques.
o Depending on the topic, it may be risky to use FGDs as a single tool.
o In group discussions, people tend to center their opinions on the most common ones,
on ‘social norms. In reality, opinions and behavior may be more diverse. Therefore it
is advisable to combine FGDs with at least some key informant and in-depth
interviews.
o Explicitly soliciting other views during FGDs should be routine as well.
o In case of very sensitive topics, such as sexual behavior or coping with HIV/AIDS,
FGDs may also have their limitations, as group members may hesitate to air their
feelings and experiences freely.
o One possible remedy is the selection of students who do not know each other (e.g.,
selection of children from different schools in FGDs about adolescent sexual
behavior), while assuring absolute confidentiality.
o It may also help to alternate the FGD with other methods, for example, to precede it
by a self-developed role play on sexual behavior, or to administer a written
questionnaire immediately after the FGD with open questions on sexual behavior in
which the students can anonymously state all their questions and problems. This
worked in Tanzania and Nepal.
 How to Conduct a Focus Group Discussion
o Determine the purpose
 A FGD can be regarded as a mini-study. It therefore requires one or two clear
objectives.
 These objectives will guide the research team in the formulation of discussion
questions.
o Situation analysis
 Any FGD requires good knowledge of local conditions. Communities are seldom
or never homogeneous. There are always differences between community
members, for example in education, political power, gender, economic status and
ethnic group.
 These differences will be reflected in their perceptions of the problems they suffer
from and possible solutions.
 A researcher must be aware of these differences, otherwise (s)he may miss
important groups of students or obtain a hotchpotch of information.
 Similarly, she/she must know which key persons or organizations could be good
entry points for the selection of students in the FGDs (e.g.: women’s groups,
parent associations, youth clubs, etc.).
 For example: In an intervention study on sexual health among out-of-school youth
in an urban area, the researcher first planned some interviews with key informants.
  He selected the leaders of a political youth club and of a Christian youth club and
some teachers, with whom he thoroughly discussed his research topic.
• Through them he came in contact with youth of different backgrounds. He let
each of the three groups, separated into boys and girls, draw maps of the town
and asked them to mark places which they thought riskful in terms of sexual
behavior (easy contacts, unprotected sex).
• The drawings formed a good basis for further FGDs but also helped him to
identify wider networks of adolescents at risk who had to be included in the
study.
 Points to be Considered when Preparing the FGD
o Recruitment of students: Students should be roughly of the same socio-economic group
or have a similar background in relation to the issue under investigation. The age and
sexual composition of the group should facilitate free discussion.
o Selection of students: If you are an outsider in the research area, you may have to rely on
your key informants for the first selection of students in FGDs.
o Your key informants to whom you have explained thoroughly the purpose and the
process of the FGD might each suggest some individuals who could be invited to a focus
group discussion.
o Another way of getting students is to conveniently select individuals in a systematic way,
to try and ensure a range of views.
o You might, for example, ask every third or fourth person you find. This method might be
more suitable in urban areas.
o Physical arrangements:
 Communication and interaction during the FGD should be encouraged in every way
possible. Arrange the chairs in a circle. Make sure that there will be no disturbances,
sufficient quietness, adequate lighting, etc.
 Try to hold the FGD in a neutral setting which encourages students to freely express
their views. A health center, for example, is not a good place to discuss traditional
medical beliefs or preferences for other types of treatment.
 Preparation of a discussion guide:
o There should be a written list of topics to be covered, formulated as a series of open-
ended questions.
o Guides for different groups gathered to discuss the same subject may vary slightly,
depending on their knowledge or attitudes and how the subject should first be
explored with them.
 Conducting the session
o One of the members of the research team should act as ‘facilitator’ or ‘moderator’ for
the focus group discussion.
o One should serve as ‘recorder’.
o The facilitator should preferably be as close as possible to the students in their
characteristics (same sex, roughly same age).
Handout 16.4: Function of Focus Group Facilitator
 Functions of the Facilitator of the FDG ( Focus Discussion group)
o The facilitator should NOT act as an expert on the topic. His or her role is to stimulate
and support discussion.
o Introduce the session
 Introduce yourself as facilitator and introduce the recorder.
 Let students introduce themselves with whatever names they wish to use.
 Put the students at ease and explain the purpose of the FGD, the kind of information
needed, and how the information will be used (for the planning of a health
programmes, an education programmes).
 Ask permission to use a tape-recorder, let people hear their own voices before the
session starts.
 You might offer drinks and allow some informal discussion before the actual session
starts.
o Encourage discussion
 Be enthusiastic, lively, and humorous and show your interest in the groups’ ideas.
 Formulate questions and encourage as many students as possible to express their
                 views.  
 Remember there are no ‘right’ or ‘wrong’ answers.
 React neutrally to both verbal and non-verbal responses.
o Encourage involvement
o Avoid a question-and-answer session. Some useful techniques include:
 Asking for clarification: ‘Can you tell me more about...?’
 Reorienting the discussion when it goes ‘off the track’: Saying: ‘Wait, how does
 this relate to...?’
 Saying: ‘Interesting point, but how about...?’
 Using one student’s remark to direct a question to another, for example, ‘Mrs. X
said ..., but how about you, Mrs. Y?’
 When dealing with a dominant participant, avoiding eye contact or turning
 slightly away to discourage the person from speaking, or thanking the person and
changing the subject.
 When dealing with a reluctant participant, using the person’s name, requesting
his/her opinion, making more frequent eye contact to encourage his/her
participation is important.
o Deal correctly with sensitive issues.
o If you notice that the discussion stops when dealing with a sensitive topic, you could
o ask students (if literate) to anonymously write down their responses or opinions on the
topic.
 o Alternatively, you could summarize for the group some of the opinions from previous
focus group discussions, focusing on one or two major contrasting opinions.
o Still another strategy is to form sub-groups, and to get a member of the sub-group to
summarize and present the opinions of their sub-group members after which the whole
group can still discuss these opinions.
o Build rapport, empathize
o Observe non-verbal communication.
o Ask yourself, ‘What are they saying? What does it mean to them?’
o Be aware of your own tone of voice, facial expressions, body language, and those of the
students.
o Avoid being placed in the role of expert
o When asked for your ideas or views by a respondent, remember that you are not there
o to educate or inform.
o Direct the questions back to the group by saying: ‘What do you think’, ‘What would you
do?’
o Set aside time, if necessary, after the session to give students the information they have
asked for.
o Do not try to comment on everything that is being said.
o Don’t feel you have to say something during every pause in the discussion.
o Wait a little and see what happens.
o Control the rhythm of the meeting, but in an unobtrusive way
o Listen carefully and move the discussion from topic to topic. Subtly control the time
allocated to various topics so as to maintain interest.
o If students spontaneously jump from one topic to another, let the discussion continue for
a while since useful additional information may surface; then summarize the points
brought up and reorient the discussion.
o Take time at the end of the meeting to summarize, check for agreement and thank the
Students
o Summarize the main issues brought up, check whether all agree and ask for additional
comments.
o Thank the students and let them know that their ideas have been a valuable contribution
and will be used for planning the proposed research, intervention, or health education
materials.
o Listen for additional comments and spontaneous discussions which occur after the
meeting has been closed.
 Functions of the Recorder
o The recorder should keep a record of the content of the discussion as well as emotional
reactions and important aspects of group interaction.
 o Assessment of the emotional tone of the meeting and the group process will enable you to
judge the validity of the information collected during the FGD.
o Items to be recorded include:
 Date, time, place
 Names and characteristics of students
 General description of the group dynamics (level of participation, presence of a
             dominant participant, level of interest)
 Opinions of students, recorded as much as possible in their own words, especially for
key statements
 Emotional aspects (e.g., reluctance, strong feelings attached to certain opinions)
 Vocabulary used - particularly in FGDs that are intended to assist in developing
questionnaires or health education materials
 Spontaneous relevant discussions during breaks or after the meeting has been closed
o It is highly recommended that a tape-recorder be used to assist in capturing
information. Even if a tape-recorder is used, notes should be taken as well, in case the
machine malfunctions and so that information will be available immediately after the
session for discussion.
o If there is no reliable tape-recorder available, it is advisable to have two recorders.
o A supplementary role for the recorder could be to assist the facilitator (if necessary)
by drawing his or her attention to: missed comments from students missed topics (the
recorder should have a copy of the discussion guide during the FGD)
 Number and Duration of Sessions
o Number of sessions. The number of focus group sessions to be conducted depends upon
project needs, resources, and whether new information is still coming from the sessions,
(that is, whether contrasting views within and between various groups in the community
are still emerging). If not, you may stop.
o One should plan to conduct at least two FGDs for each sub-group (for example, two for
males and two for females). Otherwise you have no way of assessing whether the
information you get from the first FGD is representative for that group.

 Duration
o A focus group session typically lasts up to an hour and a half.
o Generally, the first session with a particular type of group is longer than the following
ones because all of the information is new.
o Thereafter, if all the groups have a similar opinion on particular
topics, the facilitator may be able to move the discussion along more quickly to other
topics which still elicit new points of view.
Handout 17.1: Summary of points to assess during a pre-test or pilot study

1. Reactions of respondents to your Acceptable Not Suggestions

research procedures acceptable

Availability of sample needed for full

study

Work schedules of population that may

affect their availability

Desire of population to participate

Acceptability of questions

Clarity of the language used

2. The data-collection tools Acceptable Not Suggestions

acceptable

Whether the tools provide the

information you need and are reliable

The time needed for administering each

of the data-collection tools

Presentation of questions and format of

questionnaire

Accuracy of translation

Pre-categorising of questions

Coding system and coding guidelines

Handling and administering the tools
3. Sampling procedures Acceptable Not Suggestions
acceptable

Whether the instructions to obtain the

sample are used uniformly by all staff

The time needed to locate the

individuals to be included in the study

4. Preparation and effectiveness of Acceptable Not Suggestions

research team acceptable

Adequacy of staff training

Output of each team member

Team dynamics

Reliability of tools when administered

by different team members

Accuracy of interpretation

Appropriateness of plan for supervision

5. Procedures for data processing Acceptable Not Suggestions

and analysis acceptable

Use of data master sheets

Effectiveness of data quality control

Appropriateness of statistical
procedures

Ease of data interpretation

 6. Schedule for research activities Acceptable Not Suggestions
acceptable

Amount of time allowed for:

field trips for data collection

Supervision

Administration

analysis of data

Sequence of activities

Source: Corlien, Pathmanathan, & Brownlee. (2003).

Handout 18.1: Example of a GANTT

Corlien, Pathmanathan, & Brownlee. (2003).

Handout 18.2: Example of a Work Schedule
Corlien, Pathmanathan, & Brownlee. (2003).