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Dominican Republic Data Analysis Design Portfolio Lynette Henderson and Allison Mutchler Biology and Health Science

Truman State University Due: April 28th, 2009

Table of Contents I. II. III. IV. V. VI. Final Project Proposal List of Community Partners Truman Contacts Time Sheets Evidence of work to date Final Paper

Page Number(s) 1-3 4 4 4-6 6-10 11-17

I. Final Service-Learning Project Proposal 1) Project Goal and Need Fulfillment. Provide a brief project description. Please detail what community need the project will address and/or what the goal of the project is and how you will address the need and/or goal. 1. A group of students traveled to the Dominican Republic to work on a health education campaign concerning family planning, safe motherhood, and timing of births. Infant and maternal mortality rates are among the highest in the world on the island of Hispaniola (which includes Haiti and the Dominican Republic), and healthcare is especially poor in the rural parts of the Dominican Republic. The worked conducted in the Dominican Republic included the showing of a health video to the rural sugar cane batey communities surrounding La Romana, addressing the issues of family planning and safe pregnancies following the first three chapters in UNICEFs Facts for Life document. The project began this past summer were data was collected to evaluate the videos effectiveness. In addition to quantitative survey information that was gathered in a pretest/posttest format, a substantial amount of demographic data was also collected. Through continuation of this project into a series of trips conducted this past December and January to the Dominican Republic; more data was conducted on the effectiveness of the video as well as further demographic data was collected. Through work done this semester, we hope to first enter the data into an organized format in excel and SPSS, second analyze the data collected, third present findings at the Student Research conference, and finally offer suggestions for the improvement of the project those going on future trips and to our partner. Once this portion of our project is complete, the next step will be to write a procedure to be used by future students and others interested in compiling information more efficiently. The goal is to make suggestions that will help future groups complete this process more quickly and efficiently.

2) Community Partner(s). Provide the contact information for community partner(s) with whom you plan to work. Please include the name of the organization, the organizations address, and the name of the individual contact with whom you are working, their position/title, and a phone number. 1. Healthy Mothers Healthy Babies Foundation (Currently HMHB but soon to be the Maison de Naissance Foundation). i) Maison de Naissance 6401 Wornall Terrace Kansas City, MO 64113 816-812-7100 info@maisondenaissance.org ii) Our main coordinator: Pam Logan PLogan@loganlaw.com iii) Maranatha church iv) Good Samaritan hospital 3) Distribution and Weight of Responsibility. Describe the different aspects of the project and who will have the responsibility to carry out these duties. Please consider at least the following four entities in your description: students, faculty member(s), community partner(s), and/or service-learning coordinator. 1. Students: We will be entering and analyzing the data, analyzing data, presenting, and then writing protocol for the future improvement of this project. 2. Faculty: Dr. DeCock, and Dr. Shaw) will guide us through analyzing our data correctly and running the proper statistical tests on the data. 3. Community partners: Pam Logan and HMHB will be aiding us once we have analyzed the data already collected. She will then direct and give us information concerning what should be done next with the project, in particular with grant writing and future protocol for these types of projects. This will be a future project and extension of this project for those interested in continuing this project in the future. 4) Learning Objectives. Explain how this project will accomplish learning objectives outlined in the academic course. You may wish to include the learning objectives that are specific to your class as well as those specific to your academic department and/or the University as a whole. 1. As stated in our course learning objectives, A major goal for this class is to develop student skills for navigating the current issues in public health and bio-medicine, as well as global economics, ecology, and resource availability. One of the major concerns when working on international projects is sustainability as well as creativity to fuel future growth for the campaign. By networking and discovering the resources available to us through tools in this class, we hope to use the most up-to-date public health resources as we move forward in analyzing the batey communities demographics. Through data analysis and writing out our methodology, our project will serve as a model for others who are interested in similar type work, as they will be able to learn from our mistakes. We hope to stimulate growth for the campaign by learning more about the needs of individual groups in

the bateyes in order to improve the long term goal of our partner, which is to reduce infant and maternal mortality rates in the Dominican Republic. 5) Assessment. Present how you plan to assess your students and their performance in the service-learning project. If assessment includes homework or graded assignments, please outline or state the expectations of the assignment. 1. Attendance to weekly outside class meetings (8:30 pm on Tuesdays) to work on the data analysis will be the largest assessment for this project, but not completing weekly tasks will reflect poorly on students performance. 6) Reflection Activities. Offer your ideas on how you plan to incorporate reflection activities into the service-learning experience. Outline your tentative plans or ideas within the semester timeframe. 1. Weekly reflection papers from the class. 7) Time Frame. Outline the projected time frame of the project and show how the project will fit into the academic semester by filling out the Student Project Proposal Time Frame document and turn it in with the Project Proposal. Please list any important dates, especially those that would be pertinent for public relations purposes. 1. See below for time line. 8) Needs and/or Assistance. Please provide a list of any material needs and/or assistance that you anticipate for the project. 1. Access to SPSS and basic statistical analysis tools. 9) Challenges. Please describe any challenges you anticipate you will face. You may also use this section to describe any concerns or reservations you have about the project. 1. Writing out a protocol that will identify the problems we faced and offering viable solutions will be a hurdle to overcome. Most of us working on this project have limited statistical backgrounds, so we are learning as we go. In addition, we have an excess of data and not enough time to assess all of the demographics of the batey communities in the Dominican Republic. The challenge will come when we need to make suggestions to HMHB and Pam on where to go next with this project based on the analysis we complete.

Time line Data Analysis


Febru ary 1st - 7th 8th- 14th 15th - 21st 22n - 28th d M arch 1st - 7th

Data An alysis

Enter data Sort ou problem w form t s ith s 22n - 28th d

Data Com pletely En tered All paper data catalogu ed M - April ar 29th - 4th

Discu m ods of an sis ss eth aly T w professors alk ith 5th- 11th

Begin Data An sis aly B4/After screen g data com in pleted 12th - 18th

Con u tin e Data anaylsis 19th- 25th

Data An alysis

Designan w Poster d rite

Poster com plete for U .F.S Sen com d plete in to PamL. fo

T SR SU C

18th U ite for Sigh n t

II. List of Community Partners 1. Healthy Mothers Healthy Babies Foundation (Currently HMHB but soon to be the Maison de Naissance Foundation). 2. Maison de Naissance 6401 Wornall Terrace Kansas City, MO 64113 816-812-7100 info@maisondenaissance.org 3. Our main coordinator: Pam Logan PLogan@loganlaw.com 4. Maranatha church 5. Good Samaritan hospital III. Truman Contacts 1. Dean De Cock, Ph.D. Email: decock@truman.edu Phone: (660)-785-7367 Truman State University VH2240 Kirksville, MO 63501 2. Shaw, Jason. Email: jshaw@truman.edu Phone: (660)-785-7829 Truman State University VH2140 Kirksville, MO 63501 IV. Time Sheets

January Service Learning Hours Time Sheet Date: 1/14/2009 1/19/2009 1/20/2009 1/21/2009 1/26/2009 1/27/2009 1/30/2009 Activity Deciding on group Weekly Reflection on Mother Nature Data Analysis group meeting Work on Project Proposal Continuation on Project Proposal Data Analysis group meeting Individual entering of batey data # Hours: .5 1.5 1 1.5 2 1 1

February 2009 Service Learning Hours Time Sheet Date: 2/3/09 2/10/09 2/11/09 2/17/09 2/18/09 2/19/09 2/24/09 2/25/09 Activity Data Analysis group meeting Data Analysis group meeting Weekly Reflection paper grant writing Data Analysis group meeting Meeting with Dr. Shaw (Stats Prof) Updated project proposal Data Analysis group meeting Weekly Reflection paper culture brokering March 2009 Service Learning Hours Time Sheet Date: 3/2/2009 3/3/2009 3/5/2009 3/17/2009 3/17/2009 3/17/2009 3/19/2009 3/21/2009 3/22/2009 Activity Reflection Essay (Immigrants and Health Care) SPSS Data Entering Session Meeting with Dr. Shaw SPSS Analysis Organizing and compiling all data Data entry and collaboration discussions Emailing to contacts and professors Meeting with Dr. DeCock Second opinion about statistical tests to run Coding in Excel and SPSS Coding in Excel and SPSS # Hours: 2.0 2 2 1 1.5 .5 1 4 3 # Hours: 1 1 1 1 1 .5 1 1

3/23/2009 3/23/2009 3/24/2009 3/26/2009 3/29/2009 3/30/2009 3/31/2009

Meeting with Dr. DeCock SPSS Analysis Reflection Essay (Haitians in the DR) Data Analysis Meeting Meeting with Dr. Shaw SPSS Analysis Creating Graphs and Tables in Excel and SPSS Meeting with Dr. Decock SPSS Analysis Data Analysis SPSS Tests and Figure making April 2009 Service Learning Hours Time Sheet

1.5 2.0 1.0 1.0 3.0 1.0 2.5

Date: 4/1/2009 4/7/2009 4/8/2009 4/13/2009 4/14/2009 4/19/2009 4/21/2009 4/21/2009 4/23/2009 V.

Activity SPSS Figure making Portfolio Work Reflection Paper Diseases of Poverty Scanning and Editing resource materials for portfolio Portfolio work Portfolio and Final Paper work Portfolio Electronic Portion Organization Portfolio and Final Paper work Portfolio work and burning E-copy

# Hours: 1.5 2 2 3.5 2 3.5 1 3 2

Evidence of work to date .a Excel Spreadsheets and SPSS Code Data: Available upon request (in order to keep records as confidential as possible) email either Allison Mutchler at afm7777@gmail.com or Christopher Dove c.g.dove@gmail.com . .b Re-formatted and Organized Interview Process:

(see next page) Directions: Dominican Republic Individual Batey Community Member Survey

What you will need with you: a translator (who speaks both Spanish and Kreyol), translated question sheet in the language the viewing of the movie is showing that evening for the translator, at least five copies of the Dominican Republic Individual Batey Community Member Survey sheet, a pen, five bags of rice, five candles, and a headlamp (for after the movie when it is dark). Have PRE-FILLED out before you begin surveys: Date, Batey name, your name and the translator you will be working with that day, the screening language (Spanish or Kreyol), and the approximate time that the video was shown (noon, mid afternoon, early evening, etc), the ID Numbers (these will be decided for each surveyor prior to any surveys conducted and will serve as a means to identify individuals for data analysis example 1001, next would be 1002, etc), and which question set you will begin with that evening (some teams will start with question set one for their first survey and other teams will start with question set two) and alternate which one you begin with for every other survey. With a translator, approach a member of the specific batey you are showing the video to later that evening. You want to conduct at least 5 surveys before the movie begins make sure to survey people near the viewing area, have a mix of both men and women any age above 12 years old. When first speaking to them, have the translator do introductions. Ask them if they would allow us to ask them 5 questions, have them watch the video that will be playing a little later (give time), and then ask them 5 more questions. If they agree let them know that in return for their time, they will receive a little gift. Double check that in order to complete the survey they must watch the video in its entirety because we are trying to see if they in fact learned something from the movie. Remind them that at any time if they feel uncomfortable or would prefer NOT to answer a question they may do so, and they are not required to answer any of the questions and that they may stop the interview at any time. If they agree, begin filling out the demographic information as follows: To fill out first: The persons name you are interviewing, their sex (male or female). Next ask them their age, how many years of education they attended (none to all the way through high school), their partnership status (single, engaged which is equivalent to being married in the US living with someone, etc), number of children they have, how many people live in their physical household, the primary language spoken at home (typically Spanish or Kreyol), and for women the total number of pregnancies they have had (not just number of children born). Then prior to asking them the question set ask them what they think their community needs the most. Remind them that we are not looking for any particular answer, and that anything they think would be most beneficial for the future of their community. This is done so that we can continue assessing the batey communities and allows us to plan other health campaigns. Then begin with your designated question set. Ask them the five questions, then direct them to the video screening, have them watch the entire film with the rest of the community, find them afterward, ask them the other question sets five questions and hand them their gift. Please Note: Surveys are subject to change as needed in order to assess comprehension of health education video. This serves as a template for the video shown this past December, but modifications will need to be made as needed for your individual project. Updated Dominican Republic Individual Batey Community Member Survey

Preliminary Information Date: Batey Code #: Interviewer Code #: Translator Code #: Screening language (circle one): 1 Kreyol 2 Spanish Time of screening (circle one): 1 (Before 1 pm) 2 (From 1:00 pm to 5:30 pm) 3 (After 5:30 pm)

What do you need most in your community? Pre-Screening of Video Question Set: 1 1. 2. 3. 4. 5. A A A A A B B B B B C C C C C

Recorded Information ID No: Sex (circle one): Female 0 Male 1

Describe Interview/Pertinent Info:

Reported Information: Name:

Post-Screening of Video Question Set: 1 1. A A A A A B B B B B C C C C C

Age: 2. Years of education: 3. Partnership status (circle one): 1 Engaged/Married 2 Anything else No. of Children: Household size: Language at home (circle one): 1 Kreyol 2 Spanish 3 Both 4 Other No. of pregnancies: 4. 5.

Describe Interview/Pertinent Info:

Follow-up question:

c.

Descriptive and Inferential Statistics Handout Attachment (PDF File at end of Paper Copy) : This document clearly lays out what statistical tests to run with the type of data you have collected and what you hope to find. We wish we had found this before conducting numerous meetings and emails with Dr. Shaw and Dr. DeCock. Internet Resources for Future Projects Facts for Life at www.unicef.org/ffl Childinfo at http://www.childinfo.org/ Statistical tool at www.gapminder.org The R Project (free software) at www.r-project.org Epidemiological information at www.cdc.gov/epiinfo http://office.microsoft.com/en-us/excel/HP052038731033.aspx http://projects.gnome.org/gnumeric/doc/sect-analysis-statistical.shtml IRB Forms available at: http://irb.truman.edu/forms.asp Suggestions for future research: 1. Organize and create a code for data before you collect anything -- this will save you a ton of time. 2. Re-examine questions asked on the questionnaire. Feel free to add more topics of interest or eliminate topics unnecessary for data collection. 3. Code for the variables on the questionnaire in order to simplify future data entry. See above (part b) for an example, but create one specific to the data you are collecting. 4. Test different variable connections on existing data in order to possibly uncover more relationships this will require a thought out procedure prior to any data collection. 5. Have a typed up set of procedures for others working on the project to follow. See above in part b for an example. 6. If planning on presenting at the Student Research Conference or other research presentation materials should be submitted and approved by the IRB panel.

d.

e.

f.

Presented Research at Student Research Conference

-- See below document/JPEG for picture of poster copy that was shown at the University Student Research Conference on April 7th, 2009.

VI. Final Paper a. What do biosocial components of global health mean? Biosocial health means the effects of demography, economics, biology, and additional social factors on health problems and concerns that transcend national boundaries.

i. How have the topics weve focused on gone beyond simply relating social conditions to health outcomes? Social conditions and health outcomes do jointly affect one another, and one might venture to say that all of the topics discussed were social in nature. The topics may have been complex, but every condition was social nonetheless as we are all living, breathing, and social creatures. For example, our reading about Haitians in the Dominican Republic told of the social hardships of Haitian refugees. Their negative social standing gave rise to their poor treatment and inability to attain quality health care. Also discussed were the health implications of being an immigrant in the United States and the negative effects that lack of healthcare can have on all parties involved. Considering our focus on service, many of the topics were directly related to future research and to the longevity of the service projects involved. Instead of the simple relationship between social conditions and health outcomes, we shifted the focus to the effects of service on health outcomes. Service is a social phenomenon but is different in that it does not involve only one individualor those who are a part of that demographic. Also affected are the third-party individuals who receive the benefit of the service activity. After reading

a speech given by Ivan Illich, we were prompted to consider the meaning of our service abroad and determine the true underlying motivation behind the work that we plan to do. This is one of the first steps of any successful service group and is most necessary for efficacy.

ii. What social structures have contributed to international healthcare inequality that we have addressed in class? We have identified at least five social structures that contribute to international healthcare inequality. They are as expense of drug treatments, political unrest, poor economy, lack of education, and lack of health education.

b. What has your project done to explore the concept of biosocial health? Our project actively explored biosocial health by recognizing possible relationships between demographic information and health outcomes. In studying the demographics of individuals living in the batey communities, we acknowledged the possibility that education and race are two major social constructs affecting their health outcomes. By showing a health education video, we sought to alleviate some of the symptoms of poor education and health awareness.

i. How does your project specifically relate to the topics and readings weve addressed in the course? While statistically analyzing data collected in batey communities surrounding La Romana, our project benefited from many of the topics and readings of this course.

The revision of the questionnaire was supported by the guidelines given in the excerpt about collecting demographic data--we were able to double check and ensure that all information requested was relevant and culturally appropriate for its audience. The UNICEF Facts for Life excerpts may possibly apply to any future health education videos shown in the bateyes by offering specific rules for health situations. The reading and discussion of the NHCR report of treatment of Haitians in the bateyes was especially useful. It offered great insight into the political problems that have led to the harsh treatment of workers. The information was essentially a confirmation that poor healthcare is only a symptom of deeper issues within the bateyes.

c. What are you doing to fix biosocial inequities? The idea behind this project is to assess the effectiveness of the health education video Enciende Una Luz for the batey populations residing in the rural Dominican Republic. There are numerous ways to look at potential biological and social inequalities of this population as a whole. Ideally this project serves as the first steps in a long-term project that will come up with the best way(s) to combat health disparities present in these areas. Through our initial analysis of the data we were able to uncover subpopulations within the whole batey community that did not understand the messages presented in the video as well as others. These are the people that will need more attention during future videos and projects down in the bateyes of the Dominican Republic. It is our job as entrepreneurs of local public health projects to conduct a variety of personal public health services, such

as health education, health surveillance and advice for mothers and newborn babies, and personal care of vulnerable groups within the bateyes. Although there are biological and genetic limits to extending and improving health, the aim should be to harness the available knowledge to optimize health for a diverse society in the rural Dominican Republic.

i. Where does your project stand now? The project is currently in a state of organized paper and data entry. While all of the surveys conducted on the summer and winter trips have been entered, organized, and minimally analyzed, much remains to be uncovered. There is plenty of information that could still be analyzed from the population that was surveyed, but future analysis will depend on Pam Logans (and other working for Healthy Mothers Healthy Babies) need of certain demographic or quantitative information.

ii. Is this a good stopping point for your project? Why? This is not a simple yes or no answer. While yes the data has been fully entered into a statistical tool (SPSS) not all of the tests and graphs that we had initially wanted to create were completed. Furthermore, another semester is needed to fully develop a more systematical approach (i.e. a more thorough methodology) to create a more functional database. While this serves as a rough draft for future groups to elaborate on, it is in no way an all inclusive way to organize or code data.

iii. Where does your project stand with respect to your timeline. Our project rests pretty concurrently with our initial timeline created. All of the posters and information was created and presented on the dates mentioned in the timeline above.

iv. Where would you like this to go in the future? As somewhat already mentioned in part ii of this section, a more adaptable coding system would need to be developed in order to create a broader database to enter and analyzed data in. Also, I would like to see a project like this get IRB approval prior to conducting surveys. This would allow for more review and credibility of the project, as well as allow more collaborators and gather more interest in the future. Gaining university support and interest is of the utmost importance when we look for the sustainability and longevity of this type of work.

d. Reflecting on your team i. What obstacles have you overcome that you would want people working on your project in the future to understand? The major thing we had to overcome was to know our time constraints and what we wanted to see accomplished with our project by the end of the semester. Due to the unorganized state that our project was in when we started working on it this semester, things picked up later than we would have hoped. Get everything organized as soon as possible to save yourself a lot of time and get to the good stuff earlier. This was easily the biggest hurdle to wade through in the beginning and

could easily be overcome if more planning was put into a research project design before the fact rather than after the data has been collected. The other main obstacle we encountered was deciding what statistical tests to run and more importantly learning about statistics as the semester progressed. Our advice: find someone early (a professor or friend) who knows a lot about SPSS or statistical tools and can explain it to you in laymans terms.

ii. What necessary skills or tools did your group have that made progress on your project possible? Basic excel spreadsheet knowledge SPSS coding and entry Delegation of responsibilities (preferably early in the semester) Entrepreneurs of on-campus resources (i.e. we sought out professors and friends who knew more about the topic than we did initially)

iii. What skills do your team lack that will be critical or useful for future progress? Prior SPSS analysis and program knowledge (we learned as we went) A thorough understanding of applied statistical methods

More creativity with designing an all-encompassing database design (ours is specific to our project)

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