Generating and framing HPSR questions

Generating and framing HPSR questions

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  Generating and framing HPSR questions IHPSRPresentation 4 www.hpsa-africa.org @hpsa_africa www.slideshare.net/hpsa_africa Introduction to Health Policy and Systems Research
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  Four key stepsin HPSR 1. Identify research focus (problem/concern/opportunity) and question 2. Design study 3. Ensure quality and rigour 4. Apply ethical principles
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  Key issues inthis session • Starting points for HPSR questions • Different kinds of HPSR questions • What is a ‘good’ HPSR question • How to generate substantively relevant questions
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  • The questiondrives the study
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  Generating questions • Startingpoints = focus/terrain of health policy & health systems – consider level (macro/meso/micro/cross-level) • And consider – What are research users’ ideas? – What past work? – Disciplinary perspectives? • Thinking about purpose of research: normative vs exploratory/ descriptive/ explanatory questions
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  Start with the problem/concern/opportunity and aimto inform decision-making by policy and system actors
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  Whose ideas? Research question Community group Patient group District manager Hospital manager National manager International agency Researcher Same issue, different questions? Different issues& questions?
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  What wider knowledge? •Look at international experience (replicate don’t duplicate) – importance of literature review: add to the literature! • Use theory (relevant empirical and theoretical resources)
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  Which disciplinary perspectives? • Evaluationof removal of user fees might consider: – Implementation process: policy analysis – Motivation of health workers: psychology/management – Impact on out of pocket payments: economics – Impact on coverage and infant mortality: epidemiology
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  What is thestudy ‘purpose’? Normative/evaluative: Seeks to generate/identify norms, best practices,’gold standard’ interventions Exploratory: To find out what is happening, especially in little understood situations Descriptive: To give accurate profile of people, events, situations Explanatory: To explain patterns relating to phenomenon being researched; To identify relationships between aspects of phenomenon Emancipatory: To create opportunities and the will to engage in social action Robson, 2002; Thomas, Chataway & Wuyts, 1998; Yin, 2009
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  Normative Impact? Is it best? Whatis best practice? Exploratory What+? (new insights) Descriptive Who? What? Where? How many? How much? Explanatory Why and how? Action/ participatory research From purpose to question form
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  From purpose toquestion ... Purpose Why adopt that purpose? Questions Normative (positivist) To generate ‘best’ practice ideas • Does intervention x work? • Which intervention for issue y is most effective? Exploratory (realist/ relativist) To find out what is happening, when little is known • What categories of information are used in decision-making? • What are the social processes, including power relations, influencing actors’ understandings and experiences, and shaping impacts of interventions? Descriptive (positivist/ realist) To give accurate profile of people, events, situation • What is the quality of care in place q? • What is the level of health worker motivation in place z? • What are stakeholder positions on policy A?
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  Purpose Why adoptthat purpose? Questions Explanatory (some control over events) (positivist) To explain relationships, assuming fairly linear causality • Do managers influence facility performance? How? Exploratory/ Explanatory; Explanatory (little control over events) (relativist/realist ) To identify and explain relationships, assuming complex causality • How and why does management influence facility performance? • When and under what circumstances does management influence facility performance? Emancipatory (critical perspective) Draw on expertise of practitioners Encourage practice changes
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  Need more balancein questions asked • Past emphasis on normative/evaluative work and ‘generalisable’ answers • More work on exploratory and explanatory questions considering socio-cultural-political understandings of health systems Sheikh et al., 2011
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  Sheikh et al.,2011 Level of analysis Macro (architecture) Meso (organisation/ intervention) Micro (individual) Normative/ evaluative How can political parties be effectively involved in a country’s process of planning universal coverage? What are the reasons for the low efficiency of community governance structures that administer a decentralised fund scheme? Does individual coaching offer better support to health system managers than individual training? Exploratory/ explanatory What norms underpin effective oversight by communities? How do ‘pay for performance’ arrangements interact with local accountability structures? Why do front-line providers frequently diverge from recommended clinical guidelines?
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  What makes a‘good’ HPSR question? Adapted from Robson, 2002 • Substantively relevant: worthwhile, non-trivial questions, worthy of the effort to be expended + • Clear: unambiguous and easily understood + • Specific: sufficiently specific to be clear about what constitutes an answer + • Answerable: can see what data are needed to answer it and how those data will be collected + • Interconnected: questions are related in some meaningful way, forming a coherent whole
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  What makes a‘good’ HPSR question? (continued) Adapted from Robson, 2002 • Substantively relevant – How questions are generated >> will build on what is known not duplicate it, will assist system development in a particular context • Clear, specific, answerable, interconnected – How questions are framed/worded >> pay attention to the details: scope (time, place, people), concepts
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  Generating substantively relevant questions •Talk to people in the system of focus – What do they know and understand? – What do they see as important and useful? – What do they identify as knowledge gaps? • Review the literature – What knowledge has already been generated locally, internationally?
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  Types of literaturereviews Go find the resources – lots out there! Also qualitative review & synthesis!
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  Review basics 1. Identifythe review question or focus 2. Frame the area you are searching (year, area or topic) 3. Search for primary studies and theoretical papers (using databases, search engines, or a particular publication) 4. Select papers – inclusion/exclusion criteria; quality appraisal (assess relevance & rigour of what you find) 5. Collect the key items or extract the data 6. Review papers & data 7. Synthesis (make meaning, pull together a coherent argument)
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  ‘Critical Appraisal’ • Theart of providing a reasonable evaluation of a text by breaking it down and studying its parts • To be critical does not necessarily mean to criticise in a negative manner • Requires you to question the information and opinions in a text and present a reasonable analysis • ‘Analysis’ means to evaluate the strengths and weaknesses of the text (or research report), based on clear criteria – and with an understanding of the text’s purpose, the intended audience and why it is structured in the way it is
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  Copyright Funding You are free: ToShare – to copy, distribute and transmit the work To Remix – to adapt the work Under the following conditions: Attribution You must attribute the work in the manner specified by the author or licensor (but not in any way that suggests that they endorse you or your use of the work). Non-commercial You may not use this work for commercial purposes. Share Alike If you alter, transform, or build upon this work, you may distribute the resulting work but only under the same or similar license to this one. Other conditions For any reuse or distribution, you must make clear to others the license terms of this work. Nothing in this license impairs or restricts the authors’ moral rights. Nothing in this license impairs or restricts the rights of authors whose work is referenced in this document. Cited works used in this document must be cited following usual academic conventions. Citation of this work must follow normal academic conventions. Suggested citation: Introduction to Health Policy and Systems Research, course presentation, Presentation 4. Copyright CHEPSAA (Consortium for Health Policy & Systems Analysis in Africa) 2014, www.hpsa-africa.org www.slideshare.net/hpsa_africa This document is an output from a project funded by the European Commission (EC) FP7-Africa (Grant no. 265482). The views expressed are not necessarily those of the EC.
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  The CHEPSAA partners Universityof Dar Es Salaam Institute of Development Studies University of the Witwatersrand Centre for Health Policy University of Ghana School of Public Health, Department of Health Policy, Planning and Management University of Leeds Nuffield Centre for International Health and Development University of Nigeria Enugu Health Policy Research Group & the Department of Health Administration and Management London School of Hygiene and Tropical Medicine Health Economics and Systems Analysis Group, Depart of Global Health & Dev. Great Lakes University of Kisumu Tropical Institute of Community Health and Development Karolinska Institutet Health Systems and Policy Group, Department of Public Health Sciences University of Cape Town Health Policy and Systems Programme, Health Economics Unit Swiss Tropical and Public Health Institute Health Systems Research Group University of the Western Cape School of Public Health