Rural Community Health and Well-Being: A Guide to Action

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1 Rural Community Health and Well-Being: A Guide to Action Health Community Resiliency Population Stressors Interactions as a collective unit (Being) Safety & Security Health & Well-Being Social Supports Economics Assets & Strengths Community Processes Expression of a sense of community (Belonging) Stressors Education Stressors Recreation Heritage Arts Community Action (Becoming) Community Infrastructure Environment Rural Development Institute, Brandon University, 2004 Edited by: Robert Annis Frances Racher Marian Beattie

2 Rural Community Health and Well-Being: A Guide to Action Edited by: Robert Annis, Frances Racher and Marian Beattie Rural Development Institute Brandon University th Street Brandon, Manitoba, R7A 6A9 This project was sponsored by Social Sciences and Humanities Research Council of Canada, Grant , Strategic Theme: Society, Culture and Health of Canadians

3 2004 Rural Development Institute Brandon University, Brandon, Manitoba CANADA R7A 6A9 All rights reserved. Except where noted, no part of this book may be reprinted or reproduced or utilized in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval systems, without the written permission from the authors, editors, or publisher. Library and Archives Canada Cataloguing in Publication Data Rural community health and well-being : a guide to action / edited by: Robert Annis, Frances Racher, Marian Beattie. Includes bibliographical references. ISBN (paperback) 1. Rural health--canada. 2. Rural health services--canada. I.Annis, Robert II. Racher, Frances III. Beattie, Marian IV.Brandon University. Rural Development Institute. RA771.7.C3R '04257'0971 C

4 Foreward Bill Reimer Political analysts point to the new governance as the revolution that no one noticed. They refer to the many ways in which non-government and private sector groups have taken over government functions sometimes on their own, and sometimes in partnership. Health, environmental enhancement, recreation, economic, and social support services that used to be provided primarily by governments are now shared by complex systems of government, private, and public partnerships or left to the purview of voluntary groups. These new forms of governance make significant demands on civic groups yet these groups are seldom given the knowledge and resources enabling them to do the job. Group organization, information collection and analysis, knowledge development, conflict resolution, partnership formation, and social action are usually a hit and miss affair left up to ad hoc learning with minimal support for the complexities of the new conditions. Such an approach places civic groups at a disadvantage in their relationship with more formal institutions and it undermines their ability to act effectively to meet the challenges they face. Without strong and flexible civic engagement, this new form of governance is bound to fail. It requires communities and groups that can investigate and represent their situation in terms that are well founded and comprehensible. It requires debates on key values and objectives that are transparent and inclusive, and it requires social action that is focused and strategic. All these place additional demands on communities that are challenged already by change and uncertainty. This guidebook makes an important contribution to meeting those challenges. It provides key tools for groups to identify the nature of the issues they face, gather appropriate information, transform it into knowledge, and mobilize themselves and others to meet the new demands. It supports a knowledge culture that promises to empower communities and produce innovations in social organization that will prepare all of us for the surprises and demands of the new century. I congratulate the editors for their work and look forward to the new insights, activities, and initiatives that will follow. Bill Reimer November 9, 2004

5 Betty Havens It has been a pleasure and a privilege to watch this guidebook evolve and take form. Its precursor, as a working draft, was both tentative and prescriptive; this is truly as it is subtitled A Guide to Action. This tool enables rural communities to develop the actions that they need to undertake to ensure that their communities are healthy communities and that their populations are healthy and secure. The authors, participants, partners and communities that have developed this guidebook are to be congratulated. They have collaboratively produced a tool that will be readily accessible to assist local rural and more remote communities find the data that they need to produce the plans that will evolve into the Actions that will move them forward as both healthy and endowed with well-being. The conceptual underpinning that is provided in the first three chapters and the process, as detailed in chapter four, will lead to success by setting the stage and enabling each community that chooses to do so to move toward an action plan of their own. This will enable them to use, modify, interpret and sustain the actions laid out in the tools that constitute the majority of this guide. Such collective and collaborative action will empower communities to take true ownership of their own health and community development and the health and development of every citizen, regardless of age, gender, ethnicity, socio-economic status, residential tenure, and community roles. Again, I congratulate all those involved in this excellent resource and eagerly await the documentation of those communities that will take up the challenge of producing healthy communities based on the use of this Guide to Action. In other words, I look forward to a follow-up book of case studies and further development of the tools and conceptualizations. Betty Havens November 30, 2004

6 Table of Contents Foreward... 4 Bill Reimer...4 Betty Havens...5 Table of Contents... 1 Introduction and Acknowledgements... 3 Chapter 1 - Community Development... 4 Frances Racher and Robert Annis...4 Community...4 Community Development...7 Health...8 Quality of Life...8 The Determinants of Health and the Population Health Approach...8 Chapter 2 Information Collection & Analysis... 9 Barbara Gfellner, Kim Ryan-Nicholls, Ryan Gibson, Katherine Pachkowski and Nicole Shirray..9 Participatory Action Research...9 Establishing Research Goals...9 Research Ethics...10 Data Sources...10 Samples...12 Methodology...13 Quantitative vs Qualitative Information...15 Information Analysis...16 Chapter 3 - Rural Community Health & Well-Being Frances Racher, John Everitt, Robert Annis, Barbara Gfellner, Kim Ryan-Nicholls, Marian Beattie, Ryan Gibson and Elicia Funk...18 Rural Community Health & Well-Being Framework...19 Indicators...20 Chapter 4 - Community Action John Everitt, Frances Racher and Marian Beattie...38 Community Health Action Model...38 Communication...40 Leadership...42 Partnerships...44 Team Development...47 Consensus...49 Problem Solving...50 Conflict Management...51 Effective Meetings...53 Planning for Action...55 Planning for Action...55 Evaluation...58 Chapter 5 - Tools for Action Robert Annis, Ryan Gibson, Marian Beattie, Devron Kobluk, Katherine Pachkowski and Nicole Shirray...61 Population Indicators Worksheets...62 Health Indicators Worksheets...74 Safety & Security Indicators Worksheets Rural Community Health and Well-Being: A Guide to Action 1

7 Economics Indicators Worksheets Education Indicators Worksheets Environment Indicators Worksheets Community Infrastructure Indicators Worksheets Recreation, Heritage & the Arts Indicators Worksheets Community Processes Indicators Worksheets Social Supports Indicators Worksheets Question Design Surveys Key-Informant Interviews Focus Groups Community Climate Chart Leadership Skills Assessment Checklist Choosing the Most Appropriate Leadership Style Partner Identification Chart Partnership Considerations Partner Characteristics Checklist Partnership Implementation Checklist Group Effectiveness Checklist Group Participant Checklist Solutions Matrix Action Plan Form Conflict Resolution Worksheet Meeting Planner Form Meeting Agenda Form Detailed Meeting Agenda Form Meeting Participation Checklist Minutes Form Goal and Objectives Worksheet Workplan Worksheet Evaluation Planning Worksheet Guidelines for Engaging Evaluators References Glossary Rural Community Health and Well-Being: A Guide to Action 2

8 Introduction and Acknowledgements This Guide emerged from a Social Sciences and Humanities Research Council of Canada funded research project that examined the determinants of health of rural populations and communities. It is intended to be a hands-on tool that can be used by rural and northern communities, and others, to look at the health and well-being of their communities from a variety of perspectives. Chapters 1 4 provide information, insight and ideas for community development, rural community health and well-being, and processes for community engagement and action. Chapter 5 consists of a number of reproducible materials for use by communities. Many people spent numerous hours contributing to the research and to the development of the Guide. They include: Principal Research Investigator: Dr. Robert Annis, Director, Rural Development Institute (RDI), Brandon University; Research Co-Investigators: Dr. John Everitt, Department of Geography, Dr. Barbara Gfellner, Department of Psychology and Dr. Fran Racher, School of Health Studies from Brandon University; Dr. Betty Havens, Community Health Sciences from the University of Manitoba and Dr. Bill Reimer, Department of Sociology and Anthropology from Concordia University. Research Collaborators include: Dr. Ken Bessant, Department of Sociology; Dr. Nukte Edguer, Department of Psychology; Dr. Noreen Ek, School of Health Studies; Dr. Doug Ramsey, Department of Rural Development; Ms Renée Robinson, School of Health Studies; and Ms Kim Ryan-Nicholls, School of Health Studies from Brandon University; and Mr. Earl Backman from Brandon. Participatory Action Research (PAR) underscored the entire project. PAR involves participation in the research by people within communities, drawing on their knowledge and personal experiences to contribute to the research agenda, processes and findings. Inter- Communities Partners include: Assiniboine and Brandon Regional Health Authorities; Community Futures Partners of Manitoba; Virden-Wallace Community Development Corporation; and Wheat Belt Community Futures Corporation. The Guide was piloted and tested in two rural southwestern and one northern Manitoba communities. RDI researchers were invited into the communities and the communities fully participating in the research project. Many thanks to the Community Assessment Team from the Town and Rural Municipality of Shoal Lake, the Rural Lifestyle Assessment Project Team of the Town of Virden and Rural Municipality of Wallace and the Community Advisory Committee in the Town of Leaf Rapids. These community committees spend countless hours partnering with the university researchers to gather information to better understand their communities. They also provided invaluable feedback on the design, structure and content of this Guide. We thank the Government Partners: Rural Secretariat, Agriculture and Agri-Food Canada; Health Canada, Population and Public Health Branch; and Statistics Canada for contributing to the project and the development of this Guide. Over the course of the project, there were many RDI Contributors - Research: Marian Beattie, Pamela McTavish, Beth Peers, and Karen Rempel; Administrative: Sylvia Henry and Bev Lischka; Student Research Interns: Elicia Funk, Ryan Gibson, Lori Gould, Tanis Horkey, Devron Kobluk, Katherine Pachkowski and Nicole Shirray; and Student Research Assistants: Amanda Campbell, Rebecca Cowan, Sarah English, Elicia Funk, Zamira Gawletz, Ryan Gibson, Lori Gould, Mike Kolba, Mark Matiasek, Amber Racher, Tara Romanyszyn and Catherine Taylor. Rural Community Health and Well-Being: A Guide to Action 3

9 Chapter 1 Chapter 1 - Community Development Community A community is made up of people living in a geographically localized area, who share some type of common bond and interact on a regular basis. (Ramsey et al, 2001). Frances Racher and Robert Annis Interactions as a collective unit (Being) A sense of community occurs when there are interactions as a collective unit getting along, sense of belonging, networks, both formal and informal; and expressions of a sense of community, or community togetherness, (Kulig, 1999) Expression of a sense of community (Belonging) Community Resiliency A combination of interactions as a collective unit, expression of a sense of community and the community s reaction to stressors such as changes within the economy and social structures results in community cohesiveness, which includes common visions, goals, hopes and the lines of defense, can withstand the stressors, placed on the community and lead to action. Community Action (Becoming) Adapted from Kulig in Ramp et al, 1999 Increasingly, communities are facing significant social, economic and environment changes. In order to survive they need to adapt to these changes. A community s ability to determine their level of resilience allows them to identify their weaknesses, and strategize how to overcome those weaknesses. A resilient community is one that takes intentional action to enhance the personal and collective capacity of its citizens and institutions to respond to and influence the course of social and economic change. (Centre for Community Enterprise, 2000). Rural Community Health and Well-Being: A Guide to Action 4

10 Community Resiliency Framework Community Resiliency Interactions as a collective unit (Being) Stressors Health & Well - Being Assets & Strengths Expression of a sense of community (Belonging) Stressors Stressors Community Action (Becoming) Adapted from Neuman (1995) and Kulig (1999) Resilient communities: utilize a multi-functional approach to sustainability (economically, ecologically, politically and socially); maximize their use of limited time and resources in the areas that will yield the greatest overall benefits; develop plans that merge social and economic goals, building local capacity; focus their energies on mobilizing internal financial and human assets, while leveraging external resources; and establish a critical mass of co-operating organizations through which locally-based initiatives are implemented and evaluated (Centre for Community Enterprise, 2000). Dimensions and characteristics of a resilient community include: People beliefs, values, attitudes and behaviours. Leadership is representative of all sectors in the community. Elected officials are visionary, share power and build consensus. Community members are involved in major community decisions. People feel a sense of attachment and are optimistic about the future of their community, encompassing a spirit of mutual assistance and co-operation. The community looks to itself and its own resources to address major issues. Belief in and support for education at all levels is evident in the community. Rural Community Health and Well-Being: A Guide to Action 5

11 Organizations collaboration within local organizations, institutions and groups. Organizations have developed partnerships and collaborative working relationships. Resources internal and external. There is a diversity of employers within the community. There is openness to alternate ways of earning a living. The community has a strategy for increasing independent local ownership. The community looks outside itself for resources that will address its weaknesses. Community Processes planning, participation and action. Residents of the community are involved in the creation and implementation of the community s vision and goals, with regular evaluation of progress towards the goals. The community s development approach encompasses all sectors of the population (Centre for Community Enterprise, 2000). Community Assets Assets are the attributes of the community and are considered essential for the sustainability of the economy, society and environment of the community. They are what the community wants to keep, build upon and sustain for future generations (Fuller, et. al., 2002). Each community is a unique combination of assets that includes the gifts, skills and capacities of its residents, an inventory of the citizen s associations, and the formal institutions that are located in the community. When communities map their assets, the collect: an inventory of all the good things about their community; a ranking of the most valued aspects of the community; and why people place high value on those assets. Skills & Capacities of Individuals Capacity Finders & Developers Physical Assets Community Assets Associations Public, Private & Non-Profit Institutions Adapted from Kretzmann & McKnight (1993) Rural Community Health and Well-Being: A Guide to Action 6

12 Skills and Capacities of Individuals How can the skills, talents and capacities of every individual in the community be discovered? Usually a capacity inventory is developed. Once the information is collected, how might these capacities be connected with each other to enhance the work of local associations and institutions? Associations of Citizens What associations are present in the community? Some such as churches and service clubs will be easy to locate. Others, such as coffee clubs, often informal and less public will be more difficult to map. How are these associations connected to one another currently, and how might they be connected in the future? Local Institutions What public institutions, not-for-profit institutions and businesses are located in the community? How might these institutions reach out to a variety of individuals in the community? How can these organizations be connected to each other and to local citizen associations for mutual benefit? Physical Assets What does the community have in terms of land, buildings, streets, transportation systems, infrastructure, etc.? How are these assets connected to individuals, associations and institutions? What assets are underused? What new ways can be used for physical assets? Capacity Finders and Developers Every community has citizens who have a capacity-oriented view of the world. These are the people who understand that the proverbial glass is both half-full and half-empty but who insist on focusing first on the fullness, i.e. on the gifts and capacities of their fellow citizens. These people may be the local leaders, but they may also be people who have not been identified previously as leaders in the community. Community Development Community development is a process whereby a group of people in a community reach a decision to initiate a social action process to change their economic, social, cultural or environmental situation (Christenson & Robinson, 1980). Community Development is community-based and people-centred; is inclusive; promotes good practice; builds on strengths; ensures the decision-making comes from the community; recognizes and develops expertise of community residents; requires assessment and does not rely on assumptions; and is understood by those involved (Frank, 2001). Community Development is for the community by the community towards a shared vision with a broad base of community support. Rural Community Health and Well-Being: A Guide to Action 7

13 Health Health is a resource of everyday living, an essential dimension of the quality of our lives giving people the ability to manage and change their surroundings. This view of health recognizes freedom of choice and emphasizes the roles of individuals and communities in defining what health means to them. (Epp, 1986) Fundamental conditions for health are peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice and equity (Canadian Public Health Association, 2000). Health enables individuals, families and communities to function to the best of their ability within their environments. The population health approach focuses on the entire range of individual and collective factors and conditions and the interactions among them that determine resources for every day living. Quality of Life Quality of life can be defined as: the degree to which a person enjoys the important possibilities of his/her life. (Atlantic Health Promotion Research Centre et. al., 2002) Quality of life implies the opportunity to make choices and gain satisfaction from living (Annis, Racher, & Beattie, 2002) and is strongly linked with population health, social development and community sustainability (Lomas, 1998). The Determinants of Health and the Population Health Approach Population health is an approach to health that aims to improve the health of the entire population and to reduce health inequities among population groups. It looks at and acts upon the broad range of factors and conditions that have a strong influence on our health (Health Canada, 2004). Determinants of Health is the collective label given to the multiple factors that contribute to the health of populations. The population health approach looks at the Determinants of Health and their interactions that have shown to influence health over the life course. There is a growing body of evidence about what makes people healthy there is mounting evidence that the contribution of medicine and health care is quite limited on the other hand, there are strong and growing indications that other factors such as living and working conditions are crucially important for a healthy population. The evidence indicates that the key factors which influence population health are: income and social status; social support networks; education; employment/ working conditions; social environments; physical environments; personal health practices and coping skills; healthy child development; biology and genetic endowment; health services; gender; and culture. Each of these factors is important in its own right. At the same time, the factors are interrelated. (Health Canada, 2004). Rural Community Health and Well-Being: A Guide to Action 8

14 Chapter 2 Chapter 2 Information Collection & Analysis Barbara Gfellner, Kim Ryan-Nicholls, Ryan Gibson, Katherine Pachkowski and Nicole Shirray Community research methodology blends a participatory action research approach with established community development practices to ensure the research is driven by the community, with the community and for the community. Participatory Action Research Participatory action research (PAR) involves participation in the research by the people being studied; inclusion of popular knowledge, personal experiences and other ways of knowing; focuses on empowerment and power relations; consciousness raising and education of the participants; and political action (Dickson, 2000; Health Canada, 1996; Potvin, et al., 2003). PAR aims to empower participants through their participation in and control of the research agenda, process, and findings; their critical awareness of the causes of the problems studied; and their establishment of individual and community change as a planned outcome. PAR has great potential to effectively incorporate desirable, planned community outcomes, as it links research purposely with community action and change (Dickson, 2000). Establishing Research Goals In order to get specific, clear-cut results in research, there must be specific, discernable goals. As such, these goals and objectives will provide ideas for questions to ask of the population under study. Reading up on similar research can help provide ideas for both objectives for the project and specific questions for the interview. Also, looking at other sources of information (such as Statistics Canada) can reveal whether some or all of the data is already available. Be careful using the web, since some sites can be questionable. As a general rule, university and government sites can be trusted; use discretion with other sites. Rural Community Health and Well-Being: A Guide to Action 9

15 Research Ethics Providing Information When gathering information, it is important that participants involved in providing information and data are made aware of: the purpose of the research; the name of the researcher(s) and collaborating parties; the potential benefits; the tasks to be performed by participants; any anticipated inconveniences to participants; the rights of participants including: the right to refuse or withdraw at any time; and the right to confidentiality of personal information. Anonymity and Confidentiality Confidentiality and anonymity of information gathered from participants should be protected. It is important to clarify with participants if and how information collected will be shared with third parties. Information Collection, Handling, and Retention Only information that is relevant to the purpose of the project should be collected. The person or organization collecting the information must store, handle, and transfer all records; both written and unwritten (e.g., computer files and videotapes), in a way that ensures privacy and security of the information. Information should be retained only as long as it is necessary and destroyed when no longer needed. Data Sources A number of sources can be used to gather the information. These sources include government sources, regional sources and community-based sources. Government Statistics Canada and Manitoba Community Profiles are two main government sources of information. Statistics Canada is the national data-gathering body that produces statistics to help Canadians better understand the country, its population, resources, economy, society and culture. Statistics Canada provides objective statistical information about the population and demographics of the community. National population censuses are conducted every five years by Statistics Canada, on years ending Rural Community Health and Well-Being: A Guide to Action 10

16 with a 1 or 6 (i.e. 2006). Beyond the census of population, Statistics Canada also gathers information on issues such as health services, safety and security, youth, immigrants and economics. Much of the information from Statistics Canada is available from their website, Within the website, information is located primarily under the Community Profiles button (see figure adjacent). Information can also be found through Our Products and Services and CANSIM, a database of socio-economic information (http://www.statcan.ca/english/ads/cansimii/index.htm). Not all Statistics Canada information is available to the public through their website. Statistics Canada catalogues are often housed regionally at various institutions such as universities and libraries. These catalogues may contain information that is not reported on their website or further detail on information that is contained within the website. Further to the website and the catalogues, Statistics Canada, through the Data Liberation Initiative (DLI), provides Canadian academic institutions with access to Statistics Canada information that is neither contained in the catalogues nor the website. Detailed information on surveys, such as the Canadian Community Health Survey (CCHS), is available through institutions with a DLI agreement. Often universities have DLI agreements with Statistics Canada and are good contacts for information. It should be noted that information generated by Statistics Canada are rounded off to the nearest zero or five. In small samples, information results are suppressed by Statistics Canada to maintain confidentiality. Consequently, certain columns and rows of numbers may not add precisely due to this procedure. Manitoba Community Profiles is a website available at This site provides the most comprehensive listing of information on communities and regions of Manitoba. Each community profile offers up-to-date information covering everything from location (maps) to quality of life indicators (demographics, population, labour force, education, history, recreational facilities) to economic indicators (utilities, transportation, taxation, land, buildings & development). Staff of Manitoba Intergovernmental Affairs maintain the Manitoba Community Profiles website. Other government sources of information that may be useful include contacting federal and provincial departments and agencies, such as Health Canada or Manitoba Education & Training. Often departments/agencies collect information on programs and activities offered, which may be pertinent. Contact information for these departments can be found in telephone books or through the Internet. Regional Although regional sources of information often are often not collected on a community, regional information can be very useful in representing trends within the population. Examples of regional sources of information include regional health authorities and school divisions. Rural Community Health and Well-Being: A Guide to Action 11

17 Community Community-based sources are information that is collected locally, usually since it is not available through other data sources. Community-based information may include documents such as local reports and information gathered through interviews with relevant members of the community. Samples There are two main decisions involved in choosing a sample. First, decide who should be in a sample (this group is known as the target population, or sampling frame). This could include all members of a community, or it could be a subgroup, such as long-term residents. This decision is very important, since interviewing the wrong kinds of people will often give unusable results. Second, decide how many people will be in the sample. Researchers rarely ask every individual in a population, since a representative sample will usually give the same results at a much lower cost. The time available, budget, and necessary degree of precision for the project will all contribute to deciding sample size. Before selecting a sample, ensure that the contact list for the target population is complete and accurate. Simply looking in the phone book won t account for households without phones, unlisted numbers, and multiple listings. Selecting names randomly will go a long way towards making the sample representative. A random sample helps to minimize any biases, or errors, in the results. Below are two simple and commonly used methods for choosing such a sample. Remember that there are more available, each with different variations. Simple Random Sample A simple random sample is drawn randomly from a complete list of individuals or households in a population. This is useful when all individuals are considered equal with respect to the study. Stratified Random Sample A stratified random sample groups the population into subcategories (based on age, income, length of time as a resident, etc.) and random samples are drawn from each group. This ensures that each group is adequately represented in the results. Sampling and Non-Sampling Error Sampling error occurs when the sample population differs in some way from the target population. There are two main sources of sampling error, Sampling bias and probability. Sample bias arises from the selection process. For example, if an individual is listed twice this doubles their chance of being selected. The best way to check for selection bias is to find out if the sample is representative of the target population. To do this, compare important variables of the sample to those of a reliable census, such as the data from Statistics Canada, to see if they are similar. Good characteristics to compare include age, sex, income, and education. Eliminating all bias is next to impossible, but it is important to minimize it in order to increase the credibility of the data. Probability is simply the luck of the draw. There is no way to eliminate all error in a sample; for example, the sample might draw only females simply by chance. However, if the sample is big enough this error can be minimized so that it doesn t affect the results too strongly. Errors related to the design and application of information gathering methods is known as non-sampling errors. Being familiar with these Rural Community Health and Well-Being: A Guide to Action 12

18 common issues will also help you decide on a methodology that will work best in your situation. A change in the definition of the needs of the target population over time can happen when some important event occurs during the information gathering time. To avoid this, use careful timing and planning based on an understanding of the political and social context of the population: e.g. make sure there is no town meeting planned during the data gathering. Non-response If people aren t responding because of a particular reason (for example, they can t read the questionnaire, they re not home during the day, or they don t feel comfortable talking on the phone) then you may be missing an important subgroup of the population. This could also apply to individual questions if they are worded poorly, or perceived to be insulting or too embarrassing to answer. Measurement design When designing the information gathering method ensure that respondents feel comfortable enough to answer truthfully and make sure that the questions are worded properly so that respondents are able to answer truthfully. Being comfortable refers to the type of information gathering method chosen. Some people don t like talking on the phone, while others are not able to read well enough to complete mail surveys. The wording of questions will be addressed later. Methodology There are several methods of collecting data from a population, each with advantages and disadvantages. Determine which is the most applicable for the situation, remembering that more than one method is often best. Questions to keep in mind include: How accurate will the information be (based on advantages/disadvantages of each method)? Will it look credible to decision makers (for example, politicians, business owners, etc.)? Will the method get all of the required information? If not, what additional method(s) should and could be used to gather the other information? Will the nature of the respondents conform to the methods (fill out the questionnaires carefully, engage in focus groups, etc.)? Who can administer the methods now or is training required? Rural Community Health and Well-Being: A Guide to Action 13

19 Surveys and Questionnaires Surveys and questionnaires are used to collect information to describe, compare or explain knowledge, attitudes and behaviour. Surveys allow researchers to collect and organize large amounts of information that is not readily available from existing data sources. They consist of groups of questions designed to collectively probe into issues of relevance to an organization, program or project. Page 195 Questions may be open or closed-ended. Open-ended questions require a narrative response and do not limit the range of responses provided by the respondents. The responses have more depth and breadth than closed-ended questions. Closed-ended questions provide respondents with a guideline or context for their response. Data can be collected through logical responses such as yes or no ; likert scales that provide a range of possible responses; and multiple responses that provide respondents with a number of pre-coded responses. Surveys should have specific measurable objectives; sound research design; sound choice of population or sample, reliable (consistent) and valid (accurate) instruments; appropriate analysis and accurate reporting of survey results. To be effective, expert advice should be sought on the design of the survey, the selection of respondents to be contacted, and the analysis of the findings. Focus Groups A focus group is a group of individuals who have been selected to discuss and comment, from their personal experiences, a topic that is the subject of research. Focus groups rely on interaction within the group. The main purpose of using focus groups is to draw on the participants attitudes, feelings, beliefs, experiences and reactions in a way that is not feasible using Page 201 other methods. These attitudes, feelings and beliefs are more likely to be revealed in a social gathering and the interaction within the group. Focus groups draw out multiple views and opinions within a group context. In a focus group meeting, invited participants are given a few open-ended questions to discuss. During the focus group meeting, the facilitator encourages participant to express their feelings and opinions by asking open-ended questions, promoting debate, and steering the discussion to keep it on course. The facilitator ensures that everyone participates and gets a chance to speak, while avoiding giving his or her own personal opinions. The discussion points that are raised are recorded. gathered is later analyzed. The information Rural Community Health and Well-Being: A Guide to Action 14

20 Key-Informant Interviews Key informant interviews are similar to focus groups; however each participant is interviewed individually. Informant interviewees are usually selected based on defined criteria, have personal knowledge of the topic to be discussed, and are able to express them clearly. Page 198 Quantitative vs Qualitative Information Quantitative data is information that is often considered hard data which can be counted, tabulated and measured. Qualitative data is information that is often considered soft data and is obtained through interactions with people, such as interviews, focus groups and story telling. Questions Quantitative Focus is context- free: isolates variables, measures their presence and their corelationship to other variables. Qualitative Focus is context-rich: looks at variables in a social context, seeks to understand how & why by exploring people's experiences/stories. Sample Methodology Focus is on size: relies on statistics such as descriptive, correlation, probabilities; therefore needs a large sample size to do the mathematical equations or documentation in a meaningful way. Focus is on counting: methods include questionnaires, surveys, standardized scales. answers must be countable. Focus is on representation: relies on speaking to a representative sample based on your focus; therefore sample size is less important--what is more important is capturing a range and diversity of experience. Focus is on experiences: methods include focus groups, interviews, case studies. Rural Community Health and Well-Being: A Guide to Action 15

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