NOTA

TOPIC 1: INTRODUCTION
1.1 What is research?
Research is any sort of careful, systematic, patient study and investigation in some field of knowledge, undertaken to discover or establish facts and principles.

1.2 What is Health Systems Research?
Health System Research is a systematic study of the means by which basic medical and relevant knowledge and technology can be brought to have optimum impact on the health of the individual and communities under existing conditions. IKU (1991)

1.3 Why carry out Research?
-Gain new knowledge
-Find out why certain diseases occur in a particular area?

1.4 Characteristics of a research are:-
-Begin with question in the mind
-Require a plan
-Demand a clear statement of the problem?
-Seek direction through a series of “educated quesses”
-Builds on that has gone before, using positive and negative finding
-Collect facts and organize them so they have meanings
-Organize the derived meanings to answer the original question

1.5 What is meant by “health system”?
-A system consists of interrelated and interacting components. It can be illustrated in a model.
-Some of the issues are:-
>Provision of services
>Demand and supply of services to the community
>Individual and families
>Community structure and life styles
>Management of health services
>Health and related policies

1.6 Guidelines for Health System Research.
-Research design should focus on priority problems in health care.
-Facts of the research have to be identified and studies should be schedule so that results will be available when needed for key decisions.
-Research should be simple and practical which can yield practical results
-Cost factor should be considered when undertaking a research project
-Results should be presented in a clear, honest discussion presentation for the management for alternative course of action.

1.7 Research Process:
-the following essential steps may serva as guidelines:
a)statement of the problem:
-Problem identification
-Problem analysis
-Define the problem
b) Literature review
c) formulation of objectives
d) research methodolgy
e) data collection
f) Data analysis and interpretation
g) Dessemination of findings

TOPIC 2: PROBLEM SELECTION AND ANAYSIS OF THE PROBLEM
2.1 Selection of problem and analysis.
a. What is the problem?
b. Why is the problem important to be researched?
-Identification of the problem
-Priority of the problem
-Analysis of the problem
-Justification of the problem

2.2 Steps in selecting and analysis of the problem.
1.Clarify the viewpoint of managers, health care workers, researcher’s in relation to the problem.Examples:-
-High incidences of Dengue fever in Kampong B.
-Poor reception of health project by the rural people.
-High failure rate among male IK students

2.Clarify who is perceived to be affected by the problem. When? Where?Examples:
-High incidence of Diarrhea and vomiting Disease.

3.Analyze the Problem.What are the possible causes of the problem. Use box diagram for analyzing of the problem.

4.Identify and demarcate the boundaries of possible research projects.Review the diagram and indicate the group (s) of perceived problems and contributory factors that could be the topics of separate research projects.

5.Criteria for selecting a research project are as follows :-
-Relevance
-Duplication
-Feasibility
-Cost effectiveness
-Timeliness
-Applicability
-Ethical consideration(use of rating sheet)

6. Linking problem analysis to eventual use of research findings.
-The reason for undertaking HSR is to obtain results that can be used to improve health and health care.
-Results may be used to:-
>Improve health services
>Solving health problems.
-The result should DECISION-LINKED.

7.Formulation of Problem Statement
-The first major section in a research proposal is the “Statement of the Problem” or description of the background concerning the topic selected.

a)Why is it important to state and define the problem well?
-Is the foundation for the development of a research proposal (research objectives, methodology, work plan, budget, etc.)
-Allows to clarify the chosen topic
-Enables to systematically describe the problem, to think about its importance, its priority in the country and in the local area, and point out why the proposed research on the problem should be undertaken
-Can be important as a working tool during the discussion with community leaders, health staff, etc.
-Facilitates the presentation of the project to the authorities and donors

b)How should the statement of the problem be written for the proposal?
-The information concerning the problem should be summarized in a concise manner.
-This section of the proposal should not take more than 2 – 3 pages.
-An outline listing the major points to be covered should be prepared before any writing is done. This helps to make the statement logical and well organized.
-Definitions of all special terms and abbreviations used in the study to be prepared, with their meanings clearly explained.

c)What information should be included in the statement of the problem.
-Background concerning health status and health care in the country ( including relevant statistics), making sure to relate this information to the problem to be studied.
-A more detailed description of the research problem such as:-
>An explanation why the problem is important,
>A description of important geographical, cultural, religious or economic factors that affect the problem,
>Population behavior related to the problem,
>Services offered to reduce the problem (if applicable)
>A brief description of earlier study on the problem.
>A summary of why the problem of concern needs to be researched and how the results will be useful

d)Problem statements serve several purposes:-
-Resolve existing inconsistencies;
-Identify new inconsistencies;
-Review understanding of the problem areas;
-To improve upon the researcher’s understanding on the issue;
-To communicate view points;
-To demonstrate steps in the analysis; and
-To justify the viewpoint and the analysis.

TOPIC 3 : LITERATURE REVIEW
1. What is literature review?
Literature review is digging into the literature to find out what has been written about the topic that one is interested in investigation.

2. Why literature review is important?
-It prevents from duplicating work that has been done before.
-It helps further understand the problem planned to research, and may lead to refining of the “ statement of the problem”.
-It helps one to understand what others have learned and reported on selected topic, and take account of this in the design of the study.
-It gives a familiarity with the various types of methodology that might be used in the study.
-It should provide reasons for others to support the proposed research.

3. How to set about doing a literature research.
-Locating sources of information may be referred to as a “denominator search” and identifying the relevant and valid pieces of information leads to the production of a “citation list”.
-Sources of information and literature review can be obtained at international, national and local level.
-These sources may be classified as :
>people, unpublished sources (annual report),
>published sources (abstract journals),
>machine sources (computer databases)
>and others.

4. How should information on an index card be organized?
4.1 For an article:
Author’s surname and initials;
Title of the book;
Edition;Place of publication;
Name of publication
Year of publication;
Volume, if more than one has been published; and
Page number

4.2 For a book:
Author’s surname and initials;
Tile of the article;
Volume;Page;
Month;
Year.

4.3 For an interview:
Name of person being interviewed
Date of the interview
Status of person interviewed in relation to the research problem

4.4 For official publication:
Name of countryName of ministry/department/ other official designation
Title and year of bulletin, report, etc
Place of publication
Name of publisher; and
year of publication

4.5 From internet:
Quote article, and author(s) and the website to written as footnote.

TOPIC 5: FORMULATION OF OBJECTIVES
1.What are research objectives and why should they be developed?
-Objectives of a research project summarize what is to be achieved by the study.
-Objectives should be closely related to the statement of the problem.
-It focus the study
-To prevent collecting data which are not necessary
-To better understand and solve the problem identified, and
-To organize what is to accomplish in the study in clearly defined parts or phrases.

2. Types of objectives:
-General objective.
-Specific objectives.
-Objectives should :
>Be phrased in such a way that they focus on what the study is attempting to solve, and cover the different parts of the problem in a logical way.
>Be clearly phrased in operational terms specifying exactly what one is going to do.
>Be realistic for the objective to be achieved within the local condition.

3. In what form can research objectives be presented?
-It can be done in the form of hypothesis or research questions
-Hypothesis is an explanation or a predication of why one or more factors influence other factors.-Example;Smoking causes cancer.
-Possible objectives could be to verify the hypothesis.

4.How should objective be phrased?
-It should be stated by using verb word or action word.-Examples:To determine, to compare, to verify, to calculate, to describe, to establish, to evaluate, and etc.

TOPIC 6 :RESEARCH METHODOLOGY
6.1 VARIABLE.
6.1.1What is variable?
-A variable is a characteristic of a person, object or phenomenon, which is measurable and take on different values in a research.
-Examples:
>Sex (male, female)
>Religion (Christian, Islam, Buddhism)
>Height (short, tall or 4 ft, 5 ft)
>Weight (light, heavy or 50 kg, 80 kg
>Occupation, income, social class, crowd index, etc.

6.1.2 Types of variables:
-Dependent variable (effect/outcome)
-Independent variable (cause)
-Confounding variable (other factors)

6.1.3 Scale of measurement of variables.
There are 3 main types:-
a. Nominal scale.
-This consists of two or more categories that are mutually exclusive and presented in the form of counts.
-Examples:
>Agreement with a statement: agree, disagree;
>Smoking: never smoked, ex-smoker, smokes cigarettes
>Marital status; single, married, widowed, divorced.

b.Ordinal scale.
-The categories are ranked, the scale shows positions of a ladder.
-Example:
>Social class: 1,2,3,4,5
>Years of education: 0, 1-5, 6-9, 10-12, more than 12
>Agreement with a statement: agree completely, agree to some extent, disagree completely.
>Severity of disease: severe, moderate, mild.

c.Continuous scale.
-This consists of a continual of measurement.
-Example:
>Weight in kg
>Income measured in ringgit
>Hemoglobin level in blood

6.2 TYPES OF STUDY DESIGN
=the formal plan of action for a research project.
=helps researcher to layout their:
>research questionaire
>methodolgies
>implementation of procedure,
>data collection and analysis for the conduction of the research project.

6.2.1 Descriptive Studies type.
-Descriptive study involves the systematic collection and presentation of data to give clear picture of a particular situation.
-It aims to define what the problem is and seek to explore and identify various factors associated with the problem.
-There are two main types of descriptive studies:
a. Qualitative studies:
=Qualitative research involves in-depth exploration of a number of often mutually related variables that give insight in a certain problem and situation.
=This study concern with opinion, perception and attitudes to a topic.
=These studies describe qualitative variables which may be difficult to measure.
=It mostly concentrates on small study population.
=It may use loosely structured interview with key informants, and focused group discussion, as well as in-depth interviews with a sample of informants, and observations on behavior.

b. Quantitative study.
=Qualitative research aims at quantify the distribution of certain variables among a study population.
=Variables are easily measurable
=examples; Number of latrine built, etc.
=This type of study cover large study population.

6.2.2 Analytical studies type.(comparative study (in social science)
-Analytical study goes one step further and tries to determine the relationship between a characteristic and the problem so as to suggest possible causes for certain problem.
-This is done by comparing two or more groups, where one group has the problem (or risk factor) under study and the other does not

a. Case-control study design. (Retrospective study)
-In case-control study, the investigator compares one group of informants among which the problem that he wishes to investigate is present (e.g. malnutrition), and another group called a control, where the problem is absent, in order to find out what factors have contributed to the problem.
-The cases and the controls are matched on certain variables, but not on the variables which expects to cause the problems
-This type of study is relatively quick, easy and cheap to undertake. The problem is the selection of an appropriate control group.

b. Cohort study design (Prospective study)
-In a cohort study, a group of individuals that are exposed to risk factor (study group) are compared to a group of individual s not exposed to the risk factor (control group).
-The research follows over time in both groups whether and when diseases or problems appear that she or he expects to be related to the risk factor, and compares the occurrence of these problems.
-An example of a cohort study is that carried out among smokers and non-smokers to determine the importance as a risk factor for developing lung cancer.
-Another example is this type of study is to investigate the causal relationship between the use of a certain water source and the incidence of children under five in a village with different water sources

6.2.3 Experimental study type
-An experimental study is the strongest possible type of study to prove causation.
-In an experimental study, individuals are randomly allocated to at least two groups.
-One group is subjected to an intervention, or experiment while the other group is not.
-The outcome of the intervention is obtained by comparing the two groups.

-Example:
>To study the effects of a new drug.
-Advantage;
>It is the most powerful method of testing the cause-and-effect relationship between variables.
-Disadvantage;
>Certain variables cannot be manipulated in this way
>Ethical issues may be raised.

-This type of study is commonly used in laboratory and clinical research.
-Types of experimental study.
>Experimental study
>Quasi-experiment

6.3 VALIDITY AND RELIABILITY IN RESEARCH DESIGNS.
Research is valid when the conclusions are true. It is reliable when the findings are repeatable.
a.Internal Validity of research can be influenced by:-
-Confounding factors
-History and maturation
-Instrumentation-Selectivity

b.Threats to external validity.
-Sample is not representative;
-Hawthorn effect

TOPIC 7.TECHNIQUE OF DATA COLLECTION
1. RECORD SOURCES:
-adv:
>inexpensive because data already collected.
>permits examination of trands over the past.
-disadv:
>difficulty in gaining access/issues concerning privacy.
>information recorded may be biased/purpose of producing data.
>change in record-keeping procedures overtime.

2. OBSERVATION:
-adv:
>give more detailed information.
>allow to collect information on focus not mentioned in the questionaire.
> allow to test reliability of responses to questionaire
-disadv:
>Observation bias ( researcher may only notice what interests him).
>Presence of researcher can influence the situation he observes.
>Future plan cannot be obsereved.

3.INTERVIEW:
-adv:
>Suitable for illiterates.
>Clarification of questions is possible.
>High response rate than written questionnaires.
>Extra information can be gathered through observation. [small scale flexible interview]
>easy to analyse [large scale fixed interviews]
-disadv:
>presence of researcher can influence responses and actions of respondents.
>records of events may be less complete than with observations (record only what respondents say they think, believe or fell)
>Observer bias, if information not scheduled [small scale flexible interview]
>more difficult to analyse in a standard way [small scale flexible interview]
>easy to miss the important information. [large scale fixed interviews]

4.NOMINAL GROUP TECHNIQUE:
-adv:
> Allow target group to single out critical problem dimensions by means of group process which is unthreatening & depersonalised.
>Clarifies the meaning of critical items
>Can explore objective and subjective dimensions of problem area.
>through 'content analysis' helps in formulation of wording of questions for field interview.
-disadv:
> Not applicable with illiterates.
>Weighing is subjective.

5.FOCUS GROUP DISCUSSION:
-adv:
>Provides in depth qualitative information on the concepts and ideas of group of persons.
-disadv:
>Shy participants
>Domineering participants.

6.WRITTEN QUESTIONNAIRE (self administ)
-adv:
>No need for research assistants.
>No bias
>More honest response
-disadv:
>Not suitable for illiterates.
>Low responses rates.
>Questions may be misunderstood.

Questionnaire:
-Questionnaire is the most commonly used instrument for collecting and recording of information in research.
-It is useful to use a questionnaire in combination with other data collection techniques (observation).

a. Two types of questionnaires:
-i. Open ended question - This permits free responses.
Advantages:
>Allow the respondent to “tell it like it is”.
>Enable the respondent to bring up issues not previously thought of in planning the study.
Disadvantages:
>Make heavy demand on the interviewer
>Difficult to analyze

ii. Closed ended question. - Offers a list of options that are exhaustive.
Advantages:
>Answers can be recorded easily
>Easier to carry out analysis because the responses are already set out in a way suited for analysis.
Disadvantages:
>Leave little room for the respondent to of other possible answers.

b. Sources of bias in information collected.
-Defective instrument
-Observer bias
-Seasonality
-Effects of observer on informant.

TOPIC 8. SAMPLING
8.1. Why sampling?
-It is impossible to study the entire population due to time , financial, and constraining factors.
=Sample refers to any group on which information is obtained.
=Sampling is the process of selecting the individual of the study population
=Study population is the population that need to be studied. This can be clinic, household etc.
=Respondent is an individual from the sample where the information is obtained.
=Sampling size should not less than 30 respondents
=sample size is the number of sample needed which is representing the population that are studied.

8.2 Sampling procedures.
8. 2. 1 NON PROBABLITY SAMPLING:
-Two sampling procedures are useful for pilot study on attitudes or opinion where the aim is to get a rough impression on how certain variables are distributed in the population.
-They are most convenient methods but their great disadvantage is biasness.
a. Convenience sampling:
-This is a sampling method in which the sample that happens to be available at the period of the research is selected for convenience’s sake.
-The disadvantage is that the sample may not be representatives.
b. Quota Sampling:
-This method ensures that all the known elements in the population occur in the sample.
-The investigator interviews as many people in each category as he can find until he fill his quota

8.2.2 PROBABLITY SAMPLING:
-Probability sampling employs random procedures to ensure that the sampling unit is selected on the basis of chance.
-Each member of the population should have a known chance of being included in the sample.
a. Simple random sampling:
-This type of sampling ensures each unit in the population list has an equal chance of being selected for the sample.
( Use of a table random numbers for selection of the unit)
b. Systematic Sampling:
-This method is to choose the individuals from the list by taking, say, every tenth person on the list.
-Ideally a random number is to be used to tell where to start.
c. Stratified Sampling:
-This is a process in which certain subgroups, or strata, are selected for the sample in the same proportion, as they exist in the population.
d. Cluster sampling:
-This is the process of selecting groups rather than individual unit for the sample.

TOPIK 9: PLAN FOR DATA COMPILATION AND ANALYSIS
-Plan should be prepared for Data compilation and analysis.
-This data plan should include the followings:
>Storing and labeling of data when it comes in from the field
>Systematic quality control of data
>Processing the data
>Data analysis
>Preliminary plans for the interpretation of results.

Chapter 10:MANAGEMENT OF A RESEARCH PROJECT.
i. Planning for data collection
-Permission to proceed
-Pre-testing the methodology
-Data collection
-Data handling
ii. Work plan and scheduling
-Work schedule
-Gantt chart
iii. Budgeting

Chapter 11:STATISTICAL DESCRIPTION OF VARIABLES
In analyzing data, it is important first of all to determine the type pf data that are dealing with. The two common types of data are:
11.1 Categorical data;
a. Nominal data
b. Ordinal data
-Both nominal and ordinal data can be examined through;
=Frequency distributions
=Percentages and proportion=Presentation in figures

11.2 Numerical data
-Numerical data can be examined through:
>Frequency distributions,
>Percentages, proportions and rates
>Presentation in figures, and
>Measure of central tendency.

11.3 Presentation in figures.
-The most frequently used figures for presenting data are:-
a. Categorical data:
-Bar charts
-Pie charts
b. Numerical data
-Histogram
-Line graphs
-Scatter diagram

TOPIC 12: REPORT WRITINGA.STEPS IN PREPARING REPORT
i. Preliminary Consideration
-Who is the reader?
-Why does he want to read the report?
-The report should meet the needs of the audience of the health managers and the researchers.

ii. Verify and complete the data analysis.
-Are the conclusions appropriate to the specific objectives.
-Are further analytic tables needed?
-State the final conclusions in relation to each objectives.
-Construct supportive tables to appear in the text of the report.

iii. Writing the report.
-The aim of the report is to tell the reader the facts in a simple, logical, sequentialfashion.
-Avoid confusion and distracting the reader.
-Main components of a research report:

-Cover page;
=Title, author (s) name with tiles and position, and the institution that publish the report.

-Summary or abstract:
=What? Why? Where? How?
=All main findings and conclusions, followed by recommendations-Introduction (background information, problem statement, and literature review);

-Objectives;
=Include the general and specific objectives.

-Methodology;
=Include the study type, variables, population sample, sampling size, sampling method, data collection techniques, source of data and how are collected.

-Findings;
=The systematic presentation of findings in relation to the research objectives.
=Description of findings may be complemented by tables or graphs summarizing the findings

-Discussion and conclusions;
=The findings can be discussed per objective or per cluster of related variables.

-Recommendations;
=Recommendations should cover findings of the study and also supportive information from other sources and available information on related factors.

-References of literature used;
=Use of Harvard System of listing.

-Appendices; and

-Acknowledgement (optional).

LITERATURE REVIEW
APA?
-Kajian Kepustakaan mengenai topik penyelidikan.
-Gelintaran sastera

Kenapa Perlu?
1. Mengelakkan duplikasi kerja
2. Memperbaiki pemahaman mengenai masalah penyelidikan dan memurnikan “pernyataan masalah” (problem statement)
3. Membantu memahami penyelidikan orang lain dan kaitannya dengan penyelidikan yang akan dijalankan
4. Kefahaman mengenai pelbagai metodologi yang digunakan dalam penyelidikan
5. Mengukuhkan keyakinan orang lain untuk menyokong penyelidikan.

Bagaimana membuat LR?
• Sumber Maklumat
• Valid (Boleh pakai) “Citation
• Releven (Berkaitan) List”
• Pencarian Maklumat Mesti Spesifik
• Bahan Rujukan
• Dibaca
• Buat ringkasan dalam bentuk Kad Indeks

Kad Indeks
-Ciri Umum
1. Saiz = 5’ X 3’

2. Maklumat Muka Hadapan
a) Buku
b) Artikel
c) Temubual
d) Terbitan Rasmi
e) Internet

3. Maklumat Muka Belakang

Maklumat Muka Hadapan Buku:
• Surname Penulis dan Initials
• Tajuk Buku
• Edisi
• Tempat Diterbitkan
• Nama Penerbit
• Tahun Penerbitan
• Volume (jika > 1 diterbitkan)
• Bilangan Muka Surat
CONTOH
Davis, M.L & Cornwell, D.A. Introduction to Environmental Engineering. 3rd Edition. Boston, Massachusetts. McGraw Hill. 1998: xvi + 919 pg.

Maklumat Muka Hadapan Artikel:
• Surname Penulis dan Initials
• Tajuk Artikel
• Volume
• Bulan Diterbitkan
• Tahun Diterbitkan
• Bilangan Muka Surat
CONTOH
Taylor, C.E. The uses of health systems research. Public Health Papers 78. Geneva: World Health Organization, 1984:1

Maklumat Muka Hadapan Temubual:
• Nama individu ditemubual
• Tarikh
• Status Individu dan kaitannya dengan penyelidikan
CONTOHDr. Lily Yong (MD). April, 22nd 2006. Director of Family Planning Unit QEH, Kota Kinabalu, Sabah.

Maklumat Muka Hadapan Terbitan Rasmi
• Nama negara
• Kementerian/ Jabatan / Bahagian Rasmi
• Tajuk
• Tahun Buletin/ Laporan
• Tempat diterbitkan
• Nama Penerbit dan Tahun Terbit
CONTOH
Malaysia. Ministry of Health, Public Health Institute. Training Modules in Designing and Conducting Health Systems Research Projects. Kuala Lumpur: 1991.

Maklumat Muka Hadapan Iternet:
• Tajuk Artikel
• Nama Penulis
• Website add/ URL
CONTOH
Family Planning Methods. Dr. Martin, M. http://en.wikipedia.org/familyplanningmethods

Maklumat Muka Belakang
• Topik Utama Artikel/ Temubual/ Buku etc.
• Klasifikasi BahanSangat Berkaitan/ kurang berkaitan
• Nombor Rujukan kepada “Nota Ringkasan”
CONTOH
Davis, M.L & Cornwell, D.A. Introduction to Environmental Engineering. 3rd Edition. Boston, Massachusetts. McGraw Hill. 1998: xvi + 919 pg.

Topik;Pengenalan Kejuruteraan Persekitaran – pencemaran air, udara dan pelupusan sisa.

Klasifikasi;
Kurang berkaitan tetapi satu sumber rujukan am yang sangat membantu

Nombor rujukan kepada “Nota Ringkasan”;
Davis & Cornwell. Introduction to Environmental Engineering. 19984-1 to 4-7. water quality management. Pg 283-337