Module two

Conceptualizing health system research

and problem identification

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 Module objectives
At the end of this module, participants will able to:
 Define research

 Describe major characteristic of research

 Describe the major purposes of research

 Describe Health System Research (HSR)

 Explain characteristic of HSR

 Describe research problem identification and analysis

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 Contents
Introduction

Characteristic of research

Basic concept of research

Purpose of research

Health system research

Identification of research problem and its analysis

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 Introduction

Definition
 Research is the systematic process of collecting, analyzing

and interpreting data in order to increase our understanding

of the phenomenon about which we are concerned or
interested, with the ultimate goal of solving a particular
problem.

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 Introduction
When you say that you are undertaking a research study to
find answers to a question, you are implying that the process;

1.is being undertaken within a framework of a set of

philosophies ( approaches);

2.uses procedures, methods and techniques that have been

tested for their validity and reliability;

3.is designed to be unbiased and objective .

Adherence to the three criteria mentioned above enables the

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process to be called ‘research’.
 Introduction…

Characteristics of research
 It demands a clear statement of the problem.

 It requires clear objectives and a plan

 It is not aimlessly looking for something in the hopes that

you will come across a solution.

 It builds on existing data, using both positive and negative

findings.
 New data should be systematically collected and analyzed to
6 answer the original research objectives
 Introduction…

Desired attributes of research

Timeliness

Dynamic

Context related

Reliable

Unbiased

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 Types of research

Research can be classified from three perspectives:

1. application of research study

2. objectives in undertaking the research

3. inquiry mode employed

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 Based on application
 From the point of view of application, there are two broad

categories of research:- pure research and applied research.

Pure research involves developing and testing theories and

hypotheses.
The knowledge produced through pure research is sought in

order to add to the existing body of research methods

Applied research is done to solve specific, practical

questions; for policy formulation, administration and

9 understanding of a phenomenon.
 Based on objectives
Research purpose
 The main purpose of research is to create knowledge essential

for action.
 The three general purposes of research are:

 Exploration

 Description

 Explanation

Note: a given study can have more than one of these purposes.
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 Based on objectives…
1) Exploratory Research
Usually conducted when relatively little is known about

the phenomenon under study

The subject of study is itself relatively new and

unstudied
The researcher explores the topic in order to become

familiar with it and to gain ideas and knowledge about

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 Based on objectives…
2) Descriptive Research
Conducted to numerically to describe some phenomenon.

Descriptive studies summarize the characteristics of

particular individuals, groups, organizations, communities,

events, or situations as completely, precisely and
accurately as possible.
The ultimate purpose is to formulate these descriptions

into conceptual categories.

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 Based on objectives…
Descriptive Research…
 Descriptive studies seek to accurately describe current or past

phenomena to answer questions such as: e.g.

 What is the absentee rate for ANC follow up?
 What is the success rate for particular treatment?
 What is the dropout rate on particular immunization
programme?

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 Based on objectives…
3) Explanatory (analytic) research
 Seeks to explain the reasons behind a particular occurrence by

discovering causal relationships.

 Answers questions of “Why” and “what will be”

Example

What factors might account for the high dropout rate on a

particular immunization programme?

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 Based on inquiry mode
From the process adopted to find answer to research

questions – the two approaches are: Structured approach

and Unstructured approach
 Structured approach: is usually classified as quantitative

research
 Unstructured approach to inquiry is usually classified as

qualitative research. This approach allows flexibility in all

aspects of the research process.
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 Introduction…

Health research
 Is a research whose effort is to address health and health related

problems and come up with better solutions to mitigate the

prevailing problem.
 Different types of health research vary in their focus.

 Each plays a different role in overall health development.

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 Introduction…

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 Introduction…
Health Systems Research (HSR)
 Health system includes:
 different levels of public health care services
 district council, district development committee and village
development committee
 Private sectors which include:
- NGOs
- Medical practice by private doctors, nurses, or quacks who
provide injections and drugs without medical training.
- Pharmaceutical sectors (licensed pharmacies, unlicensed sellers)
- ‘non-biomedical’ professionalised healing systems (e.g. Chinese)
- Traditional (or folk) medicine
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 Introduction…
A broadly defined health system

Private sector Public sector

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 Introduction…
 HSR is ultimately concerned with improving the health of

people and communities, by enhancing the efficiency and

effectiveness of the health system as an integral part of the
overall process of socio-economic development, with full
involvement of all partners.
 Its major objective is to provide people at all levels with the

relevant information they need to make decisions on health-

related problems they are facing.

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 Introduction…
a) Operational Research
 Type of HSR which looks at the actual delivery of health

services.
 It examines the resources and processes used by the health

services and the outputs they attain.

 It aims to improve health service delivery by providing

practical answers to the questions asked by managers of the

health services.
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 Introduction…

b) Policy Research
 Type of HSR which is not carried out at service delivery

level and which is more explicitly aimed at informing higher

levels of health policy choices.

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 Introduction…
Characteristics of HSR
 It should focus on priority problems

 It should be action-oriented; i.e. aimed at developing solutions

for health problems

 It utilizes an integrated multi-disciplinary approach

 It should be participatory

 It must be timely; i.e. studies must be done in such a way that

results will be available when needed for key decisions.

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 Introduction…

Characteristics of HSR…
 Research designs should be simple and effective.

 Results should be accessible and easily understood.

 Its projects should focus on finding solutions which are

affordable and effective.

 It should be evaluated by how much it has influenced

policy, improved services, and ultimately led to better health

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 Introduction…
Stages of HSR (Research Process)

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 Problem Identification and Analysis
What is a problem?
 Problem is a gap between the real and the desired
or
 Problem is a contradiction between principle and practice

Sources of Research Problems

 Observation
 Literature reviews
 Professional conferences
 Experts

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 Problem Identification…

 Researchers choose the topics that they study based on:

 Interest

 Problem solving (having motivation to solve a particular

problem)
 Previous research

 Theory

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 Problem Identification…

Prioritizing research problems

 The problem should be researchable

 It should contribute to new knowledge

 There must be appropriate method available to investigate

the problem (i.e. consider participant, ethical implication,

time & money constraints)

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 Problem Identification…

Prioritizing research problems…

 In general, whether a problem requires research depends

on three conditions:
 Perceived difference or discrepancy b/n what exists

and the ideals or planned situation

 The reason(s) for this difference should be unclear

 There should be more than one possible answers to the

question
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 Problem Identification…

Criteria for prioritizing problems for research

1) Relevance
 How large or widespread is the problem?

 Who is affected?

 How severe is the problem?

 Who considers it as a problem?

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 Problem Identification…
Criteria for prioritizing…
2) Avoidance of duplication
 Has the problem been investigated before?

3) Feasibility
 How complex is the problem?

 What resources will be needed to carry out the study?

 Is enough time available?

 Are there people around who can give you technical
assistance?
 Will there be anyone willing to fund the research?
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 Problem Identification…
Criteria for prioritizing…
4) Political acceptability
 Change is often political and can lead to resistance
5) Applicability
 Will the recommendations of the research be applied?
6) Urgency of the data needed
 How urgently are the results needed for decision making?
 Which research should be done first and which can be done
later?
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 Problem Identification…

Criteria for prioritizing…

7) Ethical acceptability
 Is there any possibility of inflicting harm on others while

carrying out the research?

 How acceptable is the research to those who will be

studied?

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 Problem Identification…

Problem analysis
 A systematic analysis of the problem is crucial to:

1. Pool knowledge on the problem

2. Clarify the problem

3. Determine the focus and scope of the research

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 Problem Identification…

Steps in analyzing the problem

1. Clarify the viewpoints of managers, health care workers and
researchers in relation to the problem
2. Further specify and describe the core problem
3. Analyze the problem
i. Write down the core problem(s) as defined in step 2
ii. Brainstorm on possible causes or factors contributing to the problem
iii. Identify further contributing factors
iv. Attempt to organize related factors together into larger categories,
and develop your final draft of the diagram (Conceptual
Framework)
v. Formulate the problem statement

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 Problem Identification…

Literature review
 Why is it important to review already available information
when preparing a research proposal?
 It helps to identify theories related to the topic of interest
 It helps to narrow down the topic and refine your statement of
the problem.
 It helps to identify relevant as well as control variables
 It provides convincing arguments for why your particular
research project is needed
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 Problem Identification…

Literature review…
 It helps to find out what others have learned and reported on

the problem you want to study.

 It prevents from duplicating work that has been done before.
 It helps to become more familiar with the various research
approaches that might be used in your study.
 It suggests pertinent research design, procedures and

analysis method by indicating how other researchers have

addressed the topic.
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 Problem Identification…

Literature review…
What are the possible sources of information?
 Individuals, groups, and organizations

 Published information (books, articles, indexes, abstract of

journals); and
 Unpublished information (other research proposals in related

fields, reports, records, computer data bases)

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 Problem Identification…

Conceptualization
 The refinement and specification of abstract into concrete

terms.
or
 The process of finding out what data need to be collected

and analysed.

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 Problem Identification…

The conceptualization stages

1. Determine the research purpose

2. Select specific research topic

3. Identify relevant theories and literature related to the topic

4. Specify the meaning of the concepts and variables to be

studied (operationalization)

5. Formulate general hypotheses or research questions

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 Problem Identification…
Conceptual framework
 It is diagrammatic representation of philosophical concerns,
theories, and methodological approaches toward scientific
inquiry that characterize a particular discipline.
 It is the diagram that identify and illustrate the relationships
among factors that influence outcome.

Example

Conceptual framework to assess the magnitude of mortality from

Tuberculosis.
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 Problem Identification…

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 Problem Identification…
Operationalization
 It is describing or defining a variable in terms of the operations

used to produce it or techniques used to measure it

 Points to keep in mind for any operational definition are:

 What is the unit of analysis?

 Be able to justify your operational definition (i.e. don’t make

arbitrary decisions)
 Try to be consistent about level of analysis unless this is part
of your theory and/or research question.
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 Problem Identification…
Operationalization…

Example
“What effects do large class sizes have on the academic

performance of gifted children in high-population schools?”

“large classes” – classes with 30 or more students
“academic performance” – scores received on standardized
achievement tests
“gifted” children – children who are in advanced classes;
“high-population schools” – schools with more than 1,000
students.
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 Problem Identification…

Problem statement
 A problem statement is a concise and precise, well

documented, detailed description of the nature, scope,

causes, severity and the effect or impact of a problem to be
addressed and the need for the proposed project or
research.
 It is specific description of a problem which is essential

to understand it properly.
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 Problem Identification…
Problem statement…
 It is the initial step before venturing into any kind of research

 A good problem statement would always be specific and focus

on one particular issue instead of being vague and running the

risk of being confused.
 It would be restrictive and would express one major idea

 Therefore, it is necessary to formulate a good and effective

problem statement to ensure that the research is successful.

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 Problem Identification…
Importance of stating and defining a problem
 It is the foundation for further development of research proposal

(objectives, methodology, work plan, budget, etc)

 Makes it easier to find information and reports of similar studies

from which our study design can benefit.

 Enables us to systematically point out why the proposed research

on the problem should be undertaken and what you hope to achieve

with the study results.
 To focus the attention of the problem solving team

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 Problem Identification…
 Information that should be included in problem statement:

A brief description of socio-economic and cultural characteristics and

the health care system.

Description of nature of the problem (discrepancy between what is and

should be and size, distribution and severity)

Major factors that may influence the problem.

A brief description of any solutions that have been tried in the past to

solve the problem.

A description of type of information expected from the current study

and how it can solve the problem (justification)

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 Problem Identification…
 A good problem statement should answer these questions:

What is known about the area of inquiry?

How does the proposed project relate to what is known?

What will be the social and economic costs without external

funding support to address the problem or meet the need?

Why was the particular approach to the problem selected?

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 Problem Identification…
How to write problem statement
 It should be precise and concise, while not forgetting to

mention essential points.

 Information concerning the problem should be summarized.

 An outline listing the major points to be covered could be

prepared before any writing is done, so that the section will

be logical and well organized

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 Summary
In general, conceptualizing health system research involves:

Understanding the health system itself

Identifying the problem (topic)

Analyzing the problem

Revising literatures

Drawing conceptual framework

Operationalizing the variables

Stating the problem

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