Frundi L. Fru, B.Sc., M.Sc.

(PhD Candidate) Microbiology, LPN, HRE&GCP-AMANET

RESEARCH METHODOLOGY
FOR HEALTH AND CLINICAL SCIENCE STUDENTS
LECTURE NOTES
Frundi L. Fru

GENERAL OBJECTIVES
After going through this course, the student (or aspirant researcher) should be able to:
❖ Explain the basic concepts in clinical/medical research and the purpose for which research is
conducted and also explain the risks and benefits of research
❖ Explain the research process as it pertains to the various steps in the conduct of research.
❖ Appreciate the implications of ethics in research.
❖ Describe the role of research in health and social welfare.
❖ Identify the various types of research designs.
❖ Apply the principles of hypothesis formulation, data collection, analysis, and interpretation
of research findings.

EXPECTED OUTCOMES
At the end of this course, the student (aspirant researcher) is expected to be able to:
1. Identify researchable topics and source for necessary information to carryout research.
2. Plan, organize and conduct a small research.
3. Write a scientific (or term) paper either presenting a review or quantitative research findings.
4. Prepare and present both in written and oral format, research findings.
5. Plan and present posters, a seminar, scientific talk or conference.

In addition to the aforementioned objectives and expectations, the student after completing this
course should be able to answer the following questions:
❖ What is research and how is it different from problem solving?
❖ Describe the criteria for researchable topics in clinical/medical sciences.
❖ Why is literature review helpful in conducting research?
❖ Identify the purpose of hypothesis.
❖ Explain why research questions are necessary.
❖ Describe the characteristics of different variables.
❖ Identify major research designs.
❖ Describe the purpose of the pilot study.
❖ Distinguish the different study designs.

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GENERAL INTRODUCTION
The course Research Methods is designed to create consciousness of and the need for research by
all health practitioners for improvement of care. The course enables the student and young
researcher to acquire the basic skills and knowledge required of a researcher, and to conduct simple
research studies.

Whatever field of study one may belong to, it is an obligation to strive and extend the body of
knowledge and for health/clinical sciences, a lot can be gained through research. This course will
also equip you with information on the evolution of research in nursing, and further expose you to
the collaborative nature of research among nurses and other health care personnel for the benefit of
patient’s care.

Research Method as a course is essential for continued improvement in patient care. Health
practitioners are being increasingly required to utilize research – based practice (evidence – based
practice) to make decisions and take action in respect of patient care. They are accepting the need
to base their professional actions and decisions on evidence to show that the actions are clinically
appropriate, cost effective, and so more acceptable to the patients.

Research findings will help health practitioners eliminate actions that do not achieve the desired
results, and help them to identify those practices that can change outcomes. It is only through
research that clinicians can in the real sense improve their effectiveness, and enhance their
professional lives. With research, one could attend research presentations at conferences, be in
position to evaluate completed research work, and be able to discuss implications and relevance of
the findings. Nurses are also able to incorporate research results into nursing practice. Professionals
with research skills are better placed to make contributions to the profession and to the body of
scientific knowledge.

This lecture note on research methodology is primarily aimed at health science students. It is also
hoped to be useful for other individuals who would like to understand the basic principles and
undertake health research. There is a strong belief that it will serve as a guideline for undergraduate
health science students as they are required to identify the most important health problems and
carry out some research work.

In general, this lecture note tries to cover the three major components of a research process:
development of the research proposal, fieldwork (data collection) and write-up of the scientific
report. General learning objectives followed by introductory sections which are specific to each
chapter are placed at the beginning of most of the chapters. The lecture note also includes a number
of exercises for the students so that they can examine themselves whether they have understood the
topic under consideration. It is assumed that this lecture note on research methodology will be
given to health science students who have taken basic Epidemiology and Biostatistics courses. It is
also important to note that this lecture note focuses on quantitative research. When the point of
discussion refers to qualitative research, it would be clearly shown so as to avoid the confusion that
may arise. As we go through the concepts of research, we will look through the definition of
research as a systematic and scientific approach towards the solution of problems.

This course requires that the student spends some time to read. The course content available for this
course is quite vast and one needs to spend great time to study it. This explains why a great amount
of effort and time was put into the development of this course, to make it more understandable and
readable. It is advised that the student endeavour to attend all tutorial sessions where s/he would
have the opportunity to compare his/her knowledge with that of peers.

ASSIGNMENT: History of research in medicine, nursing and other clinical professions.

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CHAPTER ONE
INTRODUCTION TO RESEARCH

1.0 LEARNING OBJECTIVES

After completing this chapter, the student should be able to:
1. Define research in general and health systems research in particular and key terms.
2. Define who a researcher is, who a participant is, and state when research involves human
participation.
3. Explain the characteristics of scientific methods.
4. Enumerate the characteristics of research
5. Identify the different types of research
6. List the essential features of health systems research
7. Describe the broad divisions (steps) involved in the research process
8. Explain the roles of research in development

1.1 INTRODUCTION: EXPLORING HEALTH RESEARCH

The ultimate goal of any good national health-development process is to provide its people with the
necessary capabilities to attain a level of health that will enable them to make meaningful
participation in the social and economic life of the community in which they live. To attain this
objective, stakeholders (countries) need to decide on the best approaches to adopt. However, this
requires detailed and accurate information on the existing health systems of these countries.
Unfortunately, such information is often lacking, inadequate, or unreliable. As a result, decisions
are based on assumptions and unjustified conclusions and often result in inappropriate policy
choices. In this regard, the search for scientific knowledge and information should be strongly
supported. Research in the context of public health thus aims to provide all aspects of information
necessary for planning and the effective implementation of a health system. For all communities,
whether affluent or poor, health research is the top priority. The research questions are formidable:
how to join with policy makers and communities in assessing priority needs, planning, financing
and implementing programs, and evaluating them in terms of coverage, efficiency and
effectiveness. Health research is a process of finding out the solution to a problem (this however,
should not be confused with problem solving which often requires immediate action). It is a
sequence of activities which when followed enables the investigator to achieve his aim. Research
follows the scientific method which is why it can stand the test of time. A scientific practice base
for health/clinical professionals means that nursing practice is guided by nursing theory or
empirical clinical research findings. Health research involves scientific inquiry and so would
require knowledge of the characteristics of scientific methods.

1.11 Characteristics of Scientific Methods

1. Order and Control: Scientific methods follow a systematic approach to problem solving. The
aspect of control concerns the effort made to reduce interference in the study situation. For
example, in a study to explore the relationship between diet and heart disease, the researcher must
take steps to control or exclude other possible causes of heart disease like stress, cigarette smoking,
as well as age and sex.

2. Empiricism: The scientific method searches for evidence (empirical – real) through
observations, verified through our sense organs – sight, taste, touch, smell, and hearing. E.g. the
colour of a patient’s eye; the presence or absence of skin inflammation etc.. Sometimes, our senses
may not record fully what is real and so, extensions of our senses are used to collect the empirical
evidence in the form of instruments, equipment, tools e.g. weighing scale, thermometer,
questionnaires, or other instruments that aid the senses to gather the necessary information.

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3. Generalization: The goal of science is to understand phenomena or occurrences. The pursuit of

knowledge is focused on more generalized understanding of relationships among events. The
ability to go beyond the specifics at hand is an important aspect of the scientific method, and that is
generalization. The generalizability of research findings is an important criterion for evaluating the
quality of the research.

4. Theory Development: Scientific generalizations are enhanced by the development of theories.

Theories represent a method of organizing integrating, and deriving abstract views about the
manner of relationships that exist between phenomena or variables. They provide the opportunity
for explaining how and why phenomena are related to one another, and for predicting the
occurrence of future events and relationships.

1.2 DEFINITION AND CHARACTERISTICS OF RESEARCH

1.2.1 Definitions

1. Research: Research is a scientific inquiry aimed at learning new facts, testing ideas or theories.
It is the systematic collection, analysis and interpretation of data to generate new knowledge and
answer a certain question or solve a problem.

Generally, research can be defined as a methodical investigation into a subject in order to discover
facts, to establish or revise a theory, or to develop a plan of action based on discovered facts.

Research can also be defined as a systematic investigation; including development testing and
evaluation, designed to discover or contribute to the body of generalisable knowledge.
Generalisable knowledge consists of theories, principles or relationships, (or the accumulation of
data on which they may be used) that can be corroborated by accepted scientific observation and
inference.

The practice of medicine and behavioural therapy refers to the class of activities designed solely to
enhance the wellbeing of an individual patient or client. The purpose of practice is to provide
diagnosis, preventive and treatment therapy. These practices must be distinguished from research
although the two often occur together in the same place.

2. Researcher: In a broad sense a researcher is the individual who undertakes to study; a person
who conducts a carefully designed study especially to discover new facts or information. In
research terminology, the term “INVESTIGATOR” is more frequently used and is defined as: “A
person responsible for the conduct of a trial at a trial site”. If a trial is conducted by a team of
individuals at a trial site, the investigator is responsible for the team and may be called the principal
investigator.

3. Research participant: A research (human) participant is a living individual about whom a

researcher obtains either: data through intervention or interaction with the individual; or identifiable
private information. In other words this is the individual upon whom a researcher or investigator
performs research. The following terms are used interchangeably: “subject”, “volunteer”,
“respondent”, or “participant”.

ASSIGNMENT: When does research involve human participation?

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1.2.2 Characteristics of research

❖ It demands a clear statement of the problem
❖ It requires a plan (it is not aimlessly “ looking” for something in the hope that you will come
across a solution)
❖ It builds on existing data, using both positive and negative findings
❖ New data should be collected as required and be organized in such a way that they answer the
research question(s)

1.3 TYPES OF RESEARCH

Research is a systematic search for information and new knowledge. It covers topics in every field
of science and perceptions of its scope and activities are unlimited. The classical broad divisions of
research are: basic and applied research.

1.3.1 Basic (pure) research is necessary to generate new knowledge and technologies to deal
with major unresolved health problems. IT is investigation or study carried out to satisfy a desire to
increase the knowledge base in an area of interest. Basic or pure research provides the baseline
information in the area of knowledge which could be necessary to undertake further research in that
area. For example, a research to establish factors responsible for poor compliance to dietary
regimen by diabetic patients will result in a list of many factors. Those factors could form the basis
for more research in the future that could lead to certain important decisions in the care of diabetic
patients.

1.3.2 Applied research on the other hand is necessary to identify priority problems and to design
and evaluate policies and programs that will deliver the greatest health benefit, making optimal use
of available resources. It is the research whose findings could have immediate practical utility.

1.3.3 Quantitative and Qualitative research

Early forms of research originated in the natural sciences such as biology, chemistry, physics,
geology etc., and were concerned with investigating things which we could observe and measure in
some way. Such observations and measurements can be made objectively and repeated by other
researchers. This process is referred to as “quantitative” research. Much later, along came
researchers working in the social sciences: psychology, sociology, anthropology etc. They were
interested in studying human behaviour and the social world inhabited by human beings. They
found increasing difficulty in trying to explain human behaviour in simply measurable terms.
Measurements tell us how often or how many people behave in a certain way but they do not
adequately answer the “why” and “how” questions. Research which attempts to increase our
understanding of why things are the way they are in our social world and why people act the ways
they do is “qualitative” research. Qualitative research is concerned with developing explanations
of social phenomena. That is to say, it aims to help us to understand the world in which we live and
why things are the way they are. It is concerned with the social aspects of our world and seeks to
answer questions about:
❖ Why people behave the way they do.
❖ How opinions and attitudes are formed.
❖ How people are affected by the events that go on around them.
❖ How and why cultures have developed in the way they have.

Qualitative research is concerned with finding the answers to questions which begin with: why?
How? In what way?

Quantitative research, on the other hand, is more concerned with questions about: how much? How
many? How often? To what extent? etc.

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Public health problems are complex, not only because of their multicausality but also as a result
of new and emerging domestic and international health problems. Social, economic, political,
ethnic, environmental, and genetic factors all are associated with today’s public health concerns.
Consequently, public health practitioners and researchers recognize the need for multiple
approaches to understanding problems and developing effective interventions that address
contemporary public health issues. Qualitative methods fill a gap in the public health toolbox; they
help us understand behaviors, attitudes, perceptions, and culture in a way that quantitative methods
alone cannot. For all these reasons, qualitative methods are getting renewed attention and gaining
new respect in public health. A thorough description of qualitative research is beyond the scope of
this lecture note. Students interested to know more about qualitative methods could consult other
books which are primarily written for that purpose. The main purpose of this lecture note is to give
a detailed account on the principles of quantitative research.

1.4 RESEARCH TERMINOLOGIES

1.4.1 HEALTH RESEARCH

Health research is the application of principles of research on health. It is the generation of new
knowledge using scientific method to identify and deal with health problems. Knowledge, both
generalizable (worldwide) and locally (specific), is essential to effective action for health.
Worldwide knowledge is the basis on which new tools, strategies, and approaches are devised
which are applicable to health problems facing many countries. Local knowledge, specific to the
particular circumstances of each country can inform decision regarding which health problems are
important, what measures should be applied and how to obtain the greatest health benefit from
existing tools and limited resources. In this regard, health research is both global and local in
nature. In most cases, health research has been divided into three overlapping groups.

Essential health research: Consists of activities to define the health problems of a given country
or community, to measure their importance and to assure the quality of activities to deal with them.
Much of this research comes within the category of health service research but there will be
elements of clinical research and development of technology, depending on the situation. The
information, which may be obtained in a number of ways, is essential and specific to each country
for planning and monitoring health services. Some of the research conclusions, however, may be
generalized and applicable to other areas.

Clinical research: In its widest sense, this group of topics ranges from studies of the prevention
and diagnosis of diseases through new methods of treatment to problems of care and rehabilitation.
The sophistication will vary from problem to problem and there will be overlap with the fields of
essential and biomedical research. Some of the research will be mainly of local importance; much
will be useful for other individuals in other countries. Examples include clinical trials of disease
prevention and the design of new chemotherapeutic agents. Wherever clinical facilities exist, there
is a potential for clinical research.

Biomedical research: It is the most basic part of health research which demands more resources,
facilities and skilled investigators. The results of biomedical research are more often of universal
importance and thus of general significance. During the past two decades, concepts and research
approaches to support health development have evolved rapidly. Many of these have been
described by specific terms such as operations research, health services research, health manpower
research, policy and economic analysis and decision-linked research. Each of these has made
crucial contributions to the development of health research.

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1.4.2 HEALTH SYSTEMS RESEARCH

It is a component of health research. Research that supports health development has come to be
known as Health Systems Research. It is ultimately concerned with improving the health of a
community, by enhancing the efficiency and effectiveness of the health system as an integral part
of the overall process of socioeconomic development.

Definition of “health system”

A health system may be described as:
❖ A set of cultural beliefs about health and illness that forms the basis for health-seeking and
health-promoting behaviour.
❖ The institutional arrangements within which that behaviour occurs; and
❖ The socioeconomic (political) physical context for those beliefs and institutions.
In short, it consists of what people believe and know about health and illness and what they do to
remain healthy and cure diseases. Beliefs and action are usually closely connected. For example, if
in a society people perceive germs as the cause of disease, they will look for modern (biomedical)
health care. The institutional arrangements within which the health-seeking and health-promoting
behaviour occurs may include:

1. The individual, family and the Community

2. Health care services Private sector: Traditional/Alternative & modern medical
practice (legal or illegal)
Public sector: Health workers, Health Institutions, etc
3. Health related sectors Education, Agriculture, etc
4. International sector, including bilateral and unilateral donor agencies (UNICEF, WHO,
USAIDS, etc) that may support health as well as Essential Features of Health System Research

Bearing in mind that HSR is undertaken primarily to provide information to support decision-
making at all levels that can improve the functioning of the health system, some of the essential
features are summarized as follows:

❖ HSR should focus on priority problems.

❖ It should be action oriented (i.e., aimed at developing solutions)
❖ An integrated multidisciplinary approach is required (research approaches from many
disciplines)
❖ The research should be participatory in nature (from policy makers to community members)
❖ Research must be timely.
❖ Emphasis should be placed on comparatively simple, short-term research designs that are likely
to yield practical results.
❖ The principle of cost-effectiveness is important in the selection of research projects.
❖ Results should be presented in formats most useful for administrators, decision makers and the
community.
➢ A clear presentation of results with a summary of the major findings adapted to the interests
of the party being targeted by the report.
➢ Honest discussion of practical or methodological problems that could have affected the
findings.
➢ Alternative courses of action that could follow from the results and the advantages and
drawbacks of each.
❖ Evaluation of the research undertaken - An HSR project should not stop at finding answers to
the research questions posed, but include an assessment of what decisions have been made
based on the results of the study. This is the ability of research findings to influence policy,
improve services and contribution to the betterment of health.

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1.5 MAIN COMPONENTS OF ANY RESEARCH WORK

❖ Preparing a research proposal

❖ Fieldwork (i.e., data collection)
❖ Analyzing data and preparing a research report

N.B: The roles of health managers and the community should be identified in the various phases of
the research process.

1.6 STEPS IN A RESEARCH PROCESS

The following seven steps outline a simple and effective strategy for finding information for a
research paper and documenting the sources you find. Depending on your topic and your
familiarity with the library, you may need to rearrange or recycle these steps. Adapt this outline to
your needs. We are ready to help you at every step in your research. There are many models
available and taught concerning how to conduct a research process. Therefore, the process
presented here is only one of many; however, it is a tried and proven process.

❖ Step 1: Decide on a topic

❖ Step 2: Develop an overview of the topic
❖ Step 3: Determine the information requirements
❖ Step 4: Organize the information
❖ Step 5: Analyze and evaluate the information
❖ Step 6: Synthesize the information
❖ Step 7: Communicate/present the research

Step 1: Identify and decide on a topic

State your topic as a question. For example, if you are interested in finding out about use of
alcoholic beverages by college students, you might pose the question, "What effect does use of
alcoholic beverages have on the health of college students?" Identify the main concepts or
keywords in your question. To begin, state the research question, problem or issue. Then, develop a
topic and thesis.
❖ topic = a broadly defined subject area - example: effects of Alcohol
❖ formulate a question = find a narrower perspective or focus on the topic by asking a series of
questions about the topic
➢ example: what are the effects of Alcohol on the health of college students?
❖ thesis statement = answer you suspect to find or points you will argue about the topic question
➢ example: Alcohol increases liver metabolism, putting the students at risk of developing liver
cancer.

Step 2: Develop an overview of the topic

This step is most often ignored, but is one of the most important. It will help you to:
❖ develop an overview of your topic
❖ gather background information
❖ refine your topic
❖ develop a general bibliography
❖ identify additional keywords related to your topic, useful when searching for additional topic-
related information
Working from "general" to "specific" is most effective:
❖ get an overview of the topic by referring to general encyclopedias, such as the online
Encyclopedia Britannica to learn more about the topic

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❖ begin to browse the library's online catalog (OPAC) to find sources held by the library that
relate to your topic
❖ browse subject-based encyclopedias, handbooks and directories to begin to refine your topic
➢ review the footnotes, endnotes and bibliographies from the end of subject-based
encyclopedia and handbook articles to identify related sources
❖ also refer to bibliographies in course textbooks and reserve readings
❖ browse subject-related, indexed sources on the World Wide Web to find sources that relate to
your topic:
➢ use the Sawyer Library's Help and Research Guides

Step 3: Determine the information requirements

In this step, you determine the information requirements for the research question -- where will you
find the information you need?
Learn what specific resources are available concerning your topic:
❖ meet with a reference librarian
❖ find books using keyword or subject searching in the library's online catalog
❖ use indexes and abstracts to find journal / periodical articles
➢ choose appropriate indexes for the subject you are researching. For example, you should not
use an index of business resources to search for information concerning African history.
➢ refer to the Library's list of databases organized by broad subject areas for assistance
❖ find resources via the World Wide Web
➢ refer to the Library's academic-based Web subject directories to locate information sources
on the Web in addition to the Library's Help and Research Guides
Summary: Look up your keywords in the indexes to subject encyclopedias. Read articles in these
encyclopedias to set the context for your research. Note any relevant items in the bibliographies at
the end of the encyclopedia articles. Additional background information may be found in your
lecture notes, textbooks, and reserve readings.

Step 4: Organize the information

Know when to stop searching for information and start thinking about what your compiled
information means. This is also one of the most important steps for ethically using information and
avoiding plagiarism.
❖ Make sure you write down where you found any information in case you have to review it
again. You will also need this information for references and your list of works cited.
❖ using complete citation information when compiling information will save you time when
writing your paper
❖ format your citations using standard formats
➢ for Web sites - print out what you find and write down the date you found it as well as the
complete Web address (the URL)
❖ Think over the ideas you read from the sources used, and write them down in your own words.
This is called paraphrasing, and it will help keep you from plagiarizing
Mildred F. Sawyer Library
A Research Process: Steps in the Research Process Page 3 of 3
Do you have enough information to complete your research? If not, you may have to repeat several
of the previous steps and/or extend the research process.

Step 5: Analyze and evaluate the information

Relate the information you have found and compiled, with your ideas from reading and thinking
about the information, to your topic.
❖ analyze your notes
➢ break down your notes into topic themes or categories
➢ decide how these themes or categories relate to your topic

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❖ discard notes that do not relate to your thesis

❖ look for holes in your thesis statement support and go back to find information you are missing
➢ Do you have enough information to complete your research? If not, you may have to repeat
several of the previous steps and/or extend the research process
❖ If you have found too many or too few sources, you may need to narrow or broaden your topic.
Check with a reference librarian or your instructor.
Step 6: Synthesize the information
❖ refine your thesis based upon the information compiled, read, and considered
❖ outline your project
❖ begin to write your paper

Step 7: Communicate/present the research citing what you find using a standard format
❖ communicate your research in the format required by your professor
❖ properly use citations to avoid plagiarism
❖ Give credit where credit is due; cite your sources.
❖ Citing or documenting the sources used in your research serves two purposes, it gives proper
credit to the authors of the materials used, and it allows those who are reading your work to
duplicate your research and locate the sources that you have listed as references.
❖ Knowingly representing the work of others as your own is plagiarism. Use one of the styles
listed in the referencing section of this lecture note or another style approved by your instructor
or institution. This lecture gives details of the APA referencing style in the referencing section.

RESEARCH TIPS:
❖ Work from the general to the specific. Find background information first, and then use more
specific and recent sources.
❖ Record what you find and where you found it. Record the complete citation for each source;
you may need it again later.
❖ Translate your topic into the subject language of the indexes and catalogs you use. Check
your topic words against a thesaurus or subject heading list.

1.7 EXERCISES
❖ 1. The health of any community depends on the interaction and balance between the health
needs of the community, the health resources that are available, and the selection and
application of health and health related interventions. Discuss!
❖ 2. To invest in research is to invest for a better future. Does this statement sound true? Justify
your answer.
❖ 3. Describe the characteristics of HSR by giving your own examples.

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CHAPTER TWO
TOPIC SELECTION

2.1 LEARNING OBJECTIVES

After completing this chapter, the student should be able to:
1. Examine the cyclical nature of the development of a research proposal
2. Describe the principles underlying whether a problem situation is researchable.
3. List the criteria for selecting a research topic.
4. Identify and select his/her own topic (health problem) for research based on certain guidelines.

2.2 INTRODUCTION
The development of a health project goes through a number of stages. Formulation of the research
proposal is the major task in the process of developing a research project. The proposal draws on all
the preparatory steps of the research process and pulls them together in a document describing the
rationale and the methodology proposed for research. The proposal is a basis for approval and
funding. After approval, the proposal is used as a blueprint during implementation of the project. It
should be noted that development of a research proposal is often a cyclical process. The process is
not always linear. It is a usual practice to go up and down on the developed proposal and make the
necessary revisions. Is there evidence to indicate that the research proposal focuses on a problem of
priority importance? Was the given health problem identified by relevant groups of the health
system? Was the problem adequately analyzed to include all possible contributory factors from
different sectors? Was it clearly stated? These questions should be clearly answered before trying to
develop the research proposal. The sections that follow are devoted to giving the guidelines useful
for identification, selection, analysis and statement of the given problem.

2.3 PROBLEM IDENTIFICATION

If the answer to the research question is obvious, we are dealing with a management problem that
may be solved without further research. A number of research questions could be presented that
may be posed at the various levels of the health system.

Whether a problem requires research depends on three conditions:

❖ There should be a perceived difference or discrepancy between what it is and what it should
be;
❖ The reason(s) for this difference should be unclear (so that it makes sense to develop a
research question); and
❖ There should be more than one possible and plausible answer to the question (or solution to
the problem).

Example1:
Problem situation: In district “ Y “ a report showed that in the first month there were 500 children
under one year old who started immunization, but at the end of the year it was found out that there
were only 25 children who completed their vaccination.
Discrepancy: All the 500 children at district “Y “should have completed their vaccination but only
5% out of those who started vaccination has completed.
Problem (research) question: why only 5% of the children completed their vaccination?
Definite answer: Out of the 1 hospital, 2 health centers and 10 health stations found in district “Y”
only 2 health stations were functioning, the rest were closed due to insecurity in the area.

Decision: In the above example, assuming that all the given facts are true, there is no need of
undertaking a research, since definite answer is obtained to the problem situation.

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Example 2:
Problem situation: In district “Z” (population 150,000) there are 2 health centers, 1 hospital and 15
health stations and all of them function smoothly. However, at the end of the year it was found that
the EPI coverage was only 25%.
Discrepancy: Although district “Z” had 100% availability of health services and at least 80% of
the children should have had full vaccinations the EPI coverage was only 25% as seen above.
Problem question: What factors influence the low EPI coverage in district “Z”?
Possible answers:
❖ Mothers might have problems for not attending in the EPI sessions.
❖ The MCH, EPI, OPD, etc… programmes might not have been integrated; hence children
might have missed opportunities in getting immunization.
❖ The follow up of defaulting children might not be effective and other reasons.
Decision: Thus, the above problem situation is researchable.

2.4 CRITERIA FOR PRIORITIZING PROBLEMS FOR RESEARCH

Each problem that is proposed for research has to be judged according to certain guidelines or
criteria. There may be several ideas to choose from. Before deciding on a research topic, each
proposed topic must be compared with all other options. The selection and analysis of the problem
for research should involve those who are responsible for the health status of the community. This
would include managers in the health services, health-care workers, and community leaders, as
well as researchers. The guidelines or criteria given below can help in the process of selection.

2.4.1 Criteria for selecting a research topic

1. Relevance: The topic you choose should be a priority problem:

Questions to be asked include:
❖ How large or widespread is the problem?
❖ Who is affected?
❖ How severe is the problem?

2. Avoidance of duplication: Investigate whether the topic has been researched.

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.

3. Feasibility: Consider the complexity of the problem and the resources you will require to carry
out the study.
Thought should be given first to personnel, time, equipment and money that are locally available.
In situations where the local resources necessary to carry out the project are not sufficient, you
might consider sources available at the national level.

4. Political acceptability: It is advisable to research a topic that has the interest and support of the
authorities. This will facilitate the smooth conduct of the research and increases the chance that the
results of the study will be implemented.

5. Applicability of possible results and recommendations: Is it likely that the recommendations

from the study will be applied? This will depend not only on the blessing of the authorities but also
on the availability of resources for implementing the recommendations.

6. Urgency of data needed: How urgently are the results needed for making a decision? Which
research should be done first and which can be done late?
7. Ethical acceptability: We should always consider the possibility that we may inflict harm on
others while carrying out research. Therefore, it will be useful to review the proposed study.

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2.4.2 Scales for rating research topics

Relevance Applicability
1 = Not relevant 1 = No chance of recommendations being
2 = Relevant implemented
3 = very relevant 2 = Some chance of recommendations being
Avoidance of duplication implemented
1 = Sufficient information already available 3 = Good chance of recommendations being
2 = Some information available but major issues implemented
not covered Urgency
3 = No sound information available on which to 1 = Information not urgently needed
base problem-solving 2 = Information could be used but a delay of
Feasibility some months would be acceptable
1 = Study not feasible considering available 3 = Data very urgently needed for decision-
resources making
2 = Study feasible considering available Ethical acceptability
resources 1 = Major ethical problems
3 = Study very feasible considering available 2 = Minor ethical problems
resources 3 = No ethical problems
Political acceptability N.B. The above rating should be based on the
1 = Topic not acceptable existing data and not on mere assumptions.
2 = Topic somewhat acceptable
3 = Topic fully acceptable

EXERCISES
1. In a certain district (population, 150,000), sanitary conditions are very poor (only 5% of
households have latrines) and diseases connected with poor sanitation, such as, gastroenteritis and
worms are very common. The Ministry of Health has initiated a sanitation project that aims at
increasing the number of households with latrines by 20% each year. The project provides
materials and the population should provide labour. Two years later, less than half of the target has
been reached. State the discrepancy, research question and the possible answers. Is this problem
situation researchable?

2. Go to the nearby health institution and identify three health problems. Discuss about these health
problems and rate them based on the selection criteria. When rating these problems based on the
criteria, use the rating sheet indicated at the bottom of the table (you can also refer to the "Scales
for rating research topics” presented in section 2.4.2). You can do the exercise in small groups.
Which topic do you select for research? Defend your first choice in a plenary session.

Rating Sheet
Criteria for selecting a research topic Proposed topics
Problem I Problem II Problem III
Relevance
Avoidance of duplication
Feasibility
Political acceptability
Applicability
Urgency of data needed
Ethical acceptability
Total
Rating scale: low = 1; moderate = 2; High = 3

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CHAPTER THREE
ANALYSIS AND STATEMENT OF THE PROBLEM

3.1 LEARNING OBJECTIVES

After completing this chapter, the student should be able to:
1. Describe the advantages of a systematic analysis of a problem
2. Describe the importance of a clear statement of a problem
3. Enumerate the points that should be included in the statement of a problem

3.2 INTRODUCTION
Was the problem adequately analyzed to include all possible contributory factors from different
sectors? Was it clearly stated? These questions should be clearly answered before trying to develop
the research proposal. The sections that follow are devoted to giving the principles useful for the
analysis and statement of the given problem.

3.3 ANALYZING THE PROBLEM

A systematic analysis of the problem, completed jointly by the researchers, health workers,
managers, and community representatives is a very crucial step in designing the research because
it:
❖ Enables those concerned to bring together their knowledge of the problem,
❖ Clarifies the problem and the possible factors that may be contributing to it,
❖ Facilitates decisions concerning the focus and scope of the research.

3.4 FORMULATING THE PROBLEM STATEMENT

After identifying, selecting and analyzing the problem, the next major section in a research
proposal is “statement of the problem”

a) Why is it important to state and define the problem well?

Because a clear statement of the problem:
❖ Is the foundation for the further development of the research proposal (research objectives,
methodology, work plan, etc);
❖ Makes it easier to find information and reports of similar studies from which your own study
design can benefit;
❖ Enables the researcher to systematically point out why the proposed research on the problem
should be undertaken and what you hope to achieve with the study results.

b) Points that need to be considered for justifying the selected research problem
A health problem selected to be studied has to be justified in terms of its:
❖ Being a current and existing problem which needs solution
❖ Being a widely spread problem affecting a target population
❖ Effects on the health service programmes
❖ Being a problem which concerns the planners, policy makers and the communities at large.

c) Information included in the statement of a problem

❖ A brief description of socioeconomic and cultural characteristics and an overview of health
status.
❖ A more detailed description of the nature of the problem
➢ basic description of the research problem
➢ the discrepancy between what is and what should be
➢ Its size, distribution, and severity (who is affected, where, since when, etc.)

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❖ An analysis of the major factors that may influence the problem and a convincing argument
that available knowledge is insufficient to answer a certain question and to update the
previous knowledge.
❖ A brief description of any solutions that have been tried in the past, how well they have
worked, and why further research is needed.
❖ A description of the type of information expected to result from the project and how this
information will be used to help solve the problem
❖ If necessary, a short list of definitions of crucial concepts used in the statement of the
problem.
A list of abbreviations may be annexed to the proposal, but each abbreviation also has to be written
out in full when introduced in the text the first time.

3.5 EXERCISES
1. Why do we need to analyze the research problem?
2. What are the points required to justify the selected research problem?
3. What information should be included in the statement of a problem?

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CHAPTER FOUR
LITERATURE REVIEW

4.1 LEARNING OBJECTIVES

After completing this chapter, the student should be able to:
1. Describe the reasons for reviewing available literature and other information during the
preparation of a research proposal.
2. Describe the resources that are available for carrying out such a review.
3. Record (organize) information obtained from literature on an index card.
4. Understand how to correctly cite and/or reference literature sources (see section on referencing
styles).

4.2 INTRODUCTION
At the outset of his/her study the investigator should be acquainted with the relevant literature. It is
of minimal use to wait until a report is written.

4.3 USE OF LITERATURE REVIEW

❖ It prevents you from duplicating work that has been done before.
❖ It increases your knowledge on the problem you want to study and this may assist you in
refining your "statement of the problem".
❖ It gives you confidence why your particular research project is needed.
❖ To be familiar with different research methods

4.4 SOURCES OF INFORMATION

❖ Card catalogues of books in libraries
❖ Organizations (institutions)
❖ Published information (books, journals, etc.)
❖ Unpublished documents (studies in related fields, reports, etc.)
❖ Computer/web based literature searches such as Medline
❖ Opinions, beliefs of key persons

Some examples of resources where information could be obtained are:

❖ Clinic and hospital based data from routine activity statistics
❖ Local surveys, annual reports
❖ Scientific conferences
❖ Statistics issued at region and district levels
❖ Articles from national and international journals (e.g., The African Journal of Health
Sciences-AJOS; International Journal of Infectious Disease; The Lancet, etc.)
❖ Internet
❖ Documentation, reports, and raw data from the Ministry of Health, Central Statistical Offices,
Nongovernmental organizations, etc.

References that are identified:

❖ Should first be skimmed or read
❖ Then summaries of the important information in each of the references may be recorded on
separate index cards
❖ These should then be classified so that the information can easily be retrieved

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4.5 ORGANIZATION OF INFORMATION ON INDEX CARDS

The index cards should contain:
❖ Key words
❖ A summary of the contents of books or articles which is relevant to one's own study.
❖ A brief analysis of the content, with comments such as:
➢ how information from that particular study could be used in one's own study
❖ Information obtained from key persons could also be summarized on the index card.
After collecting the required information on index cards, the investigator should decide in which
order he/she wants to discuss previous research findings:
❖ from global to local
❖ from broader to focused
❖ from past to current
In conclusion, while reviewing a literature, all what is known about the study topic should be
summarized with the relevant references. This review should answer
❖ How much is known?
❖ What is not known?
❖ What should be done based on what is lacking?

Overall, the literature review should be adequate, relevant and critical. In addition to this,
appropriate referencing procedures should always be followed in research proposals as well as in
research reports. While reviewing a literature give emphasis to both positive and negative findings
and avoid any distortion of information to suit your own study objectives.

Finally, after an exhaustive literature review, summarize the findings and write a coherent
discussion by indicating the research gap which supports the undertaking of your study.

4.6 EXERCISES
1. Why is literature review important when preparing a proposal?
2. The presentation of research results or scientific publications from other writers without quoting
the author is not appropriate. Does this statement sound true? Justify your answer.
3. Mention some of the sources of information in your area and describe how such information
could be summarized on index cards.

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CHAPTER FIVE
RESEARCH OBJECTIVES

5.1 LEARNING OBJECTIVES

After completing this chapter, the student should be able to:
1. Describe the need for the development of research objectives
2. Differentiate between general and specific objectives
3. Formulate specific objectives and hypotheses

5.2 INTRODUCTION
Having decided what to study, and knowing why s/he wants to study it, the investigator can now
formulate his study objectives. Objectives should be closely related to the statement of the problem.
For example, if the problem identified is low utilization of health stations in a rural district, the
general objective of the study could be to assess the reasons for this low utilization. If we break
down this general objective into smaller and logically connected parts, then we get specific
objectives.

5.3 DEFINITIONS

General objectives: aim of the study in general terms

Example: In a study on missed opportunities for EPI in Yaoundé the general objective was: “to
assess missed opportunities for EPI in Yaoundé”.

Specific objectives: measurable statements on the specific questions to be answered. Unlike the
general objectives, the specific objectives are more specific and are related to the research problem
situation. They indicate the variable to be examined and measured.
Example: In the study of missed opportunity for EPI in Yaoundé the specific objectives could be:
❖ To find out the magnitude of missed opportunities for children who attend OPD, MCH, etc. in
Yaoundé,
❖ To examine the reasons for children not being immunized while attending the OPD, MCH,
etc. services.

5.4 Formulation of the research objectives

The formulation of objectives will help us to:
❖ Focus the study (narrowing it down to essentials)
❖ Avoid collection of data that are not strictly necessary for understanding and solving the
identified problem
❖ Organize the study in clearly defined parts
The explicit formulation of study objectives is an essential step in the planning of a study. It is said
that “a question well-stated is a question half-answered”, but a question that is poorly stated or
unstated is unlikely to be answered at all.

How should we state our objectives?

We have to make sure that our objectives:
❖ Cover the different aspects of the problem and its contributing factors in a coherent way and
in a logical sequence
❖ Are clearly expressed in measurable terms
❖ Are realistic considering local conditions
❖ Meet the purpose of the study
❖ Use action verbs that are specific enough to be measured

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Examples of action verbs are: Avoid the use of vague non-action verbs such
❖ to determine as;
❖ to compare ➢ to appreciate
❖ to verify ➢ to understand
❖ to estimate ➢ to study
❖ to describe ➢ to believe
❖ to find out
❖ to establish

Research objectives can be stated as:

❖ Questions - the objectives of this study are to answer the following questions ….
❖ Positive sentence - the objectives of this study are to find out, to establish, to determine,…
❖ Hypothesis - the objective of this study is to verify the following hypothesis (examples are
given below)
Based on the type of the study problem, it might be possible to develop explanations for the
problem that can be tested. If so, we can formulate hypotheses in addition to the other study
objectives.

A hypothesis is a prediction of a relationship between one or more variables and the problem under
study. That is, it specifies the relationship among variables. These variables are to be statistically
tested at a later stage. In order to measure the relationship among variables to be studied the
dependent and independent variables need to be identified. A few examples are given below:
1. The health of children living in rural ‘villagization’ projects is better than those living in
traditional rural communities.
2. To examine whether there is any significant difference between district “A” and district “B”
with respect to their malaria prevalence rates
3. An increase in the frequency of face washing is followed by a reduction in trachoma
prevalence.

One of the most important problems usually observed among students is the tendency of stating too
many study objectives which are not appropriately addressed (or sometimes will be forgotten) in
the sections that follow. It should be noted that it is on the bases of these specific objectives that the
methods, results and discussion sections will be presented. For example, sample size calculations
for each stated objective and identifying (selecting) the most appropriate sample size that will
answer the required research questions is not covered in the development of most research
proposals. This is also true during the write up of the completed research work. It is not uncommon
to come across a situation in which some of the specific objectives are not addressed in the results
section at all. It is therefore advisable to limit the number of specific objectives. In most practical
situations, the number of specific objectives should not exceed three.

In a nutshell, your objectives should be SMART (i.e. Specific, Measurable, Attainable, Realistic
and Time-bound).

5.5 EXERCISES
1. Define general objectives, specific objectives and hypotheses by giving your own examples.
2. The objectives of a study should be written after the statement of the research problem and
before the methods section. Does this statement sound true? Justify your answer.
3. List the characteristics of research objectives.
4. Comment on the statement: “A question well-stated is a question half-answered”.
5. Mention some of the problems that may arise as a result of having too many objectives.

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CHAPTER SIX
RESEARCH METHODS

6.1 LEARNING OBJECTIVES

After completing this chapter, the student should be able to:
1. Identify the pertinent questions to consider when developing the methodology of a research
proposal
2. Describe and understand the various components of the methods section in a research proposal
3. Explain the cyclical nature of the different steps in designing the methodology.

6.2 INTRODUCTION
In the previous chapters we have dealt with the identification, selection, analysis and statement of
the problem. The importance of literature review and formulation of study objectives were also
emphasized. Now we must decide exactly how we are going to achieve our stated objectives. That
is, what new data do we need to shed light on the problem we have selected and how we are going
to collect and process these data? The major issues that constitute the "methods section" of a
research proposal will be dealt in the sections that follow.

6.3 TYPES OF STUDY DESIGNS

A study design is the process that guides researchers on how to collect, analyze and interpret
observations. It is a logical model that guides the investigator in the various stages of the research.
Several classifications of study types are possible, depending on what research strategies are used.

1. Non-intervention (Observational) studies in which the researcher just observes and analyses
researchable objects or situations but does not intervene; and

2. Intervention studies in which the researcher manipulates objects or situations and measures the
outcome of his manipulations (e.g., by implementing intensive health education and measuring the
improvement in immunization rates.)

Study designs could be exploratory, descriptive or analytical

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I. Exploratory study
An exploratory study is a small-scale study of relatively short duration, which is carried out when
little is known about a situation or a problem. It may include description as well as comparison.
For example: A national AIDS Control Programme wishes to establish counseling services for
HIV positive and AIDS patients, but lacks information on specific needs patients have for support.
To explore these needs, a number of in-depth interviews are held with various categories of patients
(males, females, married and single) and with some counselors working on a programme that is
already under way. When doing exploratory studies we describe the needs of various categories of
patients and the possibilities for action. We may want to go further and try to explain the
differences we observe (e.g., in the needs of male and female AIDS patients) or to identify causes
of problems. Then we will need to compare groups.
If the problem and its contributing factors are not well defined it is always advisable to do an
exploratory study before embarking on a large-scale descriptive or comparative study.

II. Descriptive studies

Descriptive studies may be defined as studies that describe the patterns of disease occurrence and
other health-related conditions by person, place and time.
Personal variables include basic demographic factors, such as age, sex, marital status or
occupation, as well as the consumption of various types of food or medication use. Characteristics
of place refer to the geographic distribution of disease, including variation among countries or
within countries, such as between urban and rural areas. With regard to time, descriptive studies
may examine seasonal patterns in disease onset, etc.

Uses of descriptive studies

❖ They can be done fairly quickly and easily.
❖ Allow planners and administrators to allocate resources
❖ Provide the first important clues about possible determinants of a disease (useful for the
formulation of hypotheses)

Types of descriptive studies

a) Case reports and case series

Case report: a careful, detailed report by one or more clinicians of the profile of a single patient.
The individual case report can be expanded to a case series, which describes characteristics of a
number of patients with a given disease.
Uses
❖ Important link between clinical medicine and epidemiology
❖ One of the first steps in outbreak investigation
❖ Often useful for hypothesis generating and examining new diseases, but conclusions about
etiology cannot be made.

b. Routine-data-based studies
These are the type of studies in which the data are derived from routine data-collection systems
(e.g., cancer registration or death certification). They may be carried out at an individual level if
information on the exposure(s) and outcome(s) of interest is available for each of the study subjects
or at an aggregated level (ecological studies) if the group rather than the individual is the unit of
study. Once the data from a particular study have been collected, the association between the
exposure and the outcome of interest can be quantified by calculating an appropriate measure of
effect. This may be expressed as either the ratio of the measure of disease occurrence in the exposed
relative to that in the unexposed (relative measure) or as the difference between the two (absolute
measure). The first type of measure is particularly important when assessing etiology, whereas the
second type is more useful for evaluations of the public health impact of the association.

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In ecological studies data from entire populations are used to compare disease frequencies between
different groups during the same period of time or in the same population at different points in
time. Example: Countries with low cigarette consumption have lower lung cancer rates than those
countries with high cigarette consumption.
❖ Ecological studies are usually quick and easy to do and can be done with already available
information.
❖ Since ecological studies refer to whole populations rather than to individuals, it is not possible
to link an exposure to occurrence of disease in the same person.

c) Cross-sectional studies (Surveys)

A cross-sectional (prevalence) study provides information concerning the situation at a given time.
In this type of study, the status of an individual with respect to the presence or absence of both
exposure and disease is assessed at the same point in time.
❖ Usually involve collection of new data.
❖ In general, measure prevalence rather than incidence
❖ Not good for studying rare diseases (or outcomes) or diseases with short duration; also not
ideal for studying rare exposures.
For factors that remain unaltered over time, such as sex, blood group, etc., the cross-sectional
survey can provide evidence of a valid statistical association. As can be noted from the above
explanation, a cross-sectional study can be either analytical or descriptive, according to its purpose.
If data are collected both on exposures and outcomes of interest, and if the data are analyzed so as
to demonstrate differences either between exposed and non-exposed groups, with respect to the
outcome, or between those with the outcome and those without the outcome, with respect to the
exposure, then this is an analytical cross-sectional study. If the information collected is purely of a
descriptive nature, not involving the comparison of groups formed on the basis of exposure or
outcome status, then this is a descriptive cross-sectional study. Often a cross-sectional study may
have both descriptive and analytical components. Nowadays, there is an increasing emphasis on the
value of longitudinal studies in which observations are repeated in the same community over a
prolonged period (i.e., longitudinal studies provide the required data at more than one point in time
unlike cross- sectional surveys).

III. Analytic studies

Analytic studies may be defined as studies used to test hypotheses concerning the relationship
between a suspected risk factor and an outcome and to measure the magnitude of the association
and its statistical significance. Analytic study designs can be divided into two broad design
strategies: Observational and intervention.

1. Observational studies
❖ No human intervention involved in assigning study groups; simply observe the relationship
between exposure and disease.
❖ Subject to many potential biases, but by careful design and analysis, many of these biases can
be minimized.
❖ Examples of observational studies: comparative cross-sectional, cohort and case-control
studies.

a) Comparative cross-sectional studies: Depending on the purpose of a given study, a cross-

sectional survey could have an analytical component (see previous section above).

b) Cohort studies: Study groups identified by exposure status prior to ascertainment of their
disease status and both exposed and unexposed groups followed in identical manner until they
develop the disease under study, they die, the study ends, or they are lost to follow-up.

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Strengths and limitations of the cohort study design

Strengths:
❖ Is of particular value when the exposure is rare
❖ Can examine multiple effects of a single exposure
❖ Allows direct measurement of incidence of disease in the exposed and non-exposed groups.
Limitations:
❖ Is inefficient for the evaluation of rare diseases
❖ Expensive and time consuming
❖ Validity of the results can be seriously affected by losses to follow-up.

c) Case-control studies: Group of subjects with the disease (cases) and group of subjects without
the disease (controls) are identified. Information, about previous exposures is obtained for cases
and controls, and frequency of exposure compared for the two groups.

Strengths and limitations of the case-control study design

Strengths:
❖ Is relatively quick and inexpensive
❖ Is optimal for the evaluation of rare diseases (or outcomes).
❖ Can examine multiple etiologic factors for a single disease.
Limitations:
❖ Is inefficient for the evaluation of rare exposures
❖ Cannot directly compute incidence rates of disease in exposed and non- exposed individuals.
❖ Is particularly prone to bias compared with other analytic designs, in particular, selection and
recall bias.

2. Intervention studies
In intervention studies, the researcher manipulates a situation and measures the effects of this
manipulation. Usually (but not always) two groups are compared, one group in which the
intervention takes place (e.g. treatment with a certain drug) and another group that remains
‘untouched’ (e.g. treatment with a placebo). The two categories of intervention studies are:
❖ experimental studies and
❖ quasi-experimental studies

a. Experimental studies
An experimental design is a study design that gives the most reliable proof for causation. In an
experimental study, individuals are randomly allocated to at least two groups. One group is subject
to an intervention, or experiment, while the other group(s) is not. The outcome of the intervention
(effect of the intervention on the dependent variable/problem) is obtained by comparing the two
groups. A number of experimental study designs have been developed. These are widely used in
laboratory settings and in clinical settings. For ethical reasons, the opportunities for experiments
involving human subjects are restricted. However, randomized control trials of new drugs are
common. At community level, where health research is frequently undertaken, we experience not
only ethical but also practical problems in carrying out experimental studies. In real life settings, it
is often impossible to assign persons at random to two groups, or to maintain a control group.
Therefore, experimental research designs may have to be replaced by quasi-experimental designs.

Intervention (experimental) studies can also be considered either therapeutic or preventive.

Therapeutic trials are conducted among patients with a particular disease to determine the ability
of an agent or procedure to diminish symptoms, prevent recurrence, or decrease risk of death from
that disease.

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A preventive trial (community trial) involves the evaluation of whether an agent or procedure
reduces the risk of developing disease among those free from that condition at enrolment. Thus,
preventive trials can be conducted among individuals at usual risk (e.g. vaccine trials)

b. Quasi-experimental studies
In a quasi-experimental study, one characteristic of a true experiment is missing, either
randomization or the use of a separate control group. A quasi-experimental study, however, always
includes the manipulation of an independent variable which is the intervention. One of the most
common quasi-experimental designs uses two (or more) groups, one of which serves as a control
group in which no intervention takes place. Both groups are observed before as well as after the
intervention, to test if the intervention has made any difference. (This quasi-experimental design is
called the ‘non-equivalent control group design’ because the subjects in the two groups (study and
control groups) have not been randomly assigned by the Investigator.

Another type of design that is often chosen because it is quite easy to set up uses only one group in
which an intervention is carried out is called a ‘BEFORE-AFTER’ study. The situation is analyzed
before and after the intervention to test if there is any difference in the observed problem. This
design is considered a ‘pre-experimental’ design rather than a ‘quasi-experimental’ design because
it involves neither randomization nor the use of a control group.

A particular research question may be addressed using different approaches. The choice of study
design for investigation is influenced by:
❖ Particular features of the exposure and disease.
❖ Logistic considerations of available resources.
❖ Results from previous studies and gaps in knowledge that remain to be filled.
❖ Ingenuity and creativity of the researcher

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6.4 STUDY POPULATION

At an early stage in the planning of any investigation decisions must be made concerning the study
population. That is, concerning the population of individual units (whether they are persons,
households, etc.) to be investigated. The population under consideration should be clearly and
explicitly defined in terms of place, time, and other relevant criteria. If the study population
comprises cases of a disease the procedures to be used for case identification should be stated. If
controls are to be chosen their method of selection should be stated. Often the investigator will
have implicitly chosen his study population when he defined the topic of his investigation, by
reason of his interest in a specific community or a specific health program. In other instances,
particularly when an analytic survey or an experiment is being planned, the investigator may
require purposively to select a study population. In so doing he must consider questions of
appropriateness and practicability. The appropriateness of the study population refers to its
suitability for the attainment of the objectives of the study. The selection of study population on the
basis of suitability usually affects the validity of subsequent generalizations from the findings. This
situation requires a close attention at the early stage of the given study. Two examples are given
below.

a) Volunteer populations: Persons who volunteer to enter a study may differ in many respects
from those who do not so volunteer, and therefore the findings in a volunteer population do not
necessarily apply to the population at large.

b) Hospital or clinic populations: Persons receiving medical care are obviously not representative
of the general population from which they have come from. That is, persons treated in hospital for a
certain disease may differ from those patients with the same disease but not receiving care for it.

Practical questions such as the following could also arise.

❖ Is the proposed population the one that would give the required information?
❖ Will the population cooperate to participate in the study, or will it be a 'resistant' one?
❖ If it is proposed to study patients with a specific disease, will it be possible to identify enough
cases to yield useful conclusions?
❖ If a long term 'follow up' study is planned, is the population so mobile that it may be difficult
to maintain contact with the subjects?
A preliminary exploratory study may sometimes be required in order to answer such questions.

6.5 OPERATIONAL DEFINITIONS OF VARIABLES

Before we directly go to the operational definition of variables it would be important to discuss
about the nature of variables first.

Definition:
A variable is an entity, event a characteristic of a person or object that can take on different values.
A simple example of a variable is a person's age. The variable can take on different values, such as,
20 years old, 30 years old, and so on. Other examples of variables are:
a) Temperature in oC h) Health status
b) Weight in kilograms i) Marital status (single, married, divorced and widowed)
c) Height in centimeters j) Job satisfaction index (1 to 5)
d) Monthly income in Franc k) Occupation (civil servant, farmer, student, et.)
e) Educational attainment l) Disease condition (presence or absence of a disease)
f) Weather m) The pieces of information gathered in the course of a
g) Economic status research study.

The first four variables (a - to - d) are numerical variables because they are expressed in numbers
(metric data). Since the values of the remaining three variables (e to l) are expressed in categories,

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we call them categorical variables. Because in the health research we often look for associations, it
is important to make a distinction between “dependent” and “independent” variables. Both the
dependent and independent variables together with their operational definitions (when necessary)
should be stated.

Independent Variables (IV) & Dependent Variables (DV)

The variable that is used to describe or measure the problem under study is called the dependent
variable. The variables that are used to describe or measure the factors that are assumed to
influence (or cause) the problem(s) are called independent variables. That is to say, the DV refers
to the status of the presumed ‘effect’ (or outcome) in which the researcher is interested; the
independent variable on the other hand refers to the status of the presumed ‘cause’, (changes)
which lead to changes in the status of the dependent variable – Any event or condition can be
conceptualized as either an independent or a dependent variable. For example, it has been observed
that rumor-mongering can sometimes cause a riot to erupt, but it has also been observed that riots
can cause rumors to surface. “Rumors are variables that can be conceived of as causes (IVs), and as
effects (DVs)” (Rosenthal & Rosnow, 1991, p. 71). Another example will be in a study of
relationship between smoking and lung cancer, "suffering from lung cancer" (with the values yes,
no) would be the dependent variable and "smoking" (with the values no, less than a packet/day, 1
to 2 packets/day, more than 2 packets/day) would be the independent variable.

The IV is the antecedent, whereas the DV is the consequent. In experiments, the IV is the variable
that is controlled and manipulated by the experimenter; whereas the DV is not manipulated, instead
the DV is observed or measured for variation as a presumed result of the variation in the IV. “In
nonexperimental research, where there is no experimental manipulation, the IV is the variable that
‘logically’ has some effect on a DV. For example, in the research on cigarette-smoking and lung
cancer, cigarette-smoking, which has already been done by many subjects, is the independent
variable” (Kerlinger, 1986, p.32).

In an experiment, the independent variable is the variable that is varied or manipulated by the
researcher, and the dependent variable is the response that is measured. Sometimes, researchers
are not able to actually control and manipulate an IV, this particular type of IV is technically
referred to as a status variable (e.g., gender, ethnicity, etc.). Even though researchers do not
actually control or manipulate status variables, researchers can, and often do, treat them as IVs
(Heppner, Kivlighan & Wampold, 1999).

Some Other Examples of Independent and Dependent Variables

The following is a hypothesis for a study.
1. "There will be a statistically significant difference in graduation rates of at-risk high-school
seniors who participate in an intensive study program as opposed to at-risk high-school seniors who
do not participate in the intensive study program." (LaFountain & Bartos, 2002, p. 57)
IV: Participation in intensive study program. DV: Graduation rates.
The following is a description of a study.
2. "A director of residential living on a large university campus is concerned about the large
turnover rate in resident assistants. In recent years many resident assistants have left their positions
before completing even 1 year in their assignments. The director wants to identify the factors that
predict commitment as a resident assistant (defined as continuing in the position a minimum of 2
years). The director decides to assess knowledge of the position, attitude toward residential
policies, and ability to handle conflicts as predictors for commitment to the position." (LaFountain
& Bartos, 2002, p. 8)
IV: knowledge of position, attitude toward policies, and ability to handle conflicts. DV:
commitment to position (continuing in position for 2 years or not continuing).

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Background variables - In almost every study involving human subjects, background variables,
such as, age, sex, educational status, monthly family income, marital status and religion will be
included. These background variables are often related to a number of independent variables, so
that they influence the problem indirectly. Hence they are called background variables or
background characteristics.

Confounding variable - A variable that is associated with the problem and with a possible cause of
the problem is a potential confounding variable. This type of variable may either strengthen or
weaken the apparent relationship between the problem and a possible cause.

Composite variable - A variable based on two or more other variables may be termed a composite
variable. Incidence and prevalence rates, sex ratios, and other rates and ratios are composite
variables, since they are based on separate numerator and denominator information.

I. Operationalising variables by choosing appropriate indicators

Note that the different values of many of the variables presented above can easily be determined.
However, for some variables it is sometimes not possible to find meaningful categories unless the
variables are made operational with one or more precise Indicators. Operationalising variables
means that you make them ‘Measurable'.

For example:
1. In a study on VCT acceptance, you want to determine the level of knowledge concerning HIV in
order to find out to what extent the factor ‘poor knowledge’ influences willingness to be tested for
HIV. The variable ‘level of knowledge’ cannot be measured as such. You would need to develop a
series of questions to assess a person’s knowledge, for example on modes of transmission of HIV
and its prevention methods. The answers to these questions form an indicator of someone’s
knowledge on this issue, which can then be categorized. If 10 questions were asked, you might
decide that the knowledge of those with:
❖ 0 to 3 correct answers is poor,
❖ 4 to 6 correct answers is reasonable, and
❖ 7 to 10 correct answers is good.

When defining variables on the basis of the problem analysis diagram, it is important to realize
which variables are measurable as such and which ones need indicators. Once appropriate
indicators have been identified we know exactly what information we are looking for. This makes
the collection of data as well as the analysis more focused and efficient.

2. Nutritional status of under-5 year olds is another example of a variable that cannot be measured
directly and for which you would need to choose appropriate indicators. Widely used indicators for
nutritional status include weight-for-age, weight-for-height, height-for-age, and upper-arm
circumference. For the classification of nutritional status, internationally accepted categories
already exist, which are based on standard growth curves. For the indicator weight/age, for
example, children are:
❖ Well nourished if they are above 80% of the standard
❖ Moderately malnourished if they are between 60% and 80%
❖ Severely malnourished if they are below 60%

Operational definition: This is the specifications of the operations to be performed by the

researcher in order to collect the required data. Operational definition removes ambiguity from the
meaning of the variables, and enables others to replicate the study in future. Operational definitions
are different from dictionary definitions.

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II. Defining variables and indicators of variables

To ensure that everyone (the researcher, data collectors, and eventually the reader of the research
report) understands exactly what has been measured and to ensure that there will be consistency in
the measurement, it is necessary to clearly define the variables (and indicators of variables). For
example, to define the indicator “waiting time” it is necessary to decide what will be considered the
starting point of the “waiting period” e.g. Is it when the patient enters the front door, or when he
has been registered and obtained his card?

For certain variables, it may not be possible to adequately define the variable or the indicator
immediately because further information may be needed for this purpose. The researcher may need
to review the literature to find out what definitions have been used by other researchers, so that he
can standardize his definitions and thus be able later to easily compare his findings with those of
the other studies. In some cases the opinions of “experts” or of community members of health care
providers may be needed in order to define the variable or indicator. The variables to be studied are
selected on the basis of their relevance to the objectives of the investigation.
❖ The initial list is usually too long
❖ It has to be pruned to facilitate the collection and processing of the data.

Once the variables are selected, each of them should be clarified. There are two aspects to be
considered.
❖ Clear definition of variables in terms of objectively measurable facts (i.e., operational
definition) - this was repeatedly mentioned (addressed) in the above examples
❖ The scale of measurement to be used in data collection.

Unless the variables are clearly and explicitly defined, there can be no assurance that, if the study is
performed by a different investigator, or repeated by the same investigator, similar findings would
be obtained. The following example shows the different definitions (two different definitions)
given to "obesity". The two kinds of definitions are: conceptual and operational. The conceptual
definition is often akin to a dictionary definition.

E.g. “Obesity” may be defined as: “excessive fatness”, “overweight”, etc.

In contrast, the operational definition is heavily influenced by considerations of practicability.
“Obesity”, for example, might be operationally defined as: “a weight, based on weighing in
underclothes and without shoes, which exceeds, by 10% or more, the mean weight of persons of the
subject's sex, age and height (in a specified population at a specified time)". In general, operational
definitions of variables are used in order to:
❖ Avoid ambiguity
❖ Make the variables to be more measurable

Scales of Measurement:
As part of the process of clarifying each of the variables to be studied, its scale of measurement
should be specified. There are four types of scales of measurement: Nominal, Ordinal, Interval
and Ratio. They are listed in ascending order of power and preference.

1. Nominal Scale: This consists of two or more named categories (classes) which are qualitatively
different from each other.
E.g. Sex: male (1); Female (2)
Marital status: 1. Married 2. Single 3. Divorced 4. Widowed

2. Ordinal scale: This has the additional quality that the categories are ranked and have implied
order. However, the intervals between classes are not necessarily equal.

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Example 1: Severity of a disease: Severe (grade III); moderate (grade II); mild (grade I); absent
(grade 0).
Example 2: Educational status: 0; 1-6; 7-8; 9 -12; more than 12.

3. Interval scale: This has the additional quality that the intervals between classes are equal.
Example: Temperature (in Celsius)
Equal differences between any pair of numbers in the scale indicate equal differences in the
attribute being measured. The difference in temperature between 20oC and 25oC is the same as the
difference between 30oC and 35oC. The ratio between numbers in the scale is not, however,
necessarily the same as that between the amounts of the attribute. That is, a room at 30oC is not
'twice as hot' as one at 15oC. This is because the zero on the scale does not indicate absence of the
attribute.

4. Ratio scale: This has the additional quality that zero indicates absence of the attribute. As a
result, the ratio between numbers in the scale is the same as that between the amounts of the
attribute being measured.
Example: Weight measured in kilograms, height in cm, etc.

6.6 SAMPLING

6.6.1 INTRODUCTION AND DEFINITION OF KEY TERMS

Objectives:
❖ Learn the reasons for sampling
❖ Develop an understanding about different sampling methods
❖ Distinguish between probability & non probability sampling
❖ Discuss the relative advantages & disadvantages of each sampling methods
It would normally be impractical to study a whole population, for example when doing a
questionnaire survey. Sampling involves the selection of a number of study units from a defined
study population. The population is too large for us to consider collecting information from all its
members. Instead we select a sample of individuals hoping that the sample is representative of the
population. Sampling is a method that allows researchers to infer information about a population,
without having to investigate every individual. Reducing the number of individuals in a study
reduces the cost and workload, and may make it easier to obtain high quality information, but this
has to be balanced against having a large enough sample size with enough power to detect a true
association. If a sample is to be used, by whatever method it is chosen, it is important that the
individuals chosen are representative of the whole population. This may involve specifically
targeting hard to reach groups. For example, if the electoral roll for a town was used to identify
participants, some people such as the homeless would not be registered and therefore excluded
from the study by default. There are several different sampling techniques available. Calculation of
sample size is addressed in your Statistics course. When taking a sample, we will be confronted
with the following questions:
a) What is the group of people from which we want to draw a sample?
b) How many people do we need in our sample?
c) How will these people be selected?

Why sample? 1. To effectively utilize/minimize resources (time, money) and workload. 2.

Sampling gives results with known accuracy that can be calculated mathematically.

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DEFINITIONS
❖ Target population (reference or theoretical population): Is that population about which an
investigator wishes to draw a conclusion.
❖ Study population (population sampled): Population from which the sample actually was
drawn and about which a conclusion can be made. For Practical reasons the study population
is often more limited than the target population. In some instances, the target population and
the population sampled are identical.
❖ A sample: This is “a smaller (but hopefully representative) collection of units from a
population used to determine truths about that population” (Field, 2005)
❖ Sampling unit: The unit of selection in the sampling process; For example, in a sample of
districts, the sampling unit is a district; in a sample of persons, a person, etc.
❖ Study unit: The unit on which the observations will be collected; for example, persons in a
study of disease prevalence, or households, in a study of family size.
❖ N.B: The sampling unit is not necessarily the same as the study unit.
❖ Sample design: The scheme for selecting the sampling units from the study population.
❖ The sampling frame is the list from which the potential respondents (sample) are
drawn/selected e.g. Registrar’s office, Class rosters. The existence of an adequate and up-to-
date sampling frame often defines the study population. You must assess sampling frame
errors. Possible Sampling frame errors (from frame above) may include: University versus
personal email addresses; changing class rosters; are all students in your population of interest
represented?

Two Questions:
1. What is your population of interest? That is to whom do you want to generalize your results?
Probable answers could be to: All doctors; School children; Cameroonians; Women aged 15-45
years; any other group of individuals.

2. Can you sample the entire population?

Three (3) factors that influence sample representativeness: 1. Sampling procedure. 2. Sample
size. 3. Participation (response)

When might you sample the entire population? 1. When your population is very small. 2. When
you have extensive resources. 3. When you don’t expect a very high response

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6.6.2 THE SAMPLING PROCESS

The sampling process comprises several stages:
1. Defining the population of concern.
2. Specifying a sampling frame, a set of items or events possible to measure.
3. Specifying a sampling method for selecting items or events from the frame.
4. Determining the sample size.
5. Implementing the sampling plan.
6. Sampling and data collecting.
7. Reviewing the sampling process

6.6.2.1 DEFINING YOUR POPULATION

A population can be defined as including all people or items with the characteristic that one wishes
to understand. Because there is very rarely enough time or money to gather information from
everyone or everything in a population, the goal becomes finding a representative sample (or
subset) of that population.

6.6.2.2 SPECIFYING A SAMPLING FRAME (A set of items or events possible to measure)

Note also that the population from which the sample is drawn may not be the same as the
population about which we actually want information. Often there is large but not complete overlap
between these two groups due to frame issues etc. Sometimes they may be entirely separate - for
instance, we might study rats in order to get a better understanding of human health, or we might
study records from people born in 2008 in order to make predictions about people born in 2009. In
the most straightforward case, such as the sentencing of a batch of material from production
(acceptance sampling by lots), it is possible to identify and measure every single item in the
population and to include any one of them in our sample. However, in the more general case this is
not possible. There is no way to identify all rats in the set of all rats. Where voting is not
compulsory, there is no way to identify which people will actually vote at a forthcoming election
(in advance of the election). As a remedy, we seek a sampling frame which has the property that we
can identify every single element and include any in our sample. The sampling frame must be
representative of the population.

6.6.2.3 METHODS OF SAMPLING FROM A POPULATION

Two general approaches to sampling are used in research. With probability sampling, all elements
(e.g., persons, households) in the population have some opportunity of being included in the
sample, and the mathematical probability that any one of them will be selected can be calculated.
With nonprobability sampling, in contrast, population elements are selected on the basis of their
availability (e.g., because they volunteered) or because of the researcher's personal judgment that
they are representative. The consequence is that an unknown portion of the population is excluded
(e.g., those who did not volunteer). One of the most common types of nonprobability sample is
called a convenience sample – not because such samples are necessarily easy to recruit, but because
the researcher uses whatever individuals are available rather than selecting from the entire
population. Because some members of the population have no chance of being sampled, the extent
to which a convenience sample – regardless of its size – actually represents the entire population
cannot be known.

An important issue influencing the choice of the most appropriate sampling method is whether a
sampling frame is available, that is, a listing of all the units that compose the study population.

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A) NON-PROBABILITY SAMPLING METHODS

Any sampling method where some elements of population have no chance of selection (these are
sometimes referred to as 'out of coverage'/'undercovered'), or where the probability of selection
can't be accurately determined. It involves the selection of elements based on assumptions
regarding the population of interest, which forms the criteria for selection. Hence, because the
selection of elements is nonrandom, nonprobability sampling not allows the estimation of sampling
errors.
Example: We visit every household in a given street, and interview the first person to answer
the door. In any household with more than one occupant, this is a nonprobability sample,
because some people are more likely to answer the door (e.g. an unemployed person who
spends most of their time at home is more likely to answer than an employed housemate who
might be at work when the interviewer calls) and it's not practical to calculate these
probabilities.
Nonprobability Sampling includes: Accidental Sampling, Quota Sampling and Purposive
Sampling. In addition, nonresponse effects may turn any probability design into a nonprobability
design if the characteristics of nonresponse are not well understood, since nonresponse effectively
modifies each element's probability of being sampled.

1. Convenience sampling (Sometimes known as ‘grab’ or ‘opportunity’ sampling or

‘accidental’ or ‘haphazard’ sampling): It is a method in which for convenience sake the study
units that happen to be available at the time of data collection are selected. Convenience sampling
is perhaps the easiest method of sampling, because participants are selected in the most convenient
way, the sample being drawn from that part of the population which is close to hand i.e. readily
available and convenient and are often allowed to choose or volunteer to take part. Good results can
be obtained, but the data set may be seriously biased, because those who volunteer to take part may
be different from those who choose not to. The researcher using such a sample cannot scientifically
make generalizations about the total population from this sample because it would not be
representative enough.
For example, if the interviewer was to conduct a survey at a shopping center early in the
morning on a given day, the people that he/she could interview would be limited to those
given there at that given time, which would not represent the views of other members of
society in such an area, if the survey was to be conducted at different times of day and several
times per week. This type of sampling is most useful for pilot testing.
In social science research, snowball sampling is a similar technique, where existing study subjects
are used to recruit more subjects into the sample. Snowball sampling is a method commonly used
in social sciences when investigating hard to reach groups. Existing subjects are asked to nominate
further subjects known to them, so the sample increases in size like a rolling snowball. For
example, when carrying out a survey of risk behaviours amongst intravenous drug users,
participants may be asked to nominate other users to be interviewed.

2. Quota sampling: is a method that insures that a certain number of sample units from different
categories with specific characteristics appear in the sample so that all these characteristics are
represented. In this method the investigator interviews as many people in each category of study
unit as he can find until he has filled his quota. This method of sampling is often used by market
researchers. The population is first segmented into mutually exclusive sub-groups, just as in
stratified sampling. Then judgment used to select subjects or units from each segment based on a
specified proportion; interviewers are given a quota of subjects of a specified type to attempt to
recruit. For example, an interviewer might be told to go out and select 20 adult men and 20 adult
women, 10 teenage girls and 10 teenage boys so that they could interview them about their
television viewing. It is this second step which makes the technique one of non-probability
sampling. In quota sampling the selection of the sample is non-random. For example interviewers
might be tempted to interview those who look most helpful. The problem is that these samples may

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be biased because not everyone gets a chance of selection. This random element is its greatest
weakness and quota versus probability has been a matter of controversy for many years. There are
several flaws with the method, but most importantly it is not truly random.

3. Purposeful/Judgmental sampling (for qualitative studies): The researcher chooses the sample
based on who they think would be appropriate for the study. This is used primarily when there are a
limited number of people that have expertise in the area being researched. Qualitative research
methods are typically used when focusing on a limited number of informants, whom we select
strategically so that their in-depth information will give optimal insight into an issue about which
little, is known. This is called purposeful sampling.

The above sampling methods do not claim to be representative of the entire population.

Random sampling strategies to collect quantitative data: If the aim of a study is to measure
variables distributed in a population (e.g., diseases) or to test hypotheses about which factors are
contributing significantly to a certain problem, we have to be sure that we can generalize the
findings obtained from a sample to the total study population. Then, purposeful sampling methods
are inadequate, and probability or random sampling methods have to be used.

B) PROBABILITY SAMPLING METHODS:

Probability sampling involves random selection procedures to ensure that each unit of the sample is
chosen on the basis of chance. Every unit in the population has a chance (greater than zero) of
being selected in the sample, and this probability can be accurately determined. When every
element in the population does have the same probability (an equal chance) of selection, this is
known as an 'equal probability of selection' (EPS) design. Such designs are also referred to as 'self-
weighting' because all sampled units are given the same weight.

1. Simple random sampling: This is the most basic scheme of random sampling. In this case each
individual is chosen entirely by chance and each member of the population (i.e. all subsets of the
frame) is given an equal chance, or probability, of being selected.

One way of obtaining a random sample is to give each individual in a population a number or make
a numbered list of all the units in the population from which you want to draw a sample. Each unit
on the list should be numbered in sequence from 1 to N (Where N is the Size of the population).
Decide on the size of the sample. Then select the required number of sampling units use a table of
random numbers or “lottery” to decide/determine which individuals to include. It is applicable
when population is small, homogeneous & readily available. Estimates are easy to calculate.
Simple random sampling is always an EPS design, but not all EPS designs are simple random
sampling.

Disadvantages: 1. If sampling frame large, this method impracticable. 2. Minority subgroups of

interest in population may not be present in sample in sufficient numbers for study.

Replacement of selected units

Sampling schemes may be without replacement ('WOR' - no element can be selected more than
once in the same sample) or with replacement ('WR' - an element may appear multiple times in the
one sample). For example, if we catch fish, measure them, and immediately return them to the
water before continuing with the sample, this is a WR design, because we might end up catching
and measuring the same fish more than once. However, if we do not return the fish to the water
(e.g. if we eat the fish), this becomes a WOR design
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2. Systematic Sampling: Individuals are selected at regular intervals from a list of the whole
population (the sampling frame). The intervals are chosen to ensure an adequate sample size. For
example, every 10th member of the population is included. Systematic sampling relies on arranging
the target population according to some ordering scheme and then selecting elements at regular
intervals through that ordered list. Systematic sampling involves a random start and then proceeds
with the selection of every kth element from then onwards. In this case, k = population size divided
by sample size. It is important that the starting point is not automatically the first in the list; ideally
we randomly select a number from within the first to the kth element in the list to tell us where to
start selecting individuals from the list. For example, a systematic sample is to be selected from
1000 students of a school. The sample size is decided to be 100. The sampling fraction is: 100/1000
= 1/10. The number of the first student to be included in the sample is chosen randomly by picking
one out of the first ten pieces of paper, numbered 1 to 10, also referred to as 'sampling with a skip
of 10'. . If number 5 is picked, every tenth student will be included in the sample, starting with
student number 5, until 100 students are selected. Students with the following numbers will be
included in the sample: 5, 15, 25, 35, 45, . . . , 985, 995. This method is often convenient and easy
to use, although it may also lead to bias for reasons outlined below.

Systematic sampling is an EPS method, because all elements have the same probability of selection
(in the example given, one in ten). It is NOT 'simple random sampling' because different subsets of
the same size have different selection probabilities - e.g. the set {4, 14, 24... 994} has a one-in-ten
probability of selection, but the set {4, 13, 24, 34...} has zero probability of selection.

Advantages: 1. Sample easy to select 2. Systematic Sampling is usually less time consuming and
easier to perform than SRS. 3. Suitable sampling frame can be identified easily, and unlike SRS,
systematic sampling can be conducted without a sampling frame (useful in some situations where a
sampling frame is not readily available). 4. Sample evenly spread over entire reference population.
5. It provides a good approximation to SRS.

Disadvantages: 1. It should not be used if there is any sort of cyclic pattern in the ordering of the
subjects on the list, as sample may be biased if hidden periodicity in population coincides with that
of selection. 2. Difficult to assess precision of estimate from one survey.

3. Stratified sampling: It is used when we might reasonably expect the measurement of interest to
vary between the different sub-groups. If it is important that the sample includes representative
groups of study units with specific characteristics (for example, residents from urban and rural
areas), the sampling frame must be divided into groups, or strata, according to these characteristics.
Gender or smoking habits would be examples of strata. In stratified sampling, the population is first
divided into sub-groups (or strata) who all share a similar characteristic. The study sample of a
predetermined size is then obtained by taking samples from each stratum (group) by simple random
or systematic sampling. In a stratified sample, the probability of an individual being included varies
according to known characteristics, such as gender, and the aim is to ensure that all sub-groups of
the population that might be of relevance to the study are adequately represented. Thus in a
nutshell, where population embraces a number of distinct categories, the frame can be organized
into separate "strata." Each stratum is then sampled as an independent sub-population, out of which
individual elements can be randomly selected. Every unit in a stratum has same chance of being
selected. Using same sampling fraction for all strata ensures proportionate representation in the
sample. Adequate representation of minority subgroups of interest can be ensured by stratification
& varying sampling fraction between strata as required. Finally, since each stratum is treated as an
independent population, different sampling approaches can be applied to different strata. The fact
that the sample was stratified should be taken into account at the analysis stage.

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Some of the reasons for stratifying the population may be:

❖ Different sampling schemes may be used in different strata, e.g. Urban and rural
❖ Conditions may suggest that prevalence rates will vary between strata: the overall estimate for
the whole population will be more precise if stratification is used.
❖ Administrative reasons may make it easier to carry out the survey through an organization with
a regional structure.

Drawbacks to using stratified sampling.

First, sampling frame of entire population has to be prepared separately for each stratum. Second,
when examining multiple criteria, stratifying variables may be related to some, but not to others,
further complicating the design, and potentially reducing the utility of the strata. Finally, in some
cases (such as designs with a large number of strata, or those with a specified minimum sample size
per group), stratified sampling can potentially require a larger sample than would other methods

Poststratification: Stratification is sometimes introduced after the sampling phase in a process

called "poststratification“. This approach is typically implemented due to a lack of prior
knowledge of an appropriate stratifying variable or when the experimenter lacks the necessary
information to create a stratifying variable during the sampling phase. Although the method is
susceptible to the pitfalls of post hoc approaches, it can provide several benefits in the right
situation. Implementation usually follows a simple random sample. In addition to allowing for
stratification on an ancillary variable, poststratification can be used to implement weighting, which
can improve the precision of a sample's estimates.

Oversampling: Choice-based sampling is one of the stratified sampling strategies. In this, data are
stratified on the target and a sample is taken from each stratum so that the rare target class will be
more represented in the sample. The model is then built on this biased sample. The effects of the
input variables on the target are often estimated with more precision with the choice-based sample
even when a smaller overall sample size is taken compared to a random sample. The results usually
must be adjusted to correct for the oversampling.

4. Cluster sampling: When a list of groupings of study units is available (e.g. villages, etc.) or can
be easily compiled, a number of these groupings can be randomly selected. In a clustered sample,
sub-groups of the population are used as the sampling unit, rather than individuals. Clusters are
often geographic units (e.g. districts, villages) or organizational units (e.g. clinics). The population
is divided into sub-groups, known as clusters, and a selection of these are randomly selected to be
included in the study. All members of the cluster are then included in the study. Clustering should
be taken into account in the analysis. The General Household survey, which is undertaken annually
in some countries, is a good example of a cluster sample. All members of the selected
households/clusters are included in the survey.
a) Cluster sampling is an example of 'two-stage sampling'.
b) First stage a sample of areas is chosen;
c) Second stage a sample of respondents within those areas is selected.
d) Population divided into clusters of homogeneous units, usually based on geographical
contiguity.
e) Sampling units are groups rather than individuals.
f) A sample of such clusters is then selected.
g) All units from the selected clusters are studied.

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Advantages: 1. Cuts down on the cost of preparing a sampling frame. 2. This can reduce travel and
other administrative costs.
Disadvantages: 1. Sampling error is higher for a simple random sample of same size.
Often used to evaluate vaccination coverage in EPI

Identification of clusters: List all cities, towns, villages & wards of cities with their population
falling in target area under study; Calculate cumulative population & divide by 30, this gives
sampling interval; Select a random number. less than or equal to sampling interval having same no.
of digits. This forms 1st cluster;
❖ Random no.+ sampling interval = population of 2nd cluster.
❖ Second cluster + sampling interval = 4th cluster.
❖ Last or 30th cluster = 29th cluster + sampling interval

Difference between ‘Strata’ and ‘Clusters’

Although strata and clusters are both non-overlapping subsets of the population, they differ in
several ways. All strata are represented in the sample; but only a subset of clusters is in the sample.
With stratified sampling, the best survey results occur when elements within strata are internally
homogeneous. However, with cluster sampling, the best results occur when elements within
clusters are internally heterogeneous.

5. Multi-Stage Sampling: This is a complex form of cluster sampling in which two or more levels
of units are embedded one in the other. This method is appropriate when the population is large and
widely scattered. The number of stages of sampling is the number of times a sampling procedure is
carried out. First stage, random number of districts chosen in all states; Followed by random
number of talukas (districts or Hamlets), villages; Then third stage units will be houses. All
ultimate units (houses, for instance) selected at last step are surveyed.
❖ The primary sampling unit (PSU) is the sampling unit (or unit of selection in the sampling
procedure) in the first sampling stage;
❖ The secondary sampling unit (SSU) is the sampling unit in the second sampling stage, etc. e.g.
After selection of a sample of clusters (e.g. household), further sampling of individuals may be
carried out within each household selected. This constitutes two stage sampling, with the PSU
being households and the SSU being individuals.
Advantages: less costly, we only need to draw up a list of individuals in the clusters actually
selected, and we can do that when we arrive there.
Disadvantage: less precise than SRS.

6. Multiphase Sampling: Part of the information collected from whole sample & part from
subsample. In Tb survey MT in all cases – Phase I. X –Ray chest in MT +ve cases – Phase II.
Sputum examination in X – Ray +ve cases - Phase III; Survey by such procedure is less costly, less
laborious & more purposeful.

OTHER SAMPLING TECHNIQUES

7. Panel Sampling: Method of first selecting a group of participants through a random sampling
method and then asking that group for the same information again several times over a period of
time. Therefore, each participant is given same survey or interview at two or more time points; each
period of data collection called a "wave". This sampling methodology often chosen for large scale
or nation-wide studies in order to gauge changes in the population with regard to any number of
variables from chronic illness to job stress to weekly food expenditures. Panel sampling can also be
used to inform researchers about within-person health changes due to age or help explain changes
in continuous dependent variables such as spousal interaction. There have been several proposed
methods of analyzing panel sample data, including growth curves.
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8. Probability Proportional to Size

In some cases the sample designer has access to an "auxiliary variable" or "size measure", believed
to be correlated to the variable of interest, for each element in the population. This data can be used
to improve accuracy in sample design. One option is to use the auxiliary variable as a basis for
stratification, as discussed above. Another option is probability-proportional-to-size ('PPS')
sampling, in which the selection probability for each element is set to be proportional to its size
measure, up to a maximum of 1 (one). In a simple PPS design, these selection probabilities can
then be used as the basis for Poisson sampling. However, this has the drawbacks of variable
sample size, and different portions of the population may still be over- or under-represented due to
chance variation in selections. To address this problem, PPS may be combined with a systematic
approach.
Example: Suppose we have six schools with populations of 150, 180, 200, 220, 260,
and 490 students respectively (total 1500 students), and we want to use student population
as the basis for a PPS sample of size three. To do this, we could allocate the first school
numbers 1 to 150, the second school 151 to 330 (= 150 + 180), the third school 331 to 530,
and so on to the last school (1011 to 1500). We then generate a random start between 1 and
500 (equal to 1500/3) and count through the school populations by multiples of 500. If our
random start was 137, we would select the schools which have been allocated numbers 137,
637, and 1137, i.e. the first, fourth, and sixth schools.
The PPS approach can improve accuracy for a given sample size, by concentrating the sample on
large elements that have the greatest impact on population estimates. PPS sampling is commonly
used for surveys of businesses, where element size varies greatly and auxiliary information is often
available - for instance, a survey attempting to measure the number of guest-nights spent in hotels
might use each hotel's number of rooms as an auxiliary variable. In some cases, an older
measurement of the variable of interest can be used as an auxiliary variable when attempting to
produce more current estimates.

9. Event Sampling: Event Sampling Methodology (ESM) is a new form of sampling method that
allows researchers to study ongoing experiences and events that vary across and within days in its
naturally-occurring environment. Because of the frequent sampling of events inherent in ESM, it
enables researchers to measure the typology of activity and detect the temporal and dynamic
fluctuations of work experiences. Popularity of ESM as a new form of research design increased
over the recent years because it addresses the shortcomings of cross-sectional research, where once
unable to, researchers can now detect intra-individual variances across time. In ESM, participants
are asked to record their experiences and perceptions in a paper or electronic diary. There are three
types of ESM: # Signal contingent – random beeping notifies participants to record data. The
advantage of this type of ESM is minimization of recall bias.
❖ Event contingent – records data when certain events occur
❖ Event contingent – records data when certain events occur
❖ Interval contingent – records data according to the passing of a certain period of time

ESM has several disadvantages. One of the disadvantages of ESM is it can sometimes be perceived
as invasive and intrusive by participants. ESM also leads to possible self-selection bias. It may be
that only certain types of individuals are willing to participate in this type of study creating a non-
random sample. Another concern is related to participant cooperation. Participants may not be
actually fill out their diaries at the specified times. Furthermore, ESM may substantively change the
phenomenon being studied. Reactivity or priming effects may occur, such that repeated
measurement may cause changes in the participants' experiences. This method of sampling data is
also highly vulnerable to common method variance. Further, it is important to think about whether
or not an appropriate dependent variable is being used in an ESM design. For example, it might be
logical to use ESM in order to answer research questions which involve dependent variables with a
great deal of variation throughout the day. Thus, variables such as change in mood, change in stress

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level, or the immediate impact of particular events may be best studied using ESM methodology.
However, it is not likely that utilizing ESM will yield meaningful predictions when measuring
someone performing a repetitive task throughout the day or when dependent variables are long-
term in nature (coronary heart problems).

When we take a sample, our results will not exactly equal the correct results for the whole
population. That is, our results will be subject to errors. This error has two components: sampling
and non-sampling errors.

a) Sampling error (i.e., random error)

Random error, the opposite of reliability (i.e., Precision or repeatability), consists of random
deviations from the true value, which can occur in any direction. Sampling error (random error)
can be minimized by increasing the size of the sample.

Reliability (or precision): This refers to the repeatability of a measure, i.e., the degree of closeness
between repeated measurements of the same value. Reliability addresses the question, if the same
thing is measured several times, how close are the measurements to each other?

The sources of variation resulting in poor reliability include:

a) Variation in the characteristic of the subject being measured. Example: blood pressure
b) The measuring instruments, e.g. questionnaires
c) The persons collecting the information (observer variation)

Inter-observer variation: differences between observers in measuring the same observation

Intra-observer variation: differences in measuring the same observation by the same observer on
different occasions.

b) Non Sampling error (i.e., bias)

Bias, the opposite of validity, consists of systematic deviations from the true value, always in the
same direction. It is possible to eliminate or reduce the non-sampling error (bias) by careful design
of the sampling procedure.

Validity: This refers to the degree of closeness between a measurement and the true value of what
is being measured. Validity addresses the question, how close is the measured value to the true
value? To be accurate, a measuring device must be both valid and reliable. However, if one cannot
have both, validity is more important in situations when we are interested in the absolute value of
what is being measured. Reliability on the other hand is more important when it is not essential to
know the absolute value, but rather we are interested in finding out if there is a trend, or to rank
values.

Bias in sampling
There are five important potential sources of bias that should be considered when selecting a
sample, by whatever method:
1. Any changes from the pre-agreed sampling rules can introduce bias
2. Bias is introduced if people in hard to reach groups are omitted (accessibility bias)
3. Replacing selected individuals with others, for example if they are difficult to contact, also
introduces bias
1. It is important to try and maximize the response rate to a survey; low response rates can
introduce bias. Non-response bias refers to failure to obtain information on some of the
subjects included in the sample to be studied. It results in significant bias when the

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following two situations are both fulfilled: (i) when non-respondents constitute a significant
proportion of the sample, (ii) when non-respondents differ significantly from respondents, it
4. If an out of date list is used as the sample frame, it may also introduce bias, for example if it
excludes people who have recently moved to an area. Bias resulting from incompleteness of
the sampling frame could be accessibility bias, seasonability bias, self-reporting bias,
volunteer bias, non-response bias etc.

The issue of non-response should be considered during the planning stage of the study:

a) Non-response should be kept to a minimum. E.g. below 15%

Methods that may help in maintaining non-response at a low level could be:
❖ Training data collectors to initiate contact with study subjects in a respectful way and
convince them about the importance of the given study (this minimizes the refusal type of
non-response)
❖ Offering incentives to encourage participation (this should be done by taking account of the
potential problems that may arise in conducting future research)
❖ By making repeated attempts (at least 3 times) to contact study subjects who were absent at
the time of the initial visit.
b) The number of non-responses should be documented according to type, so as to facilitate an
assessment of the extent of bias introduced by non-response.
c) As much information as possible should be collected on non-respondents, so as to see in what
ways they may differ from respondents.
❖ Selection bias cannot be corrected by increasing the size of the sample, why? How do you
remove this type of bias?

6.6.2.4 SAMPLE SIZE DETERMINATION

❖ In planning any investigation we must decide how many people need to be studied in order to
answer the study objectives. If the study is too small we may fail to detect important effects,
or may estimate effects too imprecisely. If the study is too large then we will waste resources.
❖ In general, it is much better to increase the accuracy of data collection (by improving the
training of data collectors and data collection tools) than to increase the sample size after a
certain point.
❖ The eventual sample size is usually a compromise between what is desirable and what is
feasible.
❖ The feasible sample size is determined by the availability of resources. It is also important to
remember that resources are not only needed to collect the information, but also to analyze it.

In order to calculate the required sample size, you need to know the following facts:
a) The reasonable estimate of the key proportion to be studied. If you cannot guess the
proportion, take it as 50%.
b) The degree of accuracy required. That is, the allowed deviation from the true proportion in the
population as a whole. It can be within 1% or 5%, etc.
c) The confidence level required, usually specified as 95%.
d) The size of the population that the sample is to represent. If it is more than 10,000 the precise
magnitude is not likely to be very important; but if the population is less than 10,000 then a
smaller sample size may be required.
e) The difference between the two sub-groups and the value of the likelihood or the power that
helps in finding a statistically significant difference.
➢ Note that ‘e’ is required when there are two population groups and the interest is to
compare between two means or proportions.

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Estimating a proportion
❖ Estimate how big the proportion might be (P)
❖ Choose the margin of error you will allow in the estimate of the proportion (say ± w)
❖ Choose the level of confidence that the proportion in the whole population is indeed between
(p-w) and (p+w). We can never be 100% sure. Do you want to be 95% sure?
❖ The minimum sample size required, for a very large population (N>10,000) is:

no = Z2 p (1-p) / w2

Example 1 (Prevalence of diarrhoea)

a) p = 0.26 , w = 0.03 , Z = 1.96 ( i.e., for a 95% C.I.)

no = (1.96)2 (.26 × .74) / (.03)2 = 821.25 ≈ 822; Thus, the study should include at least 822
subjects.

b) If the above sample is to be taken from a relatively small population (say N = 3000), the required
minimum sample will be obtained from the above estimate by making some adjustment.
n = noN/{(no+(N-1)} = 821.25 / (1+ (821.25/3000)) = 644.7 ≈ 645 subjects

Example 2
A hospital administrator wishes to know what proportion of discharged patients is unhappy with the
care received during hospitalization. If 95% Confidence interval is desired to estimate the
proportion within 5%, how large a sample should be drawn?

no = Z2 p(1-p)/w2 =(1.96)2(.5×.5)/(.05)2 =384.2 ≈ 385 patients

N.B. If you don’t have any information about P, take it as 50% and get the maximum value of PQ
which is 1/4 (i.e., 25%).

Estimating a mean
The same approach is used but with SE = σ / √n = Standard error.
The required (minimum) sample size for a very large population is given by: no = Z2 σ2 / w2

Example: A health officer wishes to estimate the mean serum cholesterol in a population of men.
From previous similar studies a standard deviation of 40 mg/100ml was reported. If he is willing to
tolerate a marginal error of up to 5 mg/100ml in his estimate, how many subjects should be
included in his study?
(α =5%, two sided)

a) If the population size is assumed to be very large, the required sample size would be:
no = (1.96)2 (40)2 / (5)2 = 245.86 ≈ 246 persons
- If the population size is, say, 2000, the required sample size would be 220 persons.

b) If the investigator anticipates that 15% of the subjects will fail to comply with the intended
study, the sample size required will be: n = (1/(1-0.15)) x 246 = 290 men

NB: σ2 can be estimated from previous similar studies or could be obtained by conducting a small
pilot study.

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Comparison of two proportions

n (in each region) = (p1q1 + p2q2) (f(α, β)) / ((p1 - p2)²
α = type I error (level of significance)
β = type II error ( 1-β = power of the study)
power = the probability of getting a significant result
f(α,β) =10.5, when the power = 90% and the level of significance = 5%

E.g. The proportion of nurses leaving the health service is compared between two regions. In one
region 30% of nurses is estimated to leave the service within 3 years of graduation. In other region
it is probably 15%.

Solution: The required sample to show, with 90% likelihood (power), that the percentage of nurses
is different in these two regions would be: (assume a confidence level of 95%)

n = (1.28+1.96)2 ((.3×.7) + (.15 ×.85)) / (.30 - .15)2 = 158

158 nurses are required in each region

Comparison of two means (sample size in each group)

n = (s12 + s22) f (α, β) / (m1 - m2)2

m1 and s12 are mean and variance of group 1 respectively.

m2 and s22 are mean and variance of group 2 respectively.

N.B. Sample size calculation using the STATCALC calculator of the Epi Info program is
given in chapter 8.

6.6.2.5 PLAN FOR DATA COLLECTION

Why should you develop a plan for data collection?

A plan for data collection should be developed so that:
❖ You will have a clear overview of what tasks have to be carried out, who should perform
them, and the duration of these tasks;
❖ You can organize both human and material resources for data collection in the most efficient
way; and
❖ You can minimize errors and delays which may result from lack of planning (for example,
the population not being available or data forms being misplaced).
It is likely that while developing a plan for data collection you will identify problems (such as
limited manpower), which will require modification of the proposal. Such modifications might
include adjustment of the sample size or extension of the period for data collection.

Stages in the Data Collection Process

Three main stages can be distinguished:
Stage 1: Permission to proceed
Stage 2: Data collection
Stage 3: Data handling

Stage 1: PERMISSION TO PROCEED (Clearance)

Consent must be obtained from the relevant authorities, individuals and the community in which
the project is to be carried out. This may involve organizing meetings at national or provincial
level, at district and at village level. For clinical studies this may also involve obtaining written
informed consent.

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Stage 2: DATA COLLECTION

When collecting our data, we have to consider:
❖ Logistics: who will collect what, when and with what resources
❖ Quality control

I. Logistics of Data Collection

WHO will collect WHAT data?

When allocating tasks for data collection, it is recommended that you first list them. Then you may
identify who could best implement each of the tasks. If it is clear beforehand that your research
team will not be able to carry out the entire study by itself, you might plan to look for research
assistants to assist in relatively simple but time-consuming tasks.

HOW LONG will it take to collect the data for each component of the study?

Step 1: Consider:
❖ The time required to reach the study area(s);
❖ The time required to locate the study units (persons, groups, records). If you have to search
for specific informants (e.g., users or defaulters of a specific service) it might take more time
to locate informants than to interview them.
❖ The number of visits required per study unit. For some studies it may be necessary to visit
informants a number of times, for example if the information needed is sensitive and can only
be collected after informants are comfortable with the investigator or if observations have to
be made more than once (for example, follow-up of pregnant mothers or malnourished
children). Time needed for follow-up of non-respondents should also be considered.

Step 2: Calculate the number of interviews that can be carried out per person per day

Step 3: Calculate the number of days needed to carry out the interviews. For example:
❖ You need to do 200 interviews,
❖ Your research team of 5 people can do 5 x 4 = 20 interviews per day,
❖ You will need 200÷20 = 10 days for the interviews.

Step 4: Calculate the time needed for the other parts of the study, (for example, 10 days)

Step 5: Determine how much time you can devote to the study.
If the team has fewer days for fieldwork than the required, they would need additional research
assistants to help complete this part of the study.

Note: It is always advisable to slightly overestimate the period needed for data collection to allow
for unforeseen delays.

WHEN should the data be collected?

The type of data to be collected and the demands of the project will determine the actual time
needed for the data to be collected. Consideration should be given to:
❖ Availability of research team members and research assistants,
❖ The appropriate season(s) to conduct the field work (if the problem is season-related or if data
collection would be difficult during certain periods),
❖ Accessibility and availability of the sampled population, and
❖ Public holidays and vacation periods.

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II. Ensuring quality

It is extremely important that the data we collect are of good quality, that is, reliable and valid.
Otherwise we will come up with false or misleading conclusions.

Measures to help ensure good quality of data:

❖ Prepare a field work manual for the research team as a whole, including:
➢ Guidelines on sampling procedures and what to do if respondents are not available or
refuse to co-operate,
➢ A clear explanation of the purpose and procedures of the study which should be used to
introduce each interview, and
➢ Instruction sheets on how to ask certain questions and how to record the answers.
❖ Select your research assistants, if required, with care. Choose assistants that are:
➢ from the same educational level;
➢ knowledgeable concerning the topic and local conditions;
➢ not the object of study themselves; and
➢ Not biased concerning the topic (for example, health staff are usually not the best
possible interviewers for a study on alternative health practices).
❖ Train research assistants carefully in all topics covered in the field work manual as well as in
interview techniques and make sure that all members of the research team master interview
techniques such as:
➢ asking questions in a neutral manner;
➢ showing by words or expression what answers one expects;
➢ not showing agreement, disagreement or surprise; and
➢ Recording the answers precisely as they are provided, without sifting or interpreting
them.
❖ Pre-test research instruments and research procedures with the whole research team, including
research assistants.
❖ Take care that research assistants are not placed under too much stress (requiring too many
interviews a day; paying per interview instead of per day).
❖ Arrange for on-going supervision of research assistants. If, in case of a larger survey, special
supervisors have to be appointed, guidelines should be developed for supervisory tasks.
❖ Devise methods to assure the quality of data collected by all members of the research team.
For example, quality can be assured by:
➢ requiring interviewers to check whether the questionnaire is filled in completely before
finishing each interview;
➢ asking the supervisor to check at the end of each day during the data collection period
whether the questionnaires are filled in completely and whether the recorded information
makes sense; and
➢ Having the researchers review the data during the data analysis stage to check whether
data are complete and consistent.

Stage 3: DATA HANDLING

Once the data have been collected and checked for completeness and accuracy, a clear procedure
should be developed for handling and storing them. Decide if the questionnaires are to be
numbered; identify the person who will be responsible for storing the data; and how they are going
to be stored.

6.6.2.6 METHODS OF DATA COLLECTION

Having decided on how to design the research study, the next methodological design is how to
collect information. The most commonly used methods of collecting information (quantitative data)
are the use of documentary sources, interviews and self-administered questionnaires. The choice of
methods of data collection is based on:

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❖ The accuracy of information they will yield

❖ Practical considerations, such as, the need for personnel, time, equipment and other facilities,
in relation to what is available.

Accuracy and “practicability” are often inversely correlated. A method providing more satisfactory
information will often be a more expensive or inconvenient one. Therefore, accuracy must be
balanced against practical considerations (resources and other practical limitations)

The use of documentary sources

Clinical records and other personal records, death certificates, published mortality statistics, census
publications, etc.

Advantages:
❖ Documents can provide readymade information relatively easily
❖ The best means of studying past events.

Disadvantages:
❖ Problems of reliability and validity (because the information is collected by a number of
different persons who may have used different definitions or methods of obtaining data).
❖ There is a possibility that errors may occur when the information is extracted from the
records. (This may be an important source of unreliability if handwritings are difficult to
read.
❖ Since the records are maintained not for research purposes, but for clinical, administrative or
other ends, the information required may not be recorded at all, or only partly recorded.

Interviews and Self-Administered Questionnaires

Interviews may be less or more structured. A public health worker conducting interviews may be
armed with a checklist of topics, but may not decide in advance precisely what questions he will
ask. If his approach is flexible; the content, wording and order of his questions vary from interview
to interview. Hence, his interviews are relatively unstructured. On the other hand, if a more
standardized technique where the wording and order of the questions being decided in advance is
used, it may take the form of a highly structured interview.

Self-administered questionnaire: the respondent reads the questions and fills in the answers by
himself (sometimes in the presence of an interviewer who “stands by” to give assistance if
necessary. The use of self-administered questionnaires is simpler and cheaper, such questionnaires
can be administered to many persons simultaneously.
Example:
❖ to students of a school
❖ they can also be sent by post unlike interviews.
However, they demand a certain level of education on the part of the respondent.

On the other hand, interviews have many advantages:

❖ A good interviewer can stimulate and maintain the respondents interest in the frank answering
of questions.
❖ If anxiety is aroused (e.g., why am I being asked these questions?), the interviewer can allay
it.
❖ An interviewer can repeat questions which are not understood, and give standardized
explanations where necessary.
❖ An interviewer can ask “follow-up” or “probing” questions to clarify a response.
❖ An interviewer can make observations during the interview; i.e.,, note is taken not only of
what the subject says but also how he says it.

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In general, apart from their expense, interviews are preferable to self-administered questionnaires
provided that they are conducted by skilled interviewers. While interviewing, a precaution should
be taken not to influence the responses; the interviewer should ask his questions in a neutral
manner. He should not show agreement, disagreement, or surprise, and should record the
respondent’s precise answers without shifting or interpreting them.

Questionnaire Design
Questions may take two general forms: they may be “Open ended” questions, which the subject
answers in his own words, or “closed” questions, which are answered by choosing from a number
of fixed alternative responses.

In questionnaire design remember to:

1. Use familiar and appropriate language
2. Avoid abbreviations, double negatives, etc.
3. Avoid two elements to be collected through one question
4. Pre-code the responses to facilitate data processing
5. Avoid embarrassing and painful questions
6. Watch out for ambiguous wording
7. Avoid language that suggests a response
8. Start with simpler questions
9. Ask the same question to all respondents
10. Provide other, or don’t know options where appropriate
11. Provide the unit of measurement for continuous variables (Years, Months, Kgs, etc)
12. For open ended questions, provide sufficient space for the response
13. Arrange questions in logical sequence
14. Group questions by topic, and place a few sentences of transition between topics
15. Provide complete training for interviewers
16. Pretest the questionnaire on 20-50 respondents in actual field situation
17. Check all filled questionnaire at field level
18. Include “thank you” after the last question

Importance of combining different data-collection techniques

A skillful use of a combination of different data-collection techniques can maximize the quality of
the data collected and reduce the chance of bias. Investigators often use a combination of flexible
and less flexible research techniques. Flexible techniques, such as, loosely structured interviews
using open-ended questions and focus group discussions are called qualitative research techniques.
They produce qualitative information, which is often recorded in narrative form. Structured
questionnaires that enable the researcher to quantify pre- or post-categorized answers to questions
are an example of quantitative research techniques. The answers too can be counted and expressed
numerically. Both qualitative and quantitative research techniques are often used within a single
study.

Methods of collecting qualitative data

Qualitative approaches to data collection usually involve direct interaction with individuals on a
one to one basis or in a group setting. Data collection methods are time consuming and
consequently data is collected from smaller numbers of people than would usually be the case in
quantitative approaches such as the questionnaire survey. The benefits of using these approaches
include richness of data and deeper insight into the phenomena under study. Unlike quantitative
data, raw qualitative data cannot be analyzed statistically. The data from qualitative studies often
derives from face-to-face interviews, focus groups or observation and so tends to be time
consuming to collect. Samples are usually smaller than with quantitative studies and are often
locally based. Data analysis is also time consuming and consequently expensive.

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The main methods of collecting qualitative data are: individual interviews, focus groups and
observation

Qualitative Interviews
Qualitative interviews are semi structured or unstructured. If the interview schedule is too tightly
structured this may not enable the phenomena under investigation to be explored in terms of either
breadth or depth. Semi structured interviews tend to work well when the interviewer has already
identified a number of aspects he wants to be sure of addressing. The interviewer can decide in
advance what areas to cover but is open and receptive to unexpected information from the
interviewee. This can be particularly important if a limited time is available for each interview and
the interviewer wants to be sure that the "key issues" will be covered.

Semi structured interviews (sometimes referred to as focused interviews) involve a series of open
ended questions based on the topic areas the researcher wants to cover. The open ended nature of
the question defines the topic under investigation but provides opportunities for both interviewer
and interviewee to discuss some topics in more detail. If the interviewee has difficulty answering a
question or provides only a brief response, the interviewer can use cues or prompts to encourage
the interviewee to consider the question further. In a semi structured interview the interviewer also
has the freedom to probe the interviewee to elaborate on the original response or to follow a line of
inquiry introduced by the interviewee.

Unstructured interviews (referred to as "depth" or "in depth" interviews) have very little structure
at all. The interviewer goes into the interview with the aim of discussing a limited number of
topics, sometimes as few as one or two, and frames the questions on the basis of the interviewee's
previous response. Although only one or two topics are discussed they are covered in great detail.
Subsequent questions would depend on how the interviewee responded. Unstructured interviews
are exactly what they sound like - interviews where the interviewer wants to find out about a
specific topic but has no structure or preconceived plan or expectation as to how they will deal with
the topic. The difference with semi structured interviews is that in a semi structured interview the
interviewer has a set of broad questions to ask and may also have some prompts to help the
interviewee but the interviewer has the time and space to respond to the interviewees’ responses.

Qualitative interviews should be fairly informal. Interviewees should feel as though they are
participating in a conversation or discussion rather than in a formal question and answer situation.
However, achieving this informal style is dependent on careful planning and on skill in conducting
the interview.

Focus Group Discussion

Sometimes it is preferable to collect information from groups of people rather than from a series of
individuals. Focus groups can be useful to obtain certain types of information or when
circumstances would make it difficult to collect information using other methods to data collection.

I. Characteristics and uses of focus group discussions

A focus group discussion (FGD) is a group discussion of 6-12 persons guided by a facilitator,
during which group members talk freely and spontaneously about a certain topic. The purpose of an
FGD is to obtain in-depth information on concepts, perceptions, and ideas of the group. It aims to
be more than a question-answer interaction.

FGD techniques can be used to:

a) Develop relevant research hypotheses by exploring in greater depth the problem to be
investigated and its possible causes.
b) Formulate appropriate questions for more structured, larger scale surveys.

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c) Supplement information on community knowledge, beliefs, attitudes, and behaviour already

available but incomplete or unclear.
d) FGDs are not used to test hypotheses or to produce research findings that can be generalized.

II. Conducting a Focus Group Discussion

Recruitment of participants: Participants should be roughly of the same socioeconomic group or

have a similar background in relation to the issue under consideration. The age and sex composition
of the group should facilitate free discussion. If we need to obtain information on a topic from
several different categories of informants who are likely to discuss the issue from different
perspectives, we should organize a focus group for each category. For example, a group for men
and a group for women

Physical arrangements: Communication and interaction during the FGD should be encouraged in
every possible way. Arrange the chairs in a circle. Make sure the area will be quiet, adequately
lighted, etc., and that there will be no disturbances.

Preparation of a discussion guide: There should be a written list of topics to be covered.

It can be formulated as a series of open-ended questions.

During the discussion: One of the members of the research team should act as a "facilitator" for
the focus group. One should serve as "recorder."

Functions of the facilitator:

❖ Introduce the session
❖ Encourage discussion
❖ Encourage involvement
❖ Listen carefully and move the discussion from topic to topic.
❖ Subtly control the time allocated to various topics so as to maintain interest.
❖ Take time at the end of the meeting to summarize, check for agreement and thank the
participants.
❖ In general, the facilitator should not act as an expert on the topic.
❖ His or her being there is to stimulate and support discussion.

Report writing in focus group discussions: Start with a description of the selection and
composition of the groups of participants and a commentary on the group process, so the reader can
assess the validity of the reported findings. Present your findings, following your list of topics and
guided by the objective(s) of your FGD. Include questions whenever possible, particularly for key
statements.

The method of data collection chosen for a study should be appropriate for the type of information
required. Whether the required information is quantitative or qualitative in nature is the major
consideration. It would be time wasting to use unstructured interviews for essentially quantitative
studies where information could be more efficiently collected through structured interviews or
questionnaires. Conversely, self completed questionnaires are generally unsuited to qualitative
research: even when there is space for comments or for respondents to express ideas the space is
limited and requires respondents to have skills in articulation and literacy.

Observation
Not all qualitative data collection approaches require direct interaction with people. It is a technique
that can be used when data collected through other means can be of limited value or is difficult to
validate. For example, in interviews participants may be asked about how they behave in certain

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situations but there is no guarantee that they actually do what they say they do. Observing them in
those situations is more reliable: it is possible to see how they actually behave. Observation can
also serve as a technique for verifying or nullifying information provided in face to face encounters.
In some research observation of people is not required but observation of the environment. This can
provide valuable background information about the environment where a research project is being
undertaken. For example, an action research project involving an institution may be enhanced by
some description of the physical features of the building.

Bias in Information Collection

BIAS in information collection is a distortion in the collected data so that it does not represent
reality.

Possible sources of bias during data collection:

1. Defective instruments, such as:

❖ Questionnaires with:
➢ fixed or closed questions on topics about which little is known (often asking the ‘wrong
things’);
➢ open-ended questions without guidelines on how to ask (or to answer) them;
➢ vaguely phrased questions;
➢ ‘leading questions’ that cause the respondent to believe one answer would be preferred
over another; or
➢ questions placed in an illogical order.
❖ Weighing scales or other measuring equipment that are not standardized.

These sources of bias can be prevented by carefully planning the data collection process and by
pre-testing the data collection tools.

2. Observer bias:
Observer bias can easily occur when conducting observations or utilizing loosely structured group-
or individual interviews. There is a risk that the data collector will only see or hear things in which
(s)he is interested or will miss information that is critical to the research. Observation protocols and
guidelines for conducting loosely structured interviews should be prepared, and training and
practice should be provided to data collectors in using both these tools. Moreover it is highly
recommended that data collectors work in pairs when using flexible research techniques and
discuss and interpret the data immediately after collecting it. Another possibility - commonly used
by anthropologists - is using a tape recorder and transcribing the tape word by word.

3. Effect of the interview on the informant:

This is a possible factor in all interview situations. The informant may mistrust the intention of the
interview and dodge certain questions or give misleading answers. For example: in a survey on
alcoholism you ask school children: ‘Does your father sometimes get drunk?’ Many will probably
deny that he does, even if it is true. Such bias can be reduced by adequately introducing the purpose
of the study to informants, by phrasing questions on sensitive issues in a positive way, by taking
sufficient time for the interview, and by assuring informants that the data collected will be
confidential. It is also important to be careful in the selection of interviewers. In a study soliciting
the reasons for the low utilization of local health services, for example, one should not ask health
workers from the health centres concerned to interview the population. Their use as interviewers
would certainly influence the results of the study.

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4. Information bias:
Sometimes the information itself has weaknesses. Medical records may have many blanks or be
unreadable. This tells something about the quality of the data and has to be recorded. For example,
in a TB defaulter study the percentage of defaulters with an incomplete or missing address should
be calculated. Another common information bias is due to gaps in people’s memory; this is called
memory or recall bias. A mother may not remember all details of her child’s last diarrhoea episode
and of the treatment she gave two or three months afterwards. For such common diseases it is
advisable to limit the period of recall, asking, for example, ‘Has your child had diarrhoea over the
past two weeks?’

Data quality checks at the time of the interview:

There are several ways of checking the quality of data. Some are given below:
❖ To examine consistency of data, two or more questions are asked at the beginning and these
same questions are asked at the end. This helps to find out their consistency in the response.
❖ Repeat the question in another form to avoid doubts
❖ Use strict supervision and checking on the spot and re-interviewing
❖ For data completeness, check right at the end of the interview
❖ Check for odd answers given

Confidentiality of information
❖ Should be stated right on the top of the first page of the questionnaire
❖ If possible, use code numbers instead of names
❖ The purpose of the study should be explained at the beginning
❖ The respondent has the right not to be interviewed

6.6.2.7 PLAN FOR DATA PROCESSING AND ANALYSIS

Data processing and analysis should start in the field, with checking for completeness of the data
and performing quality control checks, while sorting the data by instrument used and by group of
informants. Data of small samples may even be processed and analyzed as soon as it is collected.

Why is it necessary to prepare a plan for processing and analysis of data?

Such a plan helps the researcher assure that at the end of the study:
❖ all the information (s)he needs has indeed been collected, and in a standardized way;
❖ (s)he has not collected unnecessary data which will never be analyzed.

The plan for data processing and analysis must be made after careful consideration of the objectives
of the study as well as of the tools developed to meet the objectives. The procedures for the
analysis of data collected through qualitative and quantitative techniques are quite different.
❖ For quantitative data the starting point in analysis is usually a description of the data for
each variable for all the study units included in the sample. Processing of data may take place
during data collection or when all data has been collected; description and analysis are usually
carried out after the fieldwork has been completed.
❖ For qualitative data it is more a matter of describing, summarizing and interpreting the data
obtained for each study unit (or for each group of study units). Here the researcher starts
analyzing while collecting the data so that questions that remain unanswered (or new
questions which come up) can be addressed before data collection is over.
Preparation of a plan for data processing and analysis will provide you with better insight into the
feasibility of the analysis to be performed as well as the resources that are required. It also provides
an important review of the appropriateness of the data collection tools for collecting the data you
need. That is why you have to plan for data analysis before the pretest. When you process and
analyze the data you collect during the pre-test you will spot gaps and overlaps which require
changes in the data collection tools before it is too late!

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What should the plan include?

When making a plan for data processing and analysis the following issues should be considered:
❖ Sorting data,
❖ Performing quality-control checks,
❖ Data processing, and
❖ Data analysis.

Sorting data
An appropriate system for sorting the data is important for facilitating subsequent processing and
analysis. If you have different study populations (for example village health workers, village health
committees and the general population), you obviously would number the questionnaires
separately.

In a comparative study it is best to sort the data right after collection into the two or three groups
that you will be comparing during data analysis.
For example, in a study concerning the reasons for low acceptance of family planning services,
users and non-users would be basic categories;

In a case control study obviously the cases are to be compared with the controls. It is useful to
number the questionnaires belonging to each of these categories separately right after they are
sorted.
For example, the questionnaires administered to users of family planning services could be
numbered U1, U2, U3, etc., and those for the non-users N1, N2, N3, etc.

Performing quality control checks

Usually the data have already been checked in the field to ensure that all the information has been
properly collected and recorded. Before and during data processing, however, the information
should be checked again for completeness and internal consistency. If a questionnaire has not been
filled in completely you will have MISSING DATA for some of your variables. If there are many
missing data in a particular questionnaire, you may decide to exclude the whole questionnaire from
further analysis.
❖ If an inconsistency is clearly due to a mistake made by the researcher/research assistant (for
example if a person in an earlier question is recorded as being a nonsmoker, whereas all other
questions reveal that he is smoking), it may still be possible to check with the person who
conducted the interview and to correct the answer.
❖ If the inconsistency is less clearly a mistake in recording, it may be possible (in a small scale
study) to return to the respondent and ask for clarification.
❖ If it is not possible to correct information that is clearly inconsistent, you may consider
excluding this particular part of the data from further processing and analysis as it will affect
the validity of the study. If a certain question produces ambiguous or vague answers
throughout, the whole question should be excluded from further analysis. (Normally,
however, you would discover such a problem during the pre-test and change the wording of
the question.)

For computer data analysis, quality control checks of data must also include a verification of how
the data has been transformed into codes and subsequently entered into the computer. The same
applies if data are entered into master sheets.

Data processing – quantitative data

Decide whether to process and analyse the data from questionnaires:
❖ manually, using data master sheets or manual compilation of the questionnaires, or

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❖ By computer, for example, using a micro-computer and existing software or self-written

programmes for data analysis.

Data processing in both cases involves:

❖ categorizing the data,
❖ coding, and
❖ Summarizing the data in data master sheets, manual compilation without master sheets, or
data entry and verification by computer.

1. Categorizing
Decisions have to be made concerning how to categorize responses. For categorical variables that
are investigated through closed questions or observation, the categories have been decided upon
beforehand. In interviews the answers to open-ended questions (for example, ‘why do you visit the
health centre?’) can be pre-categorized to a certain extent, depending on the knowledge of possible
answers that may be given. However, there should always be a category called ‘Others, specify . . .’
which can only be categorized afterwards. These responses should be listed and placed in
categories that are a logical continuation of the categories you already have. Answers that are
difficult or impossible to categorize may be put in a separate residual category called ‘others’, but
this category should not contain more than 5% of the answers obtained.

For numerical variables, the data are often better collected without any pre-categorization. If you
do not exactly know the range and the dispersion of the different values of these variables when
you collect your sample (e.g., home-clinic distance for out-patients, or income), decisions
concerning how to categorize and code the data at the time you develop your tools may be
premature. If you notice during data analysis that your categories had been wrongly chosen you
cannot reclassify the data anymore.

2. Coding
If the data will be entered in a computer for subsequent processing and analysis, it is essential to
develop a CODING SYSTEM. For computer analysis, each category of a variable can be coded
with a letter, group of letters or word, or be given a number. For example, the answer ‘yes’ may be
coded as ‘Y’ or 1; ‘no’ as ‘N’ or 2 and ‘no response’ or ‘unknown’ as ‘U’ or 9. The codes should
be entered on the questionnaires (or checklists) themselves. When finalizing your questionnaire, for
each question you should insert a box for the code in the right margin of the page. These boxes
should not be used by the interviewer. They are only filled in afterwards during data processing.
Take care that you have as many boxes as the number of digits in each code.

Coding conventions
Common responses should have the same code in each question, as this minimizes mistakes by
coders.
For Example:
Yes (Positive response Code - Y or 1
No (negative response) Code - N or 2
Don’t know Code - D or 8
No response/unknown Code - U or 9

Codes for open-ended questions (in questionnaires) can be done only after examining a sample of
(say 20) questionnaires. You may group similar types of responses into single categories, so as to
limit their number to at most 6 or 7. If there are too many categories it is difficult to analyze the
data.

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3. Summarizing the data in data master sheets, manual compilation, or compilation by

computer

(1) Data master sheets

If data are processed by hand, it is often most efficient to summaries the raw research data in a so-
called DATA MASTER SHEET, to facilitate data analysis. On a data master sheet all the answers of
individual respondents are entered by hand. To illustrate the use of master sheets, we will give an
example of a rapid appraisal carried out by students of a nursing school about the smoking habits of
the inhabitants of their town. The questionnaire had only 17 questions, of which 9 were asked of
everyone, 4 exclusively to smokers and 4 exclusively to non-smokers. It was therefore decided to
process the data by hand, divided in two groups: smokers and non-smokers, which were again
subdivided in males and females. For each of the four groups, master sheets were prepared, on
which all the answers of individual respondents could be recorded. Master sheets can be made in
different ways. For short simple questionnaires you may put all possible answers for each question
in headers at the top of the sheet and then list or tick the answers of the informants one by one in
the appropriate columns.

For example, the straightforward answers of the smoking questionnaire for male smokers could be
processed as follows:

Master sheet for smokers (males)

Note that for age and number of cigarettes smoked both the raw data and the categories have been
entered. This makes it easier to control for coding mistakes and allows for calculating averages.
There are 31 male smokers; if there are less than 31 answers, there must be some non-responders
(NR), as happened in Q9, or a mistake was made.
If you work with two persons; one reading and the other writing, the risk of mistakes will be
reduced, as you can discuss the answers and control for mistakes while filling in the data.
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(2) Compilation by hand (without using master sheets)

When the sample is small (say less than 30) and the collected data is limited, it might be more
efficient to do the compilation manually. Certain procedures will help ensure accuracy and speed.

1. If only one person is doing the compilation use manual sorting. If a team of 2 persons work
together use either manual sorting or tally counting.

2. To do manual sorting the basic procedure is to:

❖ Take one question at a time, for example, ‘use of health facility’,
❖ Sort the questionnaires into different piles representing the various responses to the question,
e.g., hospital/ health centre/ traditional practitioners) and
❖ Count the number in each pile.

When you need to sort out subjects who have a certain combination of variables (e.g. females who
used each type of health facility) sort the questionnaires into piles according to the first question
(gender), then subdivide the piles according to the response to the other question (use of health
facility).

3. To do tally counting the basic procedure is:

❖ One member of the compiling team reads out the information while the other records it in the
form of a tally (e.g., /// representing 3 subjects, //// representing 4 subjects who present a
particular answer).
❖ Tally count for no more than two variables at one time (e.g., sex plus type of facility used). If
it is necessary to obtain information on 3 variables (e.g., sex by time of attending a health
facility by diagnosis), do a manual sorting for the first question, then tally count for the other
two variables.
❖ After tally counting, add the tallies and record the number of subjects in each group.

4. After doing either manual or tally counting, check the total number of subjects/responses in each
question to make sure that there has been no omission or double count.

Note: One can tally in two ways: using strokes or squares (illustrate here). The latter way is
preferable as it reduces the possibility of error.
It should be noted that hand tallying is often used in combination with master sheet analysis when
the relationship between two or three variables needs to be established, or details analyzed.

(3) Computer compilation

Before you decide to use a computer, you have to be sure that it will save time or that the quality of
the analysis will benefit from it. Note that feeding data into a computer costs time and money. The
computer should not be used if your sample is small and the data is mainly generated by open
questions (qualitative data), unless there is a resource person who is competent in using a program
for qualitative data analysis. The larger the sample, the more beneficial in general the use of a
computer will be. Computer compilation consists of the following steps:
1. Choosing an appropriate computer program
2. Data entry
3. Verification or validation of the data
4. Programming (if necessary)
5. Computer outputs/prints

i. Choosing an appropriate computer program

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The identification of an appropriate statistical package is the first step in using a computer. Some
examples of packages commonly used are: Epi Info, SPSS, STATA, etc.

ii. Data entry

To enter data into the computer you have to develop a data entry format, depending on the program
you are using. After deciding on a data entry format, the information on the data collection
instrument will have to be coded (e.g., Male: M or 1, Female: F or 2). During data entry, the
information relating to each subject in the study is keyed into the computer in the form of the
relevant code.

iii. Verification
During data entry, mistakes will definitely creep in. The computer can print out the data exactly as
it has been entered, so the printout can be checked visually for obvious errors, (e.g., exceptionally
long or short lines, blanks that should not be there, alphabetic codes where numbers are expected,
obviously wrong codes).
Example:
❖ Codes 3-8 in the column for sex where only 1(F) and 2 (M) are possible
❖ Codes above 250 when you had only 250 subjects

If possible, computer verification should be built in. This involves giving the appropriate
commands to identify errors.
Example: The computer can be instructed to identify and print out all subjects where the ‘sex’
column has a code different from 1 (F) or 2 (M).

iv. Programming
A certain amount of basic knowledge of computer programming is needed to give the appropriate
commands.

v. Computer outputs
The computer can do most of the analysis and the results can be printed. It is important to decide
whether each of the tables, graphs, and statistical tests that can be produced makes sense and should
be used in your report. That is why we PLAN the data analysis BEFOREHAND!

Data analysis – quantitative data

Analysis of quantitative data involves the production and interpretation of frequencies, tables,
graphs, etc., that describe the data.

1. Frequency counts
From the data master sheets, simple tables can be made with frequency counts for each variable. A
frequency count is an enumeration of how often a certain measurement or a certain answer to a
specific question occurs.
For example, Smokers 51; Non-smokers 93; Total 144

If numbers are large enough it is better to calculate the frequency distribution in percentages
(relative frequencies): 51/144 x 100 = 35% are smokers and 93/144 x 100 = 65% nonsmokers.
This makes it easier to compare groups than when only absolute numbers are given. In other words,
percentages standardize the data.

It is usually necessary to summarise the data from numerical variables by dividing them into
categories. This process may include the following steps:
(1) Inspect all the figures: What is their range? (The range is the difference between the largest and
the smallest measurement.)

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(2) Divide the range into three to five categories. You can either aim at having a reasonable number
in each category (e.g. 0-2 km, 3-4 km, 5-9 km, 10+ km for home-clinic distance) or you can define
the categories in such a way that they are each equal in size (e.g., 20-29 years, 30-39 years, 40-49
years, etc.). Sometimes one looks actively for a ‘critical’ value, when making different categories.
For example, in a study relating family income to prevalence of diarrhoea over a certain period,
there appeared to be no statistical relation when income was arbitrarily subdivided into four
categories. When the average income was calculated, however, this appeared to be a critical value.
The children in families with an income above average had had significantly less diarrhoea than the
children in families with an income below average.

(3) Construct a table indicating how data are grouped and count the number of observations in each
group.

2. Cross-tabulations
Further analysis of the data usually requires the combination of information on two or more
variables in order to describe the problem or to arrive at possible explanations for it. For this
purpose it is necessary to design CROSS-TABULATIONS.
Depending on the objectives and the type of study, two major kinds of cross-tabulations may be
required:
❖ Descriptive cross-tabulations that aim at describing the problem under study.
❖ Analytic cross-tabulations in which groups are compared in order to determine differences, or
which focus on exploring relationships between variables.
When the plan for data analysis is being developed, the data, of course, are not yet available.
However, in order to visualize how the data can be organized and summarized it is useful at this
stage to construct so-called DUMMY cross-tabulations.

A DUMMY TABLE contains all elements of a real table, except that the cells are still empty. In a
research proposal dummy tables should be prepared to describe the study population in order to
show the crucial relationships between variables.

Some practical hints when constructing tables:

❖ If a dependent and an independent variable are cross-tabulated, the headings of the dependent
variable are usually placed horizontally, and the headings of the independent variable
vertically.
❖ All tables should have a clear title and clear headings for all rows and columns.
❖ All tables should have a separate row and a separate column for totals to enable you to check
if your totals are the same for all variables and to make further analysis easier.
❖ All tables related to a certain objective should be numbered and kept together so the work can
be easily organized and the writing of the final report will be simplified.

To further analyse and interpret the data, certain calculations or statistical procedures must usually
be completed. Especially in large cross-sectional surveys and in comparative studies, statistical
procedures are necessary if the data are to be adequately interpreted. Statistical tests should, for
example, indicate whether differences are true differences or due to chance. When conducting such
studies it is advisable to consult a person with statistical knowledge from the start in order that:
❖ correct sampling methods are used and an appropriate sample size is selected;
❖ decisions on coding are made that will facilitate data processing and analysis; and
❖ a clear understanding is reached concerning plans for data processing, analysis and
interpretation, including agreement concerning which variables need to be cross-tabulated.
Processing and analysis of qualitative data

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Qualitative data may be collected through open-ended questions in self-administered

questionnaires, in individual interviews or focus group discussions or through observations during
fieldwork. We will concentrate here on the analysis of responses obtained from open-ended
questions in interviews or self-administered questionnaires. Commonly solicited data in open-
ended questions include:
❖ opinions of respondents on a certain issue;
❖ reasons for a certain behaviour; and
❖ descriptions of certain procedures, practices or perceptions with which the researcher is not
familiar.

The data can be analyzed in seven steps:

Step 1: Take a sample of (say 20) questionnaires and list all answers for a particular question. Take
care to include the source of each answer you list (in the case of questionnaires you can use the
questionnaire number), so that you can place each answer in its original context, if required.

Step 2: To establish your categories, you first read carefully through the whole list of answers.
Then you start giving codes (A, B, C, for example or key words) for the answers that you think
belong together in one category, and write these codes in the left margin. Use a pencil so that it is
easy to change the categories if you change your mind.

Step 3: List the answers again, grouping those with the same code together.

Step 4: Then interpret each category of answers and try to give it a label that covers the content of
all answers. In the case of data on opinions, for example, there may be only a limited number of
possibilities, which may range from (very) positive, neutral, to (very) negative.
Data on reasons may require different categories depending on the topic and the purpose of your
question. After some shuffling you usually end up with 5 to 7 categories.

Step 5: Now try a next batch of 20 questionnaires and check if the labels work. Adjust the
categories and labels, if necessary.

Step 6: Make a final list of labels for each category and give each label a code (keyword, letter or
number).

Step 7: Code all your data, including what you have already coded, and enter these codes in your
master sheet or in the computer.

Note again that you may include a category ‘others’, but that it should be as small as possible,
preferably used for less than 5% of the total answers. If you categories your responses to open-
ended questions in this way you can:
❖ Analyze the content of each answer given in particular categories, for example, in order to
plan what actions should be taken (e.g., for health education). Gaining insight in a problem, or
in possible interventions for a problem, is the most important function of qualitative data.
❖ Report the number and percentage of respondents that fall into each category; so that you gain
insight in the relative weight of different opinions or reasons.

Questions that ask for descriptions of procedures, practices, or beliefs usually do not provide
quantifiable answers (though you may quantify certain aspects of them). The answers rather form
part of a jigsaw puzzle that you have to put together in order to obtain insight in your problem/topic
under study.

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IN CONCLUSION, a plan for the processing and analysis of data may include:
❖ a decision on whether all or some parts of the data should be processed by hand or computer;
❖ dummy tables for the description of the problem, the comparison of groups (if applicable)
and/or the establishment of relationships between variables, guided by the objectives of the
study;
❖ a decision on the sequence in which tables or data from different study populations should be
analyzed;
❖ a decision on how qualitative data should be analyzed;
❖ an estimate of the total time needed for analysis and how long particular parts of the analysis
will take;
❖ a decision concerning whether additional staff will be required for the analysis; and
❖ an estimate of the total cost of the analysis.

6.7 ETHICAL CONSIDERATIONS

Why do we need ethical approval? Before you embark on research with human subjects, you are
likely to require ethical approval. You may wonder why all this bureaucracy is needed. But history
shows us that prior to the development of ethical and human rights over the last 40 years, patients’
rights were often ignored and many individuals were seriously harmed by medical experimentation.
❖ Atrocities committed during World War II in the Nazi Germany which led to the 1947
Nuremberg Code of Practice and in turn the 1964 Declaration of Helsinki
❖ Tuskegee Syphilis Study in USA (1932-1970s) to study the long-term effects of untreated
syphilis- 400 men out of the 600 participants were never told about the infection and were
never treated despite the fact that treatment became available
❖ A study to examine the natural progression of cervical carcinoma in New Zealand (1980s)-
conventional treatment was withheld from women in trial and women were not asked for their
consent.

Ethical decisions are based on three main approaches: duty, rights and goal-based. The goal-based
approach assumes that we should try to produce the greatest possible balance of value over
disvalue. Discomfort to one individual may be justified by the consequences for the society as a
whole. According to the duty-based approach, your duty as a researcher is founded on your own
moral principles. As a researcher, you will have a duty to yourself and to the individual who is
participating in the research. So even if the outcome of the proposed research is for a good cause, if
it involves the researcher lying or deceiving his subjects in some way, then this would be regarded
as unethical. In the rights-based approach, the rights of the individual are assumed to be all-
important, thus a subject’s right to refuse must be upheld whatever the consequences for the
research. Research studies should be judged ethically on three sets of criteria, namely: ethical
principles, ethical rules, and also scientific criteria. The latter is often neglected but is important
since if a study is poor or the sample size insufficient then the study is not capable of demonstrating
anything and consequently could be regarded as unethical.

Ethical principles

Autonomy- we ought to respect the right to self-determination: In research autonomy is protected

by ensuring that any consent to participate in the study is informed or real. This means it is not
enough to explain something about your project to a particular subject, it is the understanding and
free choice whether or not to participate that is the key issue. There must be no coercion of any
sort.

Non-Malfeasance- we ought not to inflict evil or harm: This principle states that we may not
inflict harm on or expose people to unnecessary risk as a result of our research project. This is

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particularly important if our subjects may not be competent in some way, such as, the ability to
give informed consent.

Beneficence – we ought to further others’ legitimate interests: This is the principle that obliges us
to take positive steps to help others pursue their interests.
These interests clearly have to be legitimate.

Justice-we ought to ensure fair entitlement to resources: This principle is concerned with people
receiving their due. This means people should be treated equally in every way since not all people
are equally competent or equally healthy.

Ethical rules
The ethical rules of research, like principles, are not absolute in that one may override another
although clearly this must be justified. These rules are essential for the development of trust
between researchers and study participants. Like the ethical principles on which the rules are based,
there are four:

Veracity (truthfulness): All subjects in any research project should always be told the truth. There
is no justification for lying, but this is not the same non-disclosure of information should it, in
particular, invalidate the research.

Privacy: When subjects enroll in a research study, they grant access to themselves, but this is not
unlimited access. Access is a broad term and generally includes viewing, touch or having
information about them.

Confidentiality: Although someone may grant limited access to him or herself, they may not
relinquish control over any information obtained. Certainly, no information obtained with the
patient’s or subject’s permission from their medical records should be disclosed to any third person
without that individual’s consent. This applies to conversations too.

Fidelity: Fidelity means keeping our promises and avoiding negligence with information. If we
agree for example, to send a summary of our research findings to participants in a study we should
do so.

Applying to ethics committee

Remember that the key questions that the Ethics Committee will be asking are:
❖ Is the research valid?
➢ How important is the research question?
➢ Can the question be answered?
❖ Is the welfare of the research subject under threat?
➢ What will participating involve?
➢ Are the risks necessary and acceptable?
❖ Is the dignity of the research subject upheld?
➢ Will consent be sought?
➢ Will confidentiality be respected?

6.8 PRETEST OR PILOT STUDY

Before the collection of data can be started, it is necessary to test the methods and to make various
practical preparations. Pretests or pilot studies allow us to identify potential problems in the
proposed study.
❖ A pretest usually refers to a small-scale trial of a particular research component.

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❖ A pilot study is the process of carrying out a preliminary study, going through the entire
research procedure with a small sample.

Pretesting is: Simpler; less time consuming; and less costly than conducting an entire pilot study.
Therefore, pretesting is recommended as an essential step in the development of the research
projects. It is useful in examining the practicability, reliability and suitability of the method. The
comments of the respondents will help in improving the sequence and layout of the questionnaire. It
is also important to know the time taken by the interview. In a community study, cooperation can
be enhanced by suitable public relations and preparatory educational work in the community. The
best results are provided by contacts with key individuals and organizations in the community.

6.9 EXERCISES
1. Identify the most appropriate study design for the research proposal you are planning to
develop.
2. Describe the various data collection techniques and state their uses and limitations.
3. State the differences between quantitative and qualitative research methods by giving
appropriate examples.
4. A nutritionist wants to determine the prevalence of malnutrition among children under 5 in
the Southwest region. If a sample of 3000 children is required, what is the sampling technique
he should use to select the required subjects? Write a short note on the procedures (steps) he
should follow in selecting these subjects.
5. In a school there are about 1800 students and the investigator wants to determine the
prevalence of a certain character (eg. KAP on HIV/AIDS) by taking 450 students). The
following table gives the distribution of students by grade and number of sections.

Grade Number of Number of

Students Sections a) What type of sampling
9 600 8 technique do you use? Why?
10 500 7
11 400 6 b) How do you select the subjects
12 300 5 who will be included in your
Total 1 800 26 sample?

6. A multi-national clinical trial is proposed to investigate the value of a gradually increasing

dose schedule of a beta blocker in the treatment of severe heart failure. The trial will be
randomized, double-blind and placebo controlled. Each patient is to be followed for 2 years,
and the main treatment comparison is for all cause mortality. Previous experience suggests a 2
year mortality rate of around 30%. The investigators propose that a one-third reduction in
mortality due to beta-blockade would be important to detect. They suggest that type I and
type II errors be set at .05 and .1, respectively.
a) Calculate the required number of patients to be recruited.
b) Suppose one anticipates that 10% of patients randomized to beta-blockade will fail to
comply with the intended treatment policy. What change in required sample size would
you suggest?
7. Prepare your data-collection tools, taking care that you cover all important variables of your
proposed study.

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CHAPTER SEVEN
WORK PLAN AND BUDGET

7.1 WORK PLAN

A WORK PLAN is a schedule, chart or graph that summarizes the different components of a
research project and how they will be implemented in a coherent way within a specific time span. It
may include:
❖ The tasks to be performed;
❖ When and where the tasks will be performed; and
❖ Who will perform the tasks and the time each person will spend on them.

Work plan could be presented in different forms, such as work schedule and GANTT chart
(developed in the Early 20th century. After the U.S. engineer H. L. Gantt (1861-1919)), but we will
demonstrate the GANTT chart here. A GANTT chart is a planning tool that depicts graphically the
order in which various tasks must be completed and the duration of each activity. The length of
each task is shown by a bar that extends over the number of days, weeks or months the task is
expected to take.

How can a work plan be used?

A work plan can serve as:
❖ A tool for planning the details of the project activities and drafting a budget.
❖ A visual outline or illustration of the sequence of project operations. It can facilitate
presentations and negotiations concerning the project with government authorities and other
funding agencies.
❖ A management tool for the Team Leader and members of the research team, showing what
tasks and activities are planned, their timing, and when various staff members will be
involved in various tasks.
❖ A tool for monitoring and evaluation, when the current status of the project is compared to
what had been foreseen in the work plan.

Example of Gantt chart

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7.2 BUDGET
Why do we need to design a budget? A detailed budget will help you to identify which resources
are already locally available and which additional resources may be required. The process of budget
design will encourage you to consider aspects of the work plan you have not thought about before
and will serve as a useful reminder of activities planned, as your research gets underway.

How should a budget be prepared? It is necessary to use the work plan as a starting point.
Specify, for each activity in the work plan, what resources are required. Determine for each
resource needed the unit cost and the total cost. The budget for the fieldwork component of the
work plan will include funds for personnel, transport and supplies. Note that UNIT COST (e.g., per
diem or cost of petrol per km), the MULTIPLYING FACTOR (number of days), and TOTAL
COST are required for all budget categories.

Budget justification: It is not sufficient to present a budget without explanation. The budget
justification follows the budget as an explanatory note justifying briefly, in the context of the
proposal, why the various items in the budget are required. Make sure you give clear explanations
concerning why items that may seem questionable or that are particularly costly are needed and
discuss how complicated expenses have been calculated. If a strong budget justification has been
prepared, it is less likely that essential items will be cut during proposal review.

SN Item Qty Unit Cost Total cost (fCFA) Supplier

1 Gloves 2 packs 3,500 7,000 Biopharcam
2 Alcohol 2 liters 5,000 10,000 Biopharcam
3 Cotton 2 rolls 5,000 10,000 Biopharcam
4 Vacutainer needles 200 100 20,000 Biopharcam
5 EDTA tubes 200 100 20,000 Biopharcam
6 Plain tubes 200 100 20,000 Biopharcam
7 Pipette tips (yellow) 1 pack(1000) 10,000 10,000 Biopharcam
8 Pipette tips (blue) 1 pack(1000) 15,000 15,000 Biopharcam
9 HBsAg ultra ELISA kit 96 reactions 120,000 120,000 Biopharcam
10 Anti-HBcAg ultra ELISA kit 96 reactions 120,000 120,000 Biopharcam
11 Anti-HBsAg ultra ELISA kit 96 reactions 120,000 120,000 Biopharcam
12 Transportation 10 weeks 6,000 60,000 //
13 Ethical Clearance and // // 15,000 //
adjuncts
14 Printing of questionnaires 250 150 37,500 Blueprint
15 Needle disposing box 3 boxes 2,000 6,000 Biopharcam
16 Cold chain/cooler, ice packs 1 15,000 15,000 //
17 Tissue paper 10 300 3,000 Sita
18 Printing and Binding of 9 copies 4,000 36,000 Blueprint
drafts and thesis
19 Miscellaneous and // // 161,125 //
exigencies
TOTAL 805, 625

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CHAPTER EIGHT
MAJOR COMPONENTS AND OUTLINE OF THE DIFFERENT PHASES IN A
RESEARCH PROCESS

8.1 SUMMARY OF THE MAJOR COMPONENTS OF A RESEARCH PROPOSAL

The details of the development of a health research proposal (protocol) are given in the previous
chapters. It is also important to give the summary of the major components and steps to assist
students to have a general idea of the outline in a relatively short period of time. It should be noted
that the proposal will be designed after a topic is accepted to be researched. And, for approval, the
protocol design is required to include at least the contents given below:

Title and cover page: The cover page should contain the title, the names of the authors with their
titles and positions, the institution (e.g., MAFLEKUMEN Higher Institute/School of Health
Sciences) and the month and year of submission of the proposal. The title could consist of a
challenging statement or question, followed by an informative subtitle covering the content of the
study and indicating the area where the study will be undertaken.

Abstract: Summary of the proposal which should include (in short):

Objectives, hypothesis, methods, time schedule and the total cost.

Table of contents: A table of contents is essential. It provides the reader a quick overview of the
major sections of your research proposal, with page references, so that (s)he can go through the
proposal in a different order or skip certain sections

I) Introduction
Statement of the research problem
❖ Background and definition of the problem of the study
❖ Why the proposed study is important, i.e., general statement on rationale behind the research
project.
State of knowledge: knowledge pertinent to subject under study
❖ Local data/knowledge
❖ Literature review
Significance of the proposed work
Specific statements on the significance of the results of the study should be given. Where to use the
results; who to make us of the results; what the result would be used for; and other details related
with the usefulness of the end results of the study.

II) Objective of the study

❖ General objective: aim of the study in general terms
❖ Specific objectives: measurable statements on the specific questions to be answered
❖ Hypotheses

The objectives should meet the purpose of the study. They should be phrased clearly,
unambiguously and very specifically. Also, they should be phrased in measurable terms.

III) Materials and methods

If the investigation deals with human beings, the terms 'study population' or 'subjects' are preferable
to 'materials'.
❖ Type of study (study design)
❖ Study population
➢ Describe the study areas and populations
➢ Mapping and numbering of the study area

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➢ Appropriateness of the study

➢ Accessibility (provide background information, travel, time, etc...)
➢ Cooperation and stability of the population
❖ Type of data (defining each variable to be collected and methods for collecting them)
➢ Operational definitions
➢ Some elements of the variables to be studied:

What characteristics will be measured? How will the variables be defined? What scales of
measurement will be used etc.
❖ Inclusion/ exclusion criteria
❖ Sampling procedure to be used and sample size and power calculation.
❖ Data collection and management
➢ Data collection and coding forms should be appended to protocol
➢ Training and quality control, bias control, data entry and storage, data clean-up and
correction of deficiencies
❖ Data analysis
➢ Management of dropouts
➢ Frequencies, rates, other parameters
➢ Statistical programs and tests to be used
➢ Data presentation (dummy tables to be appended)
❖ Ethical considerations: rights and welfare of the subjects and method of obtaining their
informed consent
❖ Pretest or pilot study: (allows us to identify potential problems in the proposed study)

IV) Work plan (project management)

❖ Personnel, job descriptions, training
❖ Schedule (timetable)- provide actual dates for each activity
➢ Pilot phase
➢ Final study
❖ Onset, data collection, analysis, write-up
➢ Relevant facilities
➢ Cooperating organizations

V) Budget (itemize all direct costs in Francs CFA) Personnel, material/supplies, travel, analysis,
contingency, etc.

VI) References: List only those cited in text using the appropriate format like the Havard-APA
(American Psychology Association') Style for citation and Bibliographic referencing.

VII) Appendices: -
❖ Glossaries
❖ Data collection and coding forms
❖ Dummy tables for data presentation
❖ Letters of support (cooperation)

EXERCISE: Develop a research proposal of your own topic. Take account of all the chapters
covered so far and write your final proposal in line with the guideline given above.

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8.2 SUMMARY OF THE MAJOR ACTIVITIES OF THE FIELDWORK PHASE

Activities to be performed during the field period

1. Briefing of managers and health service personnel: The purpose of the briefing is to obtain
support for the project. Such support is necessary to obtain resources as well as to get permission to
collect the required data. Briefing should be conducted with all important persons and/or
organizations at different levels.
2. Identifying and obtaining project resources: We have to identify and obtain the necessary
resources (manpower, materials, etc.) needed to collect the required data. We have to make sure
that all the items needed for the study are ready.
3. Reviewing availability of subjects: It is important to make personal visits to every site where
the actual data will be collected to understand the physical and manpower limitations, constraints
and special circumstances that could influence data collection. This would assist the investigators to
take an appropriate measure and make the necessary preparations.
4. Organizing logistics for data collection: Having made an inventory of available resources, the
logistics for data collection have to be organized. This will involve planning in detail how, where,
and when data collection will be carried out.
5. Preparing fieldwork manuals: Manuals or instruction sheets should be prepared for
interviewers (data collectors) and supervisors.
The manual for data collectors should have instructions concerning the:
❖ purpose of the study
❖ role of the data collectors
❖ the way data collectors should introduce themselves to respondents
❖ interviewing techniques
❖ questionnaire (general format, clarification of terms, instructions regarding how to ask
sensitive or complicated questions, instructions concerning how to fill in answers, such as,
answers to open-ended questions)
❖ Sampling procedures (and what to do if the required respondent is absent, etc.)
The manual for supervisors, in addition to the above instructions, should include information on:
❖ maintaining a record of data collectors' attendance
❖ safe-keeping of completed (filled) data
❖ Determining the number of interviews to be completed each day by every data collector
depending on the specific circumstance the data collector is found (e.g., the houses to be
covered could be scattered, etc.)
❖ ensuring the quality control of fieldwork
❖ dealing with non-responses and incomplete interviews
❖ reporting progress to the coordinator at specific intervals

6. Training of data collectors and supervisors

Data collectors and supervisors must be given explicit training. Their training should be supported
by practical exercises. They should be involved in the pretest. Following the pretest, they could
participate in the adjustment of instruction sheets and data-collection tools. During the training, the
data collectors and supervisors should be strongly instructed that they would be responsible for any
mistakes that may arise due to their negligence and lack of adherence to the manual.

7. Conducting pretest in the research location (nearby area) and revising data collection tools
❖ The pretest should assess the validity of the data-collection instruments and procedures, as
well as the sampling procedures
❖ It should identify scientific as well as logistical problems and constraints
❖ Revise the data-collection tools and other procedures after the pretest

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8. Data collection
After getting permission for the conduct of the study, obtained the necessary resources, trained the
required personnel, made pretests and modified data-collection tools and procedures, the required
data collection can be carried out.

9. Processing data
After collecting and sorting the data, all questionnaires and records should be checked for errors.
This should be done before leaving the area where data collection is done. If there is any error to be
corrected regarding a particular questionnaire, it would be easy for the data collector or supervisor
to make the changes by visiting the respondent from which the information was obtained. During
this stage, answers given for open-ended questions may be converted into quantifiable numerical
form for processing by computer or other means.

8.3 WRITING A RESEARCH REPORT

Writing a good report may take much time and effort. The most difficult task is usually the
preparation of the first draft. The report should be easily intelligible. This requires clarity of
language, a logical presentation of facts and inferences, the use of easily understood tables and
charts, and an orderly arrangement of the report as a whole. It should be no longer than is
necessary. Conventionally, a report usually contains the following major components.

Title and cover page(s)

The cover page should contain the title, the names of the authors with their titles and positions, the
institution that is publishing the report (e.g., MAFLEKUMEN Higher Institute/School of Health
Sciences), and the month and year of publication. The title could consist of a challenging statement
or question, followed by an informative subtitle covering the content of the study and indicating the
area where the study was implemented. The title should be a maximum of 20 words (counting all
words, even single-lettered words)

Abstract (Summary)
The summary should be brief and informative. A reader who has been attracted by the title will
usually look at the summary to decide whether the report is worth reading. The summary should be
written only after the first or even the second draft of the report has been completed. It should
contain:
❖ a very brief description of the problem (WHY this study was needed)
❖ the main objectives (WHAT has been studied)
❖ the place of study (WHERE)
❖ the type of study and methods used (HOW)
❖ major findings and conclusions, followed by
❖ The major (or all) recommendations.

The summary will be the first (and for busy health decision makers most likely the only) part of
your study that will be read. Therefore, its writing demands thorough reflection and is time
consuming. Several drafts may have to be made, each discussed by the research team as a whole.

Certification (or Declaration-old)

Dedication

Acknowledgements
It is good practice to thank those who supported you technically or financially in the design and
implementation of your study. Also your employer who has allowed you to invest time in the study

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and the respondents may be acknowledged. Acknowledgements are usually placed right after the
title page or at the end of the report, before the references.

Table of contents
A table of contents is essential. It provides the reader a quick overview of the major sections of
your report, with page references, so that (s)he can go through the report in a different order or skip
certain sections.

List of tables, figures

If you have many tables or figures it is helpful to list these also, in a ‘table of contents’ type of
format with page numbers.

List of abbreviations (optional)

If abbreviations or acronyms are used in the report, these should be stated in full in the text the first
time they are mentioned. If there are many, they should be listed in alphabetical order as well. The
list can be placed before the first chapter of the report. The table of contents and lists of tables,
figures, abbreviations should be prepared last, as only then can you include the page numbers of all
chapters and sub-sections in the table of contents. Then you can also finalize the numbering of
figures and tables and include all abbreviations.

I) Introduction and Literature Review

The introduction is a relatively easy part of the report that can best be written after a first draft of
the findings has been made. It should certainly contain some relevant (environmental/
administrative/ economic/ social) background data about the country, the health status of the
population, and health service data which are related to the problem that has been studied. You may
slightly comprise or make additions to the corresponding section in your research proposal,
including additional literature, and use it for your report. Then the statement of the problem should
follow, again revised from your research proposal with additional comments and relevant literature
collected during the implementation of the study. It should contain a paragraph on what you hope
(d) to achieve with the results of the study. Global literature can be reviewed in the introduction to
the statement of the problem if you have selected a problem of global interest. Otherwise, relevant
literature from individual countries may follow as a separate literature review after the statement of
the problem. You can also introduce theoretical concepts or models that you have used in the
analysis of your data in a separate section after the statement of the problem.

II) Objectives
The general and specific objectives should be included as stated in the proposal. If necessary, you
can adjust them slightly for style and sequence. However, you should not change their basic nature.
If you have not been able to meet some of the objectives this should be stated in the methodology
section and in the discussion of the findings. The objectives form the HEART of your study. They
determined the methodology you chose and will determine how you structure the reporting of your
findings.

III) Methods
The methodology you followed for the collection of your data should be described in detail.
The methodology section should include a description of:
❖ the study type;
❖ major study themes or variables (a more detailed list of variables on which data were
collected may be annexed);
❖ the study population(s), sampling method(s) and the size of the sample(s);
❖ data-collection techniques used for the different study populations;
❖ how the data were collected and by whom;

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❖ procedures used for data analysis, including statistical tests (if applicable).
If you have deviated from the original study design presented in your research proposal, you should
explain to what extent you did so and why. The consequences of this deviation for meeting certain
objectives of your study should be indicated. If the quality of some of the data is weak, resulting in
possible biases, this should be described as well under the heading ‘limitations of the study’.

IV) Results
❖ Findings should be presented
❖ Tables and graphs could be used (should be well titled and captioned)
❖ The tables should be well constructed, and without anomalies such as percentages which do
not add up to 100 percent
❖ Avoid too many decimal places
❖ Graphs should clarify and not complicate, and care should be taken that they do not mislead
❖ If appropriate statistical tests are used, the results should be included. P-values alone are not
very helpful. Confidence intervals and the type of tests used should be indicated.

V) Discussion, Conclusions and Recommendations

The findings can now be discussed by objective or by cluster of related variables or themes, which
should lead to conclusions and possible recommendations. The author interprets the findings. Care
should be taken not to introduce new findings, i.e., findings not mentioned in the result section. The
discussion may include findings from other related studies that support or contradict your own.
Limitation of the study and generalizability of the finding should also be mentioned.

The conclusions and recommendations should follow logically from the discussion of the findings.
Conclusions can be short, as they have already been elaborately discussed in chapter 5. As the
discussion will follow the sequence in which the findings have been Research methodology
presented (which in turn depends on your objectives) the conclusions should logically follow the
same order. It makes easy reading for an outsider if the recommendations are again placed in
roughly the same sequence as the conclusions. However, the recommendations may at the same
time be summarised according to the groups towards which they are directed, for example:
❖ policy-makers,
❖ health and health-related managers at district or lower level,
❖ health and health-related staff who could implement the activities,
❖ potential clients, and
❖ The community at large.

Remember that action-oriented groups are most interested in this section. In making
recommendations, use not only the findings of your study, but also supportive information from
other sources. The recommendations should take into consideration the local characteristics of the
health system, constraints, feasibility and usefulness of the proposed solutions. They should be
discussed with all concerned before they are finalized.

VII) References
The references in your text can be numbered in the sequence in which they appear in the report and
then listed in this order in the list of references (Vancouver system). Another possibility is the
Harvard system of listing in brackets the author’s name(s) in the text followed by the date of the
publication (and page number in case you are quoting) for example: (Shan, 2000). In the list of
references, the publications are then arranged in alphabetical order by the principal author’s last
name. You can choose either system as long as you use it consistently throughout the report.

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VIII) Annexes or appendices

The annexes should contain any additional information needed to enable professionals to follow
your research procedures and data analysis. Information that would be useful to special categories
of readers but is not of interest to the average reader can be included in annexes as well.
Examples of information that can be presented in annexes are:
❖ tables referred to in the text but not included in order to keep the report short;
❖ lists of hospitals, districts, villages etc. that participated in the study;
❖ Questionnaires or checklists used for data collection.

8.4 SELECTIVE STYLE GUIDELINES FOR PROJECT WRITING

The aim of this guideline is to introduce students to the basic and important elements of style
applications in project writing: Citation (references in the text), Bibliography (list of references at
the end of the text) and Quotation (direct and indirect quotations in the text). There are many forms
of citation, however in this guide we provide one of the key types of styles for citation: the APA
(American Psychology Association) style used by the Harvard University whereby the date of
publication follows the author(s) name(s) and in-text references refer to items in the bibliography
using the author surname and date of publication, in brackets. Within the system there are also
many kinds of formats or layouts, and different publishers have their own requirements or
standards. However, what is fundamentally important is to remember: Select ONE type of style and
use it CONSISTENTLY throughout the project!

I. BASIC INFORMATION FOR PROJECT WRITING

Should I single-space or double-space my project? Final drafts of projects should be in Times

New Romans, 12 font size and 2 (double) line spacing, excluding the bibliography. Spacing of
quotations is dependent on the style being used. A quotation using the Harvard Style is doubly-
spaced.

Can I print my drafts and/or final project double-sided? No! It is recommended that the final
projects should be printed on one side.

PLAGIARISM: Academic research can be defined as the act of examining and referring to the
thoughts and writings of others. Plagiarism is when an individual submits or presents the work of
another person as his or her own. Therefore, when excerpts are used in paragraphs or essays, or
when one paraphrases someone else’s idea, the author must be acknowledged using the right
approach. The overall guiding principle for references is: it should be possible for the reader to
know exactly and fully, as to any part of the text, which sources the writer has used.
According to the Merriam-Webster Online Dictionary, to “plagiarize” means:
1. To steal and pass off (the ideas or words of another) as one’s own without proper recognition of
their origins (as for “ideas”, it is debatable).
2. To directly or indirectly use (another’s production) without crediting the source.
3. To commit literary theft.
4. To present as new and original an idea or product derived from an existing source.

In other words, plagiarism is an act of fraud. It involves both stealing someone else’s work and
lying about it afterward. Plagiarism is academic misconduct and will produce serious consequences
from dismissal from university for 6 months to expulsion.

Don’t Get Caught Out!

❖ Keep a careful note of all sources used as you prepare your assignments.
❖ Record all the details you need about a library book (including page numbers) before you
return it – someone else may have the book if you try to go back and check later.

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❖ Make sure you write down the source details you need on any photocopies you make.
❖ Remember to print or save details of any website you want to refer to (your tutor may ask to
see this) and record the date when you accessed the information.
❖ Make sure you are following the referencing system used in your department.

Where to Find the Details Needed In a Reference List

Books: The details needed for a book can be found on the front and back of the title page. Make
sure you locate the name of the publisher rather than the printer or typesetter. You need the name of
the publisher in your reference list. The Library Catalogue gives the publisher’s name if you are in
any doubt. Ignore any reprint dates; you need the date when the first, second, third edition etc. of
the book was published according to which edition of the book you are using.
Journal articles: The details needed for a journal article can usually be found on the contents list,
front cover or article itself.

WRITING STYLE:
Students are expected to employ correct spelling, punctuation, and sentence and paragraph
structure. All papers should be proofread for spelling, grammatical, and typographical errors. If
unsure about these matters, students should consult a style guide or a dictionary. Students should
choose either the British, American or Canadian convention of English spelling and follow it
consistently. It is certainly acceptable to use spell check and grammar check, but they are no
substitute for careful proofreading. While a thesaurus can help a writer to vary word choices, it
should be used in conjunction with a dictionary, substituting words without knowing their precise
meaning can lead to embarrassing mistakes.

II. QUOTATION GUIDELINES

Accuracy: All quotations must reproduce exactly the original author's words, including spelling,
capitalization, and punctuation. If any words are added to the quotation for reasons of grammar or
coherence, they must be set off in square brackets ([ ]). Sometimes it is not necessary to apply a
long quotation where meaningful sentences are consecutively placed in different places.
An ellipsis (. . .) must be used to indicate where words are omitted in the midst of a quotation. It is
not necessary to begin or end quotations with ellipses. If you are quoting sentence(s) from a source,
the use of quotation marks is necessary, together with proper in-text referencing (that is, the author,
date, and page number). The source should also be inserted to the reference list. The in-text
referencing is in bold and the insert to the Reference List are given in the following examples.

Quotation from a book chapter

Short quotations e.g. up to 2 lines can be included in the body of the text:-
Example 1: Weir (1995) states that "defining roles and their remits is not simple"(p.10).

Example 2: Thailand was one of the Asian countries affected by the large outflow of capital funds
in 1997/1998. The Asian economic crisis was described as the “most severe economic contraction
in recent Thai history” (Warr, 2005: 115).
The full reference list will be: Warr, P. (2005). Poverty, Inequality, and Economic Growth: The
Case of Thailand. In A. B. Deolalikar (Ed.) Poverty, Growth, and Safety Nets: A Comparative
Regional Perspective. Toronto: De Sitter Publications.

Example 3: Despite enjoying rapid economic growth, illiteracy remains a great cause of concern in
India. According to Tharoor (2007: 137), “thirty-seven percent of all Indian primary school
children drop out before reaching fifth grade” and the number of the illiterate population of India
“exceeds the total combined population of the North American continent and Japan”.
The full reference list will be: Tharoor, S. (2007). The elephant, the tiger, and the cell phone.
New York: Arcade Publishing.

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Longer quotations should be indented in a separate paragraph:-

Example: Thomas and Ingham (1995) in discussing staff development state that: "Development is
infectious, and staff who previously have recoiled from undertaking a degree or conversion course
have been encouraged by the success of others"(p.33).

If part of the quotation is omitted then this can be indicated using three dots:-
Example 1: Weir and Kendrick (1995) state that "networking is no longer solely within the male
domain . . ."(p.88).
Example 2: The complexity of the “double movement” in market society as a given structure is
spelt out by Polanyi himself: Our thesis is that the idea of a self-adjusting market implied a stark
utopia.
Such an institution could not exist for any length of time without annihilating the human and
natural substance of society; it would have physically destroyed man and transformed his
surroundings into a wilderness. Inevitably, society took measures to protect itself, but whatever
measures it took impaired the selfregulation of the market, disorganized industrial life, and thus
endangered society in yet another way. (Polanyi, 1957: 3, italic added)

Example 3: The complexity of the “double movement” in market society as a given structure is
spelt out by Polanyi himself: “Our thesis is that …. Inevitably, society took measures to protect
itself [the second movement], but whatever measures it took impaired the self-regulation of the
market, disorganized industrial life, and thus endangered society in yet another way” (Polanyi,
1957: 3).

Formatting Quotations: Whether it is a long or short quotation is a subjective decision. Generally,

quotations of four lines or less should be incorporated into the text of the essay and enclosed in
quotation marks (“ ”). Longer quotations should be separated from the main text (see the above
example). Such block quotes begin on a new line, are indented three centimeters from both the left
and right margins, and are single-spaced. Quotation marks are omitted from block quotes. Of
course, a footnote or endnote that gives the source must accompany all quotations. If quoting more
than once from the same source in the same paragraph, a single citation may be used after the final
quotation.

How do I introduce quotations in my paper?

Before the quotation, a sentence or phrase should establish the relevance and context for the quote.
There are many ways to make “platforms” leading to the quotations. Thus, a politician's speech
should not be quoted without identifying, for example, the speaker and the occasion of the speech.
There are many ways to make “platforms” leading to the quotations. In order to make your paper
coherent and accurate, use the following tags and conventions to introduce other sources into your
work: Example 1 (Direct way): -i-Boyd argues, describes, explains, claims, asserts, refers to,
cites; -ii-Santos contends, compares, speculates, hypothesizes, concludes, recommends. Example 2
(Indirect way): -i-It is argued; it is said; it is posited; …; -ii-According to Boyd position, the world
would be far more better if ….; -iii-In line with Boyd’s argument, the global environment would be
improved when ….; iv-Weber’s observation is based on that ….

Do I need to comment after a quotation? Absolutely! Some commentary should analyze the
quotation- the reader should not be responsible to interpret its meaning. As a rule, quotations
should be grammatically integrated into the essay writer's prose; they should not stand alone as
independent sentences.

Do I need to interpret after data insertion? Absolutely! Data sources (a map, a diagram, or a
table of statistics) must be correctly given. In addition, they should be explained and interpreted

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accordingly in line with the author’s purpose. It is the responsibility of the author, not the reader, to
have the inserted data clarified reflecting the author’s purpose of applying these data.

III: PARAPHRASING AN IDEA: You can paraphrase the sentences and/or ideas of others and
document the sources appropriately.
Example: The Five Forces Model, as popularized by Michael Porter, is a widely used approach to
assist managers in developing strategies in many industries (Porter, 1980).
The full reference list will be: Porter, M. (1980). Competitive strategy: techniques for analyzing
industries and competitors. New York: Free Press.

IV: INSERTING A TABLE/CHART/FIGURE/DIAGRAM/EXHIBIT FROM A SOURCE.

1. Table

Source: Extracted from the website http://www.singstat.gov.sg on 18 Nov 2009.

The full reference list will be: Statistics Department of Singapore, Retrieved from
http://www.singstat.gov.sg on 18 Nov 2009

2. Figure.
Figure 1: Fishbone analysis - of an underperforming business

NB: Make sure all the

charts/figures/diagrams etc.
you present in your work
(whether personal or copied)
have LEGENDS/KEYS.

Source: Extracted from Grundy, Johnson and Scholes (1998;

Figure 3.5, p. 68).
The full reference list will be: Grundy, T., Johnson, G. and
Scholes, K. (1998). Exploring strategic financial management.
Essex: Prentice Hall.

V. DOCUMENTING SOURCES
Primary Sources/Secondary Sources: Primary sources are the original words of a writer - novel,
speech, eyewitness account, letter, autobiography, interview, or results of original research.
Secondary sources are works about the primary sources and about the authors who produce
primary material, i.e. about someone or about someone’s accomplishments.

Terminology
Citing means formally recognizing, within your text, the sources from which you have obtained
information;
Bibliography is the list of sources you have used;
Reference is the detailed description of the source from which you have obtained your information.

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VI. STYLES OF CITATION

All statements, opinions, conclusions etc. taken from another writer's work should be
acknowledged, whether the work is directly quoted, paraphrased or summarized.

Should I use parenthetical citations or should I use footnotes/endnotes?

In the Harvard format, parenthetical citations are the acceptable choice. The Harvard style is a type
of author-date style. Generally, when using the Harvard style a citation in your paper requires only
the name of the author(s) and the year of publication, with no punctuation between the two items.
Citations should be whenever possible placed at the end of a sentence, before the concluding
punctuation. The reader can locate the full description of the item you have cited by referring to the
alphabetical list of references (i.e. bibliography) provided at the end of the paper.
In the Harvard System cited publications are referred to in one of the forms shown below:

Single author:-
In a study by Seedhouse (1997) coping with illness was investigated ....
In a study (Seedhouse,1997) coping with illness was investigated ....

More than one citation Where more than one citation is used, arrange them by year first, then
alphabetically, and separate authors by semicolons.
(Steven 1975; James 1976; Bookchin 1980; George 1980; Francome and Marks, 1996). OR less
formally: There are indications that passive smoking is potentially threatening to the
health................ (Stevens, 1975; James, 1976; George, 1980; Francome and Marks, 1996)

Several citations by one author: Where several citations are by one author, they are listed together
under the first date. Separate years by commas and authors by semicolons.
(Steven 1975, 1978, 1992; Wood 1995, 1999).

Same author with several citations to same year: Several citations by one author in one year are
listed as a, b, c, and use commas to separate letters and years and semicolons to separate authors.
There is no space between the year and first letter. Ensure that the sequence is correct
(alphabetically) in reference list before adding letter.
(Xing 1995a, b, c)

-A book with two authors: (Marx and Engels, 1970). OR less formally: In the book by Marx and
Engels (1970) .....

-For three or more authors: Use et al. for all citations including the first. (Muchie et al., 1990).
OR less formally: Munchie et al. (1990) conclude that ....

Corporate or group authors: For corporate or group authors, use an acronym or abbreviation.
(UNDP 1992; World Bank 1995)

Citing and page numbers: Where direct quotations or indirect quotations with concrete references
are cited, specific pages must be referred to use either a comma then p. or pp. then the specific
page/pages; or a colon then the specific page/pages
Ex. (Hersh 1975, p. 172–184) or (Hersh 1975: 172- 184)

Citing another author's figure or table: Where a figure or table is cited from another author's
work, and this also applies in text. (Jackson 1999, p.13, fig. 2) or Jackson figure 2 (1999: 13)

*Quotation within someone else’s work (Citing within citing): To cite material not taken from the
original source but obtained through an intermediate source the reference must be made according

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to the reference style being used (see Styles of Citation). Where a quotation is cited within the
citing, the correct way is:
(Marx as quoted by Petras, 1999, p. 32) or (Marx in Petras, 1999: 32)
Please note that whilst many Institutions require page numbers to be included in all in-text
citations after the date, others require only direct quotations to include a page number
otherwise only dates. Please check with your supervisors for the policy in your institution.

a) References are made within the body of your essay to the full details of the work in the reference
list/bibliography in the following manner:
Stevenson (2003, p. 116) argues that …
…concerns about individual viewer responses (Stevenson, 2003, p. 118) …
Whoever is reading your essay can now turn to the reference list/bibliography and look for an entry
by Stevenson written in 2003.

b) When an author, or group of authors, has more than one publication in the same year a lower
case letter is added to the date. For example:
In two recent studies (Harding, 1986a, p. 80; Harding, 1986b, p. 138) it was suggested that ...
In two recent works Harding (1986a, p. 80; 1986b, p. 138) has suggested that ...

c) Multiple author citations

❖ With two authors both names should be listed in each citation e.g. (Duncan & Goddard,
2003, p. 99).
❖ With three to five authors name all authors the first time, then use et al. (and others). For
example: the first time it would be (Moore, Estrich, McGillis, & Spelman, 1984, p. 33) and
subsequent references to the same publication would use (Moore et al.).
❖ For six or more authors, use et al. after the first author in all occurrences. Note that when the
in-text reference occurs naturally within the sentence ‘and’ should be used before the final
author. But when the entire reference is enclosed in brackets the ampersand (&) should be
used.

d) Organisations as authors
Where you have a document produced by an organisation and the organisation is commonly
referred to by an abbreviation/acronym, in the in-text reference you should write out the name of
the organisation in full the first time and give the abbreviation in square brackets. For example:
...clearly stated policy (Food and Agriculture Organization of the United Nations [FAO], 2005,
p. 24) then subsequent in-text references can just use the abbreviation. For example: ... measures to
improve food supplies (FAO, 2005, p. 36)
In the reference list/bibliography spell out the name of the organisation in full. For example: Food
and Agriculture Organization of the United Nations. (2005). title of doc etc.

e) When a source has no author, cite the first two or three words of the title followed by
the year. For example:
... in the recent book (Encyclopedia of psychology, 1991, p. 62)...... in this article (“Individual
differences,” 1993, p. 12)... – follow this example for web pages where no author is given
The key point is that your in-text reference matches the start of the reference in your
reference list/bibliography. However, if the author is designated as Anonymous, cite the word
‘Anonymous’ in your text.
For example: (Anonymous, 1993, p. 116).
Note: Underline when handwritten or italicize when typed the title of a journal or book and use
double quotation marks around the title of an article or chapter.

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f) When using quotations in your text observe the following examples: He stated, “The relative
importance of the systems may nevertheless remain in approximately the same proportion”
(Gardner, 1973, p. 41)
Smith (1991) found that “...there is no evidence that chimpanzees can produce a drawing and
discern the object represented in it...” (p. 84)

g) If you cite a work that you discovered in another work, follow these examples: -i- Smith (1970,
p. 27) cites Brown (1967) as finding ...; -ii- Brown (1967), cited by Smith (1970, p. 27), found ...; -
iii- It was found (Brown, 1967, cited by Smith, 1970, p. 27) that...
In your reference list/bibliography only list the author whose work you have seen. In these
examples you include Smith, but not Brown, the author whose work you have not seen.

h) Acts of Parliament should be cited in your text with the full title, including year of enactment.
For example: According to section 2 of the Criminal Justice Act 2003...

VII. BIBLIOGRAPHY (REFERENCES)

A bibliography is typically an extensive list of sources that surround your topic. It is located at the
end of your paper, and it includes all of the bibliographic details your readers need in order to seek
out your sources on their own (i.e., to replicate your research). It documents the sources you have
cited in your paper, but it also represents the research you've done in preparation for writing, and it
offers your audience suggestions for further reading on your topic. University students typically use
a Selected Bibliography, a less thorough, more limited set of references to list only those works
referred to in the text. Nursing and Laboratory Science students at MAFLEKUMEN must employ a
Selected Bibliography.

Format of the Bibliography: The bibliography should begin on a new page following the last
page of your paper (or, if you are using endnotes, following the notes page). For instance, if your
paper itself is a thirty-five and a half pages long, using half of page thirty-six, the bibliography
should begin on page thirty-seven. This page should also be numbered (page 37) just like the rest of
your paper. However, most advisors do not count the bibliography in the required pages but
nonetheless it should be numbered.

Page Format: The title of the page should be centered 3cm from the top of the page. In lengthy
bibliographies, entries are often (but not necessarily) placed in categories according to type or
subject of source, for the convenience of the reader.

Entry Format: All entries should be single-spaced. Entries themselves should be formatted in the
following way: The first line of an entry is set flush with the left margin. The second line (if one
exists) and all subsequent lines are indented one inch from the left margin. The entries are listed in
alphabetical order by author's last name, and are not numbered.

SEQUENCING OF ENTRIES: (Arrangement of reference list/bibliography at end of your

essay)
Within a reference list, sequence entries according to the following rules.
❖ List all references alphabetically according to first author’s family name (surname) and
regardless of the nature of reference sources. In other words, please do not categorize the list
and divide the references into media papers, journal articles, book chapters, books, etc.
❖ If you need to start an entry with a title because there is no author, still place the entry within
your alphabetical list of authors.
❖ Put all entries in one long alphabetical list. Do not list books, journal articles, websites etc. in
separate sections.

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❖ The APA format requires book and journal titles etc. to be italicized when typed; although in
a handwritten list you can underline instead.
❖ Arrange in year sequence (oldest to most recent) where an author has more than one
publication.

NUMBER OF AUTHORS:

- Single Author of Both a One-Author Work and a Multiple Author Work: When one person
serves as both the sole author of a one-author work and the first author listed on a multiple author
work, list the one-author entry first.

- More Than One Author, but Fewer Than Four: If there is more than one author but fewer than
four, use all the authors' names by listing the first name on the book/article according to the last
name first rule. All others follow in the normal order of first name, space, and last name.

- When There Are More Than Three Authors: When there are more than three authors, it is
IDEAL to list ALL authors in the bibliographic entry, then to refer to it in the notes by using only
the first author's name, followed by “et al.,” --- a Latin term meaning “and others.”

EXAMPLES OF HARVARD STYLE BIBLIOGRAPHY

Book with One Author: Hicks, G. (1935) Proletarian Literature in the United States, International
Publishers: New York.
Book with Two or More Authors: Hicks, G., North, J. and Calmer, A. (1935) Proletarian
Literature in the United States, New York: International Publishers. or Not commonly used or
accepted you may use: Hicks, G., et al. (1935) Proletarian Literature in the United States, New
York: International Publishers.

Two or more books by the same author: Arrange alphabetically by the book's title.
Postman, N. (1985). Amusing ourselves to death: Public discourse in the age of show business.
New York: Viking.
Postman, N. (1979). Teaching as a conserving activity. New York: Delacorte Press.

Works by the same author that are published in the same year: Arrange them alphabetically by
title and add a letter after the year as indicated below.
McLuhan, M. (1970a). Culture is our business. New York: McGraw-Hill.
McLuhan, M. (1970b). From cliche to archetype. New York: Viking Press.

Book with only Editor/Translator: Buffington, N., Diogenes, M., and Moneyhun, C. (Eds.) (1997)
Living Languages: Contexts for Reading and Writing, Upper Saddle River, NJ: Prentice Hall.

Book with Editor/Translator in combination with Author (name of ed/trans. after title)
Ortiz, Simon (1997) “The Language We Know.” In Living Languages: Contexts for Reading and
Writing, edited by Nancy Buffington, Marvin Diogenes, and Clyde Moneyhun, 40-47. Upper
Saddle River, NJ: Prentice Hall.

Book Published in a Second or Subsequent Edition (edition no. after title)

Reid, S. (1998) The Prentice Hall Guide for College Writers, 4th ed. Upper Saddle River, NJ:
Prentice Hall.

Chapter in a Book: Shiva, V. (1993) “The Greening of the Global Reach,” in Wolfgang Sachs (ed.)
Global Ecology: A New Arena of Political Conflict, London: Zed Books.

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Newspaper article: -Caffeine linked to mental illness. (1991, July 13). New York Times, pp. B13,
B15.
-Young, H. (1996, July 25). Battle of snakes and ladders. The Guardian, p. 15.

Weekly Magazines: Axthelm, P. (1989) “Up Front: America's First Poet Laureate, Robert Penn
Warren, Was a Wise and Eloquent Son of the South,” People Weekly, 2 Oct., p.46.

Monthly Magazines: Lemley, B. (1995) “The Underground Architect,” New Age, Jan.-Feb.

Magazines which Include Volume or Issue Numbers (example: article with no author)
“A Passing Race,” (1989) Canadian Magazine, 71, p.34.

Article in a journal (Academic journal) - for articles retrieved online Academic Journal with
both Volume and Issue Numbers: Name of journals should be written in full and italicized.

Exapmle 1: Mellers, B. A. (2000). Choice and the relative pleasure of consequences. Psychological
Bulletin, 126, 910-924.
Note: List only the volume number if the periodical uses continuous pagination throughout a
particular volume. If each issue begins with page 1, then list the issue number as well.

Exapmle 2: Klimoski, R., and Palmer, S. (1993). The ADA and the hiring process in organizations.
Consulting Psychology Journal: Practice and Research, 45(2), 10-36.

Encyclopedia entry: Lijphart, A. (1995). Electoral systems. In The encyclopedia of democracy

(Vol. 2, pp. 412–422). London: Routledge.

Audiovisual sources: examples of references

Music- The basic pattern for a piece of music is: Writer, Initials. (Date of copyright). Title of
song etc. On title of album [medium of recording]. Location: Label. (Recording date if different
from copyright date.)
E.g.: Puccini, G. (1990). Nessun dorma. On Carreras Domingo Pavarotti in concert [CD]. London:
Decca.

Films- The basic pattern for a reference to a film is: Name of primary contributor – the director
or producer, or both, Initials. (Role of primary contributor). (year film released). Title of film
[Motion picture]. Country of origin – where the film was primarily made and released: Name of
studio.
E.g.: Spielberg, S. (Director). (1993). Jurassic Park [Motion picture]. United States: Universal
Pictures/Amblin Entertainment.
If the film doesn’t appear on the Library Catalogue, the Internet Movie Database www.imdb.com is
a good place to check all the details needed for a film reference (follow the Company credits link to
find details about the film studio/s involved). Alternatively, check Film and Video Guide at the
appropriate Subject Reference Collection in a city or University Library.

Review of a film: Kinder, M. (2002). Moulin Rouge [Review of the motion picture Moulin Rouge].
Film Quarterly, 55(3), 52–59.
E.g.: Malausa, V. (2001). Beauté du mensonge [Review of the motion picture The Tailor of
Panama]. Cahiers du Cinéma, 558, 82–83.
If the review is untitled, put everything in square brackets e.g. [Review of the motion picture
Moulin Rouge] in the normal title position.http://referencing.port.ac.uk 9

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Television programmes: Collinson-Jones, C. (Producer), & Dobson, E. (Director). (2003, July 14).
Casualties of peace [Television broadcast]. London: Channel 4.

Single episode from a television series: Fraser, R. (Writer), & Geoghegan, S. (Director). (2003).
Eyes wide open [Television series episode]. In P. Goodman (Producer), Holby City. London:
BBC1.
This example shows the most complete information possible for a television episode. If details of
the writer are unavailable, begin your reference with the name of the director.

Radio programmes: Portenier, G. (Producer). (2003, July 17). Crossing continents [Radio
broadcast]. London: BBC Radio 4.

Published Interviews: Bullard, R. (1998) “Dr. Robert Bullard: Some People Don't Have the
Complexion for...” in EMagazine, ed. by Jim Motavelli. July/August, p.10- 13.

Corporate Authors: World Bank (1993) “The East Asian Miracle: Economic Growth and Public
Policy.” New York: Oxford University Press.

Conference Proceedings:
Published conference proceedings with author or editor(s): Banks, S. et al (1998) Networked
Lifelong Learning: innovative approaches to education and training through the Internet:
Proceedings of the 1998 International Conference held at the University of Sheffield. Sheffield,
University of Sheffield.

Paper from published conference proceedings with author or editor(s): Proctor, P. (1998) The
tutorial: combining asynchronous and synchronous learning. In: Banks, S. et al. Networked
Lifelong Learning: innovative approaches to education and training through the Internet:
Proceedings of the 1998 International Conference held at the University of Sheffield. Sheffield,
University of Sheffield. p.3.1 - 3.7.
If no author or editor is given on the title page the name of the conference is cited first either in
italics or underlined.

Unpublished Papers
Xing, L. (1999) “A Critical Analysis of the Market Approach to Modernization”, conference paper
presented at the International Workshop: The Impact of Globalization on China, Russia and
Eastern Europe, organized by the Institute of East European, Russia and Central Asian Studies,
Chinese Academy of Social Sciences in cooperation with Research Center on Development and
International Relations at Aalborg University held on September 28, Beijing, China.

Dissertation: Hardman, J. P. (1999). Rainer Werner Fassbinder’s BRD trilogy: a manifesto for
social and political reform. Unpublished undergraduate dissertation, University of Portsmouth,
Portsmouth.

No author: If a work is signed Anonymous, your reference must begin with the word Anonymous,
followed by date etc. as normal.
If no author is shown, put the title in the normal author position.

Government publications
In broad terms White Papers contain statements of Government policy while Green Papers put
forward proposals for consideration and public discussion. They are cited in the same way.

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Government Documents (white paper): (alphabetize by name of largest entity, followed by lesser
entities)
U.S. Federal Energy Regulatory Commission. (1977/78) Annual Report of the U.S.Federal Energy
Regulatory Commission, Washington, D.C., GPO.

Administrative or Legislative Reports (green paper):

Colorado General Assembly, Colorado Commission on Higher Education. (1996) 1996 Legislative
Report on Higher Education Admission Standards, Denver.

An Act of Parliament: Great Britain (1990) National Health Service and Community Care Act
1990. Chapter 19. London, HMSO.
❖ Note on page numbers: Use pp. for page range only for encyclopedia entries, multi-page
newspaper articles and chapters or articles in edited books. For articles in journals or
magazines use the numbers alone separated from the volume/Issue number by a comma.

VIII. INTERNET AND ELECTRONIC SOURCES

Nowadays online sources and other electronic sources (world wide websites, newsgroups, e- mails,
full text databases, etc.) are becoming popular and widely utilized. As more sources of information
become available on the Internet and in electronic forms, it is necessary to implement some kinds
of standardization of citation formats in order to provide accurate references to authorship and to
facilitate access to the sources for validity and liability. There are various approaches to Internet
styles in general; there is little fixed agreement among them. However, there are two principles
emerging to be accepted and exercised:
1) To supply as much information as possible concerning the authorship and the availability of the
sources, and;
2) To draw an analogy to a relevant print source guideline, if there is no specific guideline for a
particular electronic source.

The followings are the minimum requirements for proper reference usage.
Web documents generally do not have fixed page numbers or any kind of section numbering. For a
document on the Web, the page numbers of a printout should normally not be cited, because the
pagination may vary in different printouts. An exception is PDF files, which appear with the same
pagination on all systems.
When citing in the text, if your source lacks page numbering, you must omit numbers from your
parenthetical references but instead provide the paragraph number. Whenever page numbers are
available on an electronic document, they must be cited otherwise the paragraph number.
The details shown below have been compiled according to the guidelines available on the APA
website (www.apastyle.org) Check this website and the recent edition of The Publication Manual
of the American Psychological Association for further guidance.

The basic pattern for a reference to an electronic source is: Author, Initials. (year when site was
produced or when document was published). Title. Retrieved month day, year, from internet
address. E.g.: Banks, I. (n.d.). The NHS Direct healthcare guide. Retrieved August 29, 2001, from
http://www.healthcareguide.nhsdirect.nhs.uk
If no date is shown on the document, use n.d.; If the author is not given, begin your reference with
the title of the document; If a document is part of a large site such as that for a university or
government department, give the name of the parent organization and the relevant department
before the web address: E.g. 1: Alexander, J., & Tate, M. A. (2001). Evaluating web resources.
Retrieved August 21, 2001, from Widener University, Wolfgram Memorial Library website:
http://www2.widener.edu/Wolfgram-Memorial-Library/webevaluation/webeval.htm

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E.g. 2: Deciding your future. (2000). Retrieved September 5, 2001, from University of Portsmouth,
Careers Service website: http://www.port.ac.uk/departments/careers/plancareer/deciding-your-
future.htm
NB: Never write the web address (URL) in the text of your essay. Use the author of the
website if your reference has one; otherwise use the first few words of the website title.

The following are examples of the Harvard style of web sources, as they would appear in the
bibliography.

HARVARD STYLE OF WEB SOURCES

Online Book: Use the same format as for a printed book, but add ‘Electronic version’ in square
brackets after the title. E.g.: Bryant, P.J. (1999) “The Age of Mammals” in Biodiversity and
Conservation [Online book] April < http://darwin.bio.uci.edu/~sustain/bio65/index.html> [11 May
1999].
In Text it will be: (Bryant 1998, p32) *Online books will have proper pagination*

Electronic Journal: Use the same reference format as for a printed journal article, but add
‘Electronic version’ in square brackets after the article title. E.g.: Foster, J.B. (2000) “Marx’s
Ecological Value Analysis” in Monthly Review [Online database] 52(4) Available
from:<http://www.umi.com/pqdauto/ > [Accessed 21 October 2001].
In Text it will be: (Foster 2000, p.2) *PDF with pagination* OR (Foster 2000, para.14) *without
pagination*
If you are referencing an online article where the format differs from the printed version or which
includes additional data or commentaries, you should add the date you retrieved the document and
the web address (URL) as in the following example (N.B. May 18 appears in the bracket next to
Wintour, P. because this is a newspaper article):
E.g.: Wintour, P. (2005, May 18). Blair believes his agenda is a moral certainty [Electronic
version]. The Guardian. Retrieved May 18, 2005, from Guardian Unlimited website:
http://politics.guardian.co.uk/queensspeech2005 /story/0,16013,1486296,00.html

E-Magazine Articles (internet-only journal):

E.g. 1: Rathbone, R (1995) “Pan-Africanism: 50 Years On” in History Today. [Online database]
October. Available from <http://www.findarticles.com/> [Accessed 30 October 1997].
E.g. 1: Korda, L. (2001, July). The making of a translator. Translation Journal, 5(3). Retrieved
August 21, 2001, from http://accurapid.com/journal/17prof.htm
Use the complete publication date shown on the article; Note that page numbers are not given;
Whenever possible, the URL you give should link directly to the article itself; Break a URL that
goes onto another line after a slash or before a full-stop. Do not insert a hyphen at the break.

Electronic Newspaper Articles: Holbrooke, R (2002) “A Defining Moment with China” in

Washington Post. [Online] 2nd January. Available from Washington Post’s web site
<http://www.washingtonpost.com/> [Accessed 5 April 2002].

Articles retrieved from a database: Use the format appropriate to the type of work retrieved and
add a retrieval date, plus the name of the database (you do not need to give the URL of the
database):
E.g. 1: Shahrani, A. M. (2002). War, factionalism, and the state in Afghanistan, American
Anthropologist,
104(3), 715–722. Retrieved June 16, 2010, from the JSTOR database.
E.g. 2: Traynor, I. (2004, July 13). US in talks over biggest missile defense site in Europe. The
Guardian, p. 2. Retrieved July 19, 2008, from the Nexis UK database.

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Electronic Government Publication: Bush, G. (1989) “Principles of Ethical Conduct for

Government Officers and Employees” Executive Order 12674, 12 April, pt. 1,
<http://www.usoge.gov/exorders/eo12674.html> [Accessed 3 May 1997].

Report retrieved from the internet: Harris, J., & Grace, S. (1999). A question of evidence?
Investigating and prosecuting rape in the 1990s (Home Office Research Study 196). Retrieved July
19, 2004, from the UK Home Office website: http://www.homeoffice.gov.uk/rds/pdfs/hors196.pdf

Intranet document: The basic pattern for an intranet document (e.g. education, health or police
documents which cannot be accessed by anyone outside the institution) is: Author, Initials. or
Organisation if no named author. (year, plus month and day if given). Document title
(policy/report/circular number if given). Unpublished intranet document, Organisation (if not listed
first). E.g.: Bonar, I. (2003, October). Library policies and decision making. Unpublished intranet
document, University of Portsmouth.

Web Reference Documents (electronic encyclopaedias, dictionaries, etc.)

The Oxford English Reference Dictionary (1996) “religion” [Online database] Available from
<http://www.xrefer.com/ > [Accessed 21 June 2001].

CD-ROM from the Internet: “Abolitionist Movement” (1996) in Compton's Interactive

Encyclopedia [CD-ROM] Softkey Multimedia, [Accessed 11 March 1996].

REFERENCE TEXTS
1. Corlien M. Varkevisser, Indra Pathmanathan, and Ann Brownlee. Designing and conducting
health systems research projects: Volume 1 Proposal development and fieldwork. KIT/IDRC. 2003
2. Degu G, Tessema F. Biostatistics for Health Science Students: lecture note series. The Carter
Center 9EPHTI), Addis Ababa; January 2005.
3. Abramson JH. Survey methods in community medicine. 2nd ed. Eidenburgh: Churchill
Livingstone, 1979.
4. Altman DG. Practical Statistics for Medical Research. London: Chapman and Hall, 1991.
5. Colton T. Statistics in Medicine. Boston: Little, Brown and Company 9INC.), November 19974.
6. Mathers, Nigel; Howe, Amanda; and Hunn Amanda. Trent focus for research and development
in primary health care. Ethical considerations in research. Trent focus, 1998
7. ESTC-EPHA/CDC PROJECT. Training modules on health research. 2004.
8. Department of Community Health ,Jimma Institute of Health Sciences. Manual for student
research project. Jimma, April 1996.
9. Department of Community Health, Gondar College of Medical Sciences. Manual for field
training. Gondar, 1995.
10. Department of Community Health, Faculty of Medicine. Handout for Rural Community Health
Training Programme. January 2002.
11. Fletcher M. Principles and Practice of Epidemiology. Department of Community Health,
Faculty of medicine, Addis Ababa University. August 1992.
12. Getu Degu Tegbar Yigzaw. Research Methodology lecture note series. The Carter Center
9EPHTI), Addis Ababa; January 2006.
13. William M.K. Trochim. Social Research Methods E-Book 2006

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