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Building the HPSR Community Building HPSR Capacity

KEYSTONE

Inaugural KEYSTONE Course on Health Policy and Systems Research 2015

Health Policy & Systems Research Frameworks – 2

Health Policy & Systems Research Frameworks – 2

(Research questions)

Kabir Sheikh

24 Feb 2015

   

 

KEYSTONE

Generating and framing HPSR

questions

IHPSR Presentation 4

www.hpsa-africa.org

@hpsa_africa

www.slideshare.net/hpsa_africa

Introduction to Health Policy and Systems Research

Four key steps in HPSR1. Identify research focus

(problem/concern/opportunity) and question

2. Design study 3. Ensure quality and rigour4. Apply ethical principles

Key issues in this session

• Starting points for HPSR questions• Different kinds of HPSR questions • What is a ‘good’ HPSR question• How to generate substantively

relevant questions

• The question drives the study

Generating questions• Starting points = 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

Start with the problem/concern/opportunity

and aim to inform decision-making

by policy and system actors

Whose ideas?

Research question

Community group

Patient group

District manager

Hospital managerNational

managerInternational agency

Researcher

Same issue, different questions?

Different issues & questions?

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)

Why do you want to do your study/What do you want to do in your study?

Do you want to • test an intervention• measure impacts or understandings• understand a phenomenon• act in a situation to improve it

what you want to do may say something about your understanding of knowledge and action

this understanding is the foundation of your study

From CHEPSAA

What is the study ‘purpose’?

Normative/evaluative: Seeks to generate/identify norms, best practices,’gold standard’ interventionsExploratory: To find out what is happening, especially in little understood situationsDescriptive: To give accurate profile of people, events, situationsExplanatory: To explain patterns relating to phenomenon being researched; To identify relationships between aspects of phenomenonEmancipatory: To create opportunities and the will to engage in social actionRobson, 2002; Thomas, Chataway & Wuyts, 1998; Yin, 2009

NormativeImpact?Is it best?What is best practice?

ExploratoryWhat+? (new insights)

DescriptiveWho? What? Where? How many? How much?

ExplanatoryWhy and how?

Action/ participatory research

From purpose to question form

From purpose to question ...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?

Purpose Why adopt that 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 practitionersEncourage practice changes

Problem: unequal availability of doctors

How can we make doctors

stay on in villages?

Why do most

doctors leave?

Why do some

doctors stay on?Can we

replace doctors with

other workers?

Can they provide quality

services?

Evaluative

Strategic / normative Diagnostic Exploratory

Need more balance in 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

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?

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

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

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?

Types of literature reviews

Go find the resources – lots out there!

Also qualitative

review & synthesis!

Review basics1. Identify the review question or focus2. 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 data6. Review papers & data7. Synthesis (make meaning, pull together a coherent

argument)

‘Critical Appraisal’• The art 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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