Caribbean Exploratory [NIMHD] Research Center of Excellence

University of the Virgin IslandsSchool of Nursing

Grant Support: National Institute on Minority Health and Health Disparities, NIH (# P20MD002286).

The Caribbean Exploratory [NIMHD] Research Center of Excellence and Global Health Research Collaboration:

Protecting Haitian Women and Children  Earthquake Survivors from Violence and Abuse 

Elizabeth Sloand, PhD, CRNPNancy Glass, PhD, RN, FAAN

Betty Dennis, DrPh, RN

Strategies for Developing Relationships to Support Research in a Foreign

Country

Situational Analysis and Community Based Participation in Port au Prince, Haiti

NBNA SYMPOSIUMJULY 13, 2011

OBJECTIVES:

• Identify the benefits of a situational analysis prior to conducting research in a foreign county

• Describe the components of a situational analysis and the steps needed to implement a situational analysis

• Discuss Participatory Action Research (PAR) as an effective strategy for community based participation in a research project in a foreign country

Situational Analysis– what is it?

Definition from Sociology: To develop a statistical picture of the community based on currently available information, using secondary data to: – Identify and Describe trends– Compare the community with others in the region, state or nation

• Includes a SWOT analysis: assessment of the organization’s current and future strengths, weaknesses, opportunities, and threats.

• Involves key informant interviews – purposes:– Define the nature of an issue confronting the community -- how do people

in the community define the issue, the nature of its roots, its consequences for the community

– Enumerate the community groups or organizations interested in or involved with the issue -- who in the community has a “stake” in the issue

– Identify community-based resources that can be mobilized to address the issue -- -- economic, social, cultural, human

From: http://srdc.msstate.edu/fop/levelone/trainarc/09fall/session5_garkovich_handoutb.pdf

Situational Analysis for Haiti Abuse and

Violence study, Post Earthquake

• Done in Three Stages:– Background information –

pre-travel– Trip One

• Two team members• Included key

informants and logistics

– Trip Two • Six team members• Included key

informants, logistics, and focus groups

Situational Analysis for Haiti Abuse and

Violence study, Post Earthquake

• Stage One: Background exploration done pre-tripQuantitative and qualitative

data collected on• Geography of area,

people and communities• Socioeconomic profile of

area• Health status of people in

area

Situational Analysis for Haiti Abuse and

Violence study, Post Earthquake

• Stage One: Background exploration done pre-trip– Other quantitative and

qualitative data collected:• Health services and

management systems in area

• Political and policy environment

• Activities of other sectors important in determining health status of populations (housing, education, water, sanitation, etc)

• Stage One: Background exploration done pre-trip

– Methods of background exploration:• Websites, reports, papers on relevant topics

– Abuse and violence, Haiti post earthquake, cholera• Incorporated a wide variety of health care providers in this planning

stage• Contacts using snowball technique• Incorporated NGOs already working in Haiti: International Rescue

Committee (IRC), Pan American Health Organization (PAHO), Catholic Medical Mission Board, JHPEIGO

• Careful review of reports already completed on abuse and violence against women and girls in Haiti post earthquake: IRC and PAHO

• Email and phone

Situational Analysis for Haiti Abuse and

Violence study, Post Earthquake

Situational Analysis for Haiti Abuse and

Violence study, Post Earthquake

Stage Two:

Onsite in Port au Prince– Assess and develop

partnerships with Haitian based NGOs, Academic Institutions and other key stakeholders

– Two academic team members plus one Haitian American

– Essential to have a Haitian American on the team, before and during travel. Our “Fixer”.

Situational Analysis for Haiti Abuse and Violence study, Post Earthquake

Stage Two: onsite in Port au Prince

• Key informant meetings with:

– Ministries of Haitian Government: Health, Women’s Affairs, Social Affairs/Labor

– General Hospital (Hospital of the State University of Haiti)

– University of Haiti, Director of Research

– Nursing school : National Nursing School of Port au Prince

Situational Analysis for Haiti Abuse and Violence study, Post Earthquake

More Key informant meetings :– General Hospital and GHESKIO

(Haitian HIV/AIDS organization)- In search of IRB approval

– Local and national women’s groups: Solidarity for Haitian Women (SOFA), associated with Madre International; KOFAVIV

– Catholic Medical Mission Board (CMMB), World Vision

– Other community leaders, religious, academic, nursing

Stage Two- onsite in Port au Prince

Situational Analysis for Haiti Abuse and

Violence study, Post Earthquake

• Stage Three: Continue to Assess and develop partnerships with Haitian based NGOs, Academic Institutions and other key stakeholders

• Focus groups: – Women survivors of earthquake who are living in

camps– Directors and Program Managers– Ministries– Health care providers– Police, criminal justice– Community organizers

Situational Assessment and Research

• Logistics of doing research:– Hire Haitian staff, including

project director, research assistants

– Housing and food for study team; price of housing

– Transportation – including car and driver

– Communication including phone and internet

– Power and water– Office space that includes

security for data– Data collection sites

Logistic challenges abound

Other goals

• Advisory Board: recruit appropriate members• Determine appropriate incentives for

participants• Determine appropriate rate of pay for staff in

Haiti• Determine logistics of paying staff in Haiti

Challenges and Obstacles• Communication –

esp. pre-travel to set up appointments and later to confirm

• Transportation – Cost– Time consuming– Difficult

More Challenges and Obstacles

Safety and practical issues

• Trips to Haiti postponed 3 times due to political unrest and cholera epidemic

• The challenge of gaining interest for our project, “selling” it to those who are already overwhelmed with their circumstances and work

• Other huge issues face professionals and organizations in Haiti, including the ongoing cholera epidemic, the overwhelmed and underfunded health system, and overextended personnel

More Challenges and Obstacles

• Lack of clarity re: payment that is appropriate

• IRB!

Participatory Action Research in

Another Country

• Components of promoting community based participation in research in a foreign country– Fostering partnerships over time– Understanding community trust/distrust of research initiatives– Motivating full participation of community representatives– Role of community representatives in providing guidance

regarding research process, acceptability, cultural and social relevance

– Evaluation and dissemination of outcomes

Kelly, P. J. (2005). Practical suggestions for community interventions using Participatory Action Research. Public Health Nurs, 22, 65–73.

Participatory Action Research with

Haitian Partners:

• Critically needed to examine the health, social, cultural and economic factors that influence survivors’ lives

• Approach: key informants and focus groups– Be prepared for the unexpected: a group of 20

youth leaders organized in one day– Another scheduled group did not come except for

one person, a physician who was very helpful and articulate about the key issues and problems

Lessons Learned

• Invite a fixer to join research team but don’t totally depend on that one person

• Lack of email and phone contact may not mean a dead end: the potential value of a drop in visit

• Email and phone is not enough – you have to discuss and negotiate in person

• Make appointments, confirm, reconfirm!• IRB: start early and keep at it!

QUESTIONS?

Return to Life; Haiti won’t die

Thank you !