To: Professor Dr. Boungnong BOUPHA
Director
National
Ministry of Health,
Health Development Study
in Lao P.D.R.
Research Proposal of 乬Human
Ecological Study of Health Seeking Behavior of Community-Dwelling People in Lao
P.D.R.乭, 2005
Mitsuhiro IWASA
(PhD Course Student,
RESEARCH SUMMARY
Principal
Investigator
Name: Mitsuhiro IWASA (Mr.)
Title or position: PhD Student, Graduate School of Social
Sciences and Humanites,
Postal Address:
E-mail: iwasamitsu@yahoo.co.jp
Institution
Responsible for Research Program
Research Institute for Humanity and Nature (Prof. Tomoya
AKIMICHI),
Objectives
and Purposes of Research Proposed
1)
To collect concrete data on behavior and idea
related in health issues of community-dwelling people through quantitative and
qualitative methods.
2)
To analyse determinants and dynamics of them
relating to ecological and socio-economical conditions.
3)
To provide information that may serve for
planning a sustainable health development of the village dwelling people of Lao
PDR.
From:
the end of June 2005 To:
March 2006 Total:
about 9 months
RESEARCH DESCRIPTION
1. RESEARCH
TITLE
Human Ecological Study of Health Seeking Behavior of
Community-Dwelling People in Lao P.D.R.
2. BACKGROUND
AND PROBLEM IDENTIFICATION
The purpose of this study is to promote detailed
understanding of Health Seeking Behaviors (HSB) through qualitative and
quantitative research of the health-related Knowledge, Attitude and Practice
(KAP) and to provide another perspective for a health care research and health
promotion.
The process of health-seeking is an important
research issue since it reveals the nature of local health issues and provides
insights into people乫s needs for kinds of health services. There is a growing
interest among scholars and national/international health agencies in both the
theoretical and practical implications of this topic. Over the past few
decades, a considerable number of studies have been conducted on HSB all over
the world, and it is made clear that HSB is influenced by various factors. A.
Kroeger [1983] and A. Kleinman [1980] reported that a decision to seek health
is affected by social and physical factors, such as patient乫s social status, her
social network, economic condition, cultural belief, access to care and ecological
condition. However, in order to understand the nature of HSB from their points
of view, it is essential to know which factors community-dwelling people consider
important and why they do so. Such orientation of ideas is constructed and
re-constructed through everyday practices that maintain their health and cope
with health problems, which can be comprehended only by qualitative methods. Some
influential factors of HSB have been identified increasingly through
quantitative research by national/international agencies [Ministry of Health et
al., 2001]. These findings may help us to understand the rough outline of HSB,
but complementally qualitative data are indispensable to figure out the
determinants of HSB. Thus, it is necessary to carry out community-based
qualitative research of HSB as well as quantitative one.
This study bears
Medical Anthropology and Health Seeking Behavior
Unit of the project 乬Health
Development study in Lao PDR" headed by Professor Kazuhiko MOJI of Nagasaki University, Japan, which is a subsection of "A Trans-Disciplinary
Study on the Regional Eco-History in Tropical Monsoon Asia: 1945-2005"
headed by Professor Tomoya AKIMICHI of Research Institute for Humanity and
Nature (RIHN), Japan.
3. RESEARCH PURPOSE
AND DATA COLLECTION
The purpose of this
study is to promote better understanding of HSB and to provide information that
may be of use to consider health care delivery, through examining the nature of
KAP of community-dwelling people. Data to be collected is as follows:
1) Quantitative data of health status,
socio-economic condition, ecological background of the target communities.
2) Qualitative data of KAP related in health issues
of the communities
3) Prospective and retrospective cases of HSB and
medical choices.
4. EXPECTED OUTPUTS
This study will be
expected in the following theoretical and practical contributions:
1) To present qualitative data on local health
issues and socio-economic condition
2) To promote better understanding of KAP related
in health idea in rural area.
3) To identify the characteristic and determinants
of HSB of community-dwelling people.
4) To provide information that may be useful to
consider an effective and efficient health care delivery system.
5. METHODOLOGY
Main research area is Lahanam
zone where is located in the northwest part of Songkhone district, Savannakhet
province, and divided into six villages: Bengkhamlay, Lahanamtha, Lahanamthong,
Thakamlian, Dongbang and Kokphok. This study will take place in the south part
of Lahanam (Dongbang, Thakhamlian and Kokphok) especially. As the need
arises, other area will be surveyed. The
tentative schedule of the investigation is planed as Appendix 1. Research
components are as the following;
1) Component 1: Quantitative Study
丒 Periodical
household census
The household census will be practiced periodically in order to
collect quantitative data on demographic transition, socio-economic transition,
changes of health situation.
Research items will be changed depending on the situation (see Appendix 2 about tentative research
items). This survey will be practiced for one week, every three months in Second and Third Phase.
丒
Questioner survey
Questioner survey to
the sampled residents will be carried out for grasping health situation and KAP
of villagers. Subject is about 350 over-20-years-old adults, who will be chosen
at random. Questioner will be made by combining some questioners about Quality
of Life (QOL), Sense of Coherence (SOC) and Activity of Daily Life (ADL), which
are evaluated internationally. Translating into Lao language and validating the
questioner will be done with Lao staffs in First Phase. This research will be conducted in Second and Third Phase.
2) Component 2: Qualitative Study
丒
Participant observation and open-ended
interviewing about health-related socio-cultural issues.
Qualitative research on
health related socio-cultural issues is carried out through participant observation
and open-ended interviewing. Observing people乫s daily practices and talking
about them on the spot, we can know their meaning and relationships with
contains from native乫s point of view. These findings help us to understand
local setting of KAP related in health issues. This investigation will be
conducted for one week every month in Second Phase.
丒
Open-ended interviewing with care-providers
This open-ended
interview will focus on health-related KAP of each care-provider such as
doctors, nurses and staffs of Ministry of Health. Comprising these data with
lay illness terminology and evaluative procedures, the differences between
care-givers and care-providers and feature of people乫s understandings of local
health issues can be identified. Around three days at each facility will be
dedicated to this form of interviewing in Third Phase.
6. PROJECT MANAGEMENT
1) Human
Resources (Main investigator)
Mitsuhiro IWASA, PhD Course Student,
2) Support Needs
丒
Application
to stay for a long period in
丒
Schedule
arrangement and NIOPH personnel for the trip to the research area (mainly Savannakhet).
丒
Translating
and evaluating questioners.
丒
Research
personnel in the research area
* Number of
the personnel and the period
of their employment will be determined after the consultation with National
Institute of Public Health (NIOPH),
Ministry of Health of Savannakhet Province, and Ministry of Health of Songkhone
District.
3) Budget and
Expenses
The budget of this research is covered by Japanese government
through RIHN, under the agreement of NIOPH. The following is the breakdown of
this budget.
丒
Traveling cost
丒
Field operational cost
丒
Expendable materials for the field survey
丒
Employment cost (research assistants wages etc.)
4) Period of Stay
丒
Arriving: the
end of June 2005 Arrival
day and time: unfixed yet.
丒
Leaving: the
end of March 2006 Departure
day and time: unfixed yet.
丒
Total stay:
about 9 months
5) Work Schedule
The tentative schedule
of the research is planed as Appendix 1.
丒 Move to research area is to use a local bus.
丒 Monthly report will be presented to NIOPH,
Ministry of Health, Savannakhet province and Ministry of Health, Songkhon
district.
*
This schedule will be negotiated with NIOPH, Ministry of Health in Savannakht
province, and Ministry of Health in Songkhon district.
*
The current research will be planed to continue in next fiscal year.
6) Ethical
Consideration
Permission to conduct the study will be sought from the National
Ethics Committee for Health Research (NECHR) in Lao PDR. All works of this
study in Lao PDR are carried out under NIOPH. In conducting the survey, we will
get informed consent of the member of the communities by document or word of
mouth. Any raw data collected in this study will not be used without academic
analysis. When academic paper will be issued, any personal data to infringe upon an individual's privacy will not be
written. If the subject individuals want to know about results or publications
of this study, they can access all results and publications without the matter
of privacy.
7. MONITORING
NIPOH will monitor all over this study in Lao PDR. Department of
Health of
8. EVALUATION
Validity and legality of methodology and results of this study
will be evaluated by NIPOH and RIHN. Academic validity of outcomes based on
this study (ex. doctoral theses) will be made a judgment by GSSSHCU mainly.
9. ANALYSES AND DISSIMINATION OF RESULTS
The information out of this study will be published as a part of
the report of Health Development Study in Lao PDR. Doctoral thesis for GSSSHCU
will be written basing on this research. In addition, research articles will be
submitted to some international or local journals.
10. COLLABORATING INSTITUTIONS
This study constitutes as a part of the project 乬Health
Development study in Lao PDR乭, in collaboration with
丒
National Institute of Public Health,
丒
National
丒
On the other hand, the project is a sub section of 乬A
Trans-Disciplinary Study on the Regional Eco-History in Tropical Monsoon Asia:
1945-2005乭, in collaboration with
丒
Research Institute for Humanity and Nature,
丒
Institute of Tropical Medicine,
丒
The main bodies of the projects are NIOPH and RINH in cooperation with provincial health department.
11. REFERENCES
Evans,
Grant ed.,
Halpern,
Joel M., Traditional Medicine and the Role of the Phi in
Kleinman,
Arthur, Patient and Healers in Cultural
Context: Comparative Studies of Health Systems and Medical Care,
Kroeger, Axel, Anthropological and
Socio-Medical Health Care Research in Developing Countries, Social Science and Medicine 17(3), 1983,
147-61.
McElroy,
A. and Townsend, P., Medical Anthropology
in Ecological Perspective, Westview, 1985.
Ministry
of Health et al, Report on National
Health Survey: Health Status of the People in Lao P.D.R, 2001.
Pelto,
Carolyn F., and Gretel H. Pelto, Research Designs in Medical Anthropology,
Sargent and Thomas M. Johnson (eds.), Handbook
of Medical Anthropology: Contemporary Theory and Method Revised Edition,
Vinar,
P., Survey on Health Seeking Behavior in
Lao P.D.R., 1994.
Westermeyer,
J., Folk Medicine in
Appendix 1: Tentative Work Schedule
|
|
Arriving at |
|
First Phase 26 JUN – 15 AUG. (around 2 month, at |
u
Research
set-up 丒
Application
of some formalities to conduct current research 丒
Making
arrangements for the research (Schedule and support needs) 丒
Translating
and validating questioners u
Learning
Lao language in |
|
Second Phase 16 AUG – 30NOV. (around 3month, at
Lahanam), |
u
Quantitative
research 丒
Periodical
household census and structured interview 丒
Questioner
survey about QOL, ADL and SOC (the first) u
Qualitative
research 丒
Participant observation and open-ended interviewing u
Presenting
the monthly report to interested institutes. |
|
Third Phase 1 DEC. – 28 FEB. 2006 (3months, at Lahanam) |
u
Quantitative
research 丒
Periodical
household census and structured interview 丒
Questioner
survey about QOL, ADL and SOC (the second) u
Qualitative
Research 丒
Open-ended interviewing with care-providers u
Presenting
the monthly report to interested institutes. |
|
Final Phase 1 – 30 MAR. (1month, at |
u
Analysing
data and supplementary surveys u
Presenting
the monthly report to interested institutes. u
Evaluating
the fist period of the research and preparation for the last period (* the current
research will be planed to continue in next fiscal year.). |
|
31 MAR. |
Leaving for |
Appendix 2: Tentative Research Items
Q.1
嘆 Household number
嘇 Unit number
Q.2
嘆
Family
members
嘇
Name
嘊
Relation
with household head
嘋
Sex
嘍
Age
嘐
Date of
birth
嘑
Occupation
(include foreign labor)
嘒
Literacy
(over 10 years old)
嘓
What was
each member doing before we visited?
Q.3 To the household head:
嘆
Ways of
cash income and an amount of last month income (price of texture, cash crop and
so on)
嘇
Ethnic
identity (which ethnic group do you belong to?)
嘊
Religious (which
religious do you believe?)
Q.4
嘆
Is there
any person, who is a pregnant?
嘇
Is there
any person, who is under breast-feed?
Q.5 If there are married women:
嘆
How many
times has she gotten pregnant?
嘇
How many
times has she been delivered off?
嘊
Where was
she usually delivered off? (if at home, ask who help her delivery)
嘋
How many
children dose she has now?
嘍
Do you precede
the family planning?
嘐
Miscarriage
and stillbirth (if yes, check the times and year)
嘑
How many
children died? (check the cause of death and age)
嘒
Check Blue
card (mother乫s card) and Yellow card (baby乫s card)
Q.6 If there has been dead parsons in
last two years:
嘆
How old was
s/he dead?
嘇
What was
the cause of death?
Q.7
嘆
What kind
of domestic animal do you have? (include cat and dog)
嘇
Number of each
animals
Q.8
嘆
What kind
of electronics (media) do you have?
嘇
Number of
electronics
嘊
倂hen did you get them?
Q.9
嘆
What kind
of the vehicles do you have?
嘇
Number of
each vehicles
嘊
When did
you get them?
Q.10
嘆
Do you use
mosquito net?
嘇
How many
nets do you have? (ask kind and size of the nets also)
嘊
How often
do you use them?
Q.11
嘆 If household member become sick, how do you do
firstly and secondly (and thirdly)?
嘇 Have you used a traditional healer and a spirit
practitioner?
(if yes)
嘊 What kind of symptoms did you get?
嘋 Cost of their practices
Q.12
嘆
Are there
sick parsons in your family now?
嘇
What kind
of sick does s/he get?
嘊
What kind
of treatment is s/he taken?
Q.13
嘆
Were your
family members sick in last 2 weeks?
(if yes)
嘇
What kind
of symptoms did you get?
嘊
How did you
do at the time firstly and secondly (and thirdly)?