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7708MED : Applied Field Methods in Public Health : Implementation Rese

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Section: 1

Does the research clearly aim to answer a question concerning implementation?

This question reflects the part of how implementation research is used. The sources of documents for this question comprise:

This question requires you to track down what is implementation and identify the what are implementation strategies studied in the paper. The sources are below:

This question asks you to distinguish the basic studies, which is conducted under the controlled conditions and may not reflect the real-life condition; whereas implementation research is conducted with consideration of real-life conditions. In addition, you are also required to identify the implementation outcome variables (e.g. acceptabilities, adoption, etc.). The sources are below:

This question requires you to identify the context or factors influencing on implementation program and provide some further discussion on how the authors looked at these contexts and factors. Sources are below:

Section: 2

1. Please identify an implementation research question that will support the controlling and elimination of schistosomiasis in Central Sulawesi Highlands, Indonesia.  Please discuss why you think that your question is an implementation research question? What would be your research objectives? 

2. If you are asked to design a mixed methods research addressing your implementation research question on the controlling and elimination of schistosomiasis in Central Sulawesi Highlands, what type of mixed methods research will you go for? Please justify your selection for this particular type of mixed methods research. Please draw a diagram showing your mixed methods research design and explain that. 
3. What would be the primary outcome variable of your study, given this is an implementation research? Please justify your answer briefly. 

4. Who will be the target population, study population and study sample for this research? 
5. Based on your research question and primary outcome variable, please mention whether you are considering a one-sample or two-sample situation, and why? What is the expected effect size? What are the other assumptions for calculating your sample size? Please use Epi Info (https://www.cdc.gov/epiinfo/index.html) software to calculate your minimum required sample size. Please provide a snapshot of your output as an appendix to this document  
6. Please design a sampling for the quantitative part of your research. Please justify why you chose to go for this sampling strategy. Please consider the administrative structure of the controlling and elimination of schistosomiasis in Central Sulawesi Highlands when designing your sampling. Please draw a flow chart showing different steps of your sampling. 
7. Please design a purposive sampling for the qualitative component of your research. Please justify why you chose to go for this sampling scheme. 
8. What statistical tests are you going to do for data analysis? Please discuss each of these steps considering your research questions, outcome variables, data types. 
9. In what form your qualitative data will be? How are you going to manage and analyze them? What underlying theory will you follow for your analysis of the qualitative data?
10. How are you going to integrate the findings of your quantitative and qualitative research? Please discuss. 

Answer: 

Section: 1

Review of the Research Paper

This paper is an implementation research because it has all the components of an implementation research. The research paper was done in a real world setting. The research targeted Eastern Kentucky regions in the areas around the cities of Morehead, Hazard, and Pikeville from October 2014. The study was conducted using 54 adults of the age between 55 and 77 years and had a history of smoking for a minimum of 30 years and is still smokers or quit smoking less than 15 years ago, Info (2017). A successive blended techniques approach was utilized to outline a screening campaign using messages created from the focus groups, trailed by execution of the effort campaign mediation in two high-hazard Kentucky districts. One region was used as a control region for assessment of LDCT rates. The educating and care fight attempted to ask high-peril individuals to chat with their therapeutic administrations provider about whether terminate lung malignancy screening was reasonable for them, Green & Salkind (2016). This examination gave fundamental proof that actualizing populace methodologies might be a reasonable technique to disperse new guidelines and addresses the perceived scholastic network partition that frequently constrains the compass as well as the usefulness of the advice given to the community. After collection of data, the underlying theory that will be used to analyze the data is thematic analysis. A thematic analysis is done to gain more insight on the data. This is done through observing likely patterns in the data collected. The data from this study will be in the form of; documentation from the discussions in focus groups formed, recordings of the interviews collected, the filled questionnaires on their awareness on Mass Drug Administration and the proposed strategies for a wider coverage.

The primary audience of this study was individuals between the age of 55-77 years, from the three regions of Kentucky and had a history of smoking. The total individuals involved in the study were 54. Two focus groups in every region were established making 6 total focus groups. The study helped identify various themes that can be effective in relaying the message on cancer awareness screening, Grunnet & Sorensen (2012). Such themes were selected due to their effectiveness, for example, testimonies about cancer survivorship, family and a prolonged life. It was also identified that old people heavily relied on the information provided to them by their health providers. With the findings, the adequate approaches to creating awareness will be employed based on the location and thus help reduce prevalence due to terminate lung cancer.

Based on the findings, the paper clearly explains the improved recommendations were made regarding the methods that can be applied so as to reach more people in the rural areas and educate them on terminate lung cancer. The main strategies applied included radio ad content, internet, family and friends, presence of fliers and promotional messages in health facilities offices, and postcard images.

The paper was done in a true setting. Implication research in a true setting doesn't attempt to control or expel conditions as causal impacts; instead, it looks to comprehend the usage of methodologies in a workplace or true setting, Purtle, Peters & Brownson (2015).  This research was conducted in Eastern Kentucky main regions and their surroundings using 54 individuals from all three regions. These were grouped into two focus groups in each region making a total of six focus groups. The individuals in the groups were made a part of a committee to help identify the optimal strategies to relay the message on terminate lung cancer, Liu, Peng, Zheng, Wang & Qin (2009). The recommended, modified strategies were applied in two regions; Hazard and Morehead whereas Pikeville was used as a control region. A survey through telephone was then conducted to test the effectiveness of the strategies and proved to be efficient as there was a remarkable increase in the number of LCDT scans performed in the regions of Hazard and Morehead whereas Pikeville, the control region did not register any improvement in the number of LCDT scans performed, Farley (2017).

Result factors are the pointers of achievement used to survey how well an implementation methodology has happened. The research discoveries on the changes made to the conventional terminate lung cancer screening conveyance display demonstrates that key factors were met that would group this exploration as being effective. Such variables included cost effectiveness, population coverage and sustainability.

References:

Info, E. (2017). CDC. Centers for Disease Control and Prevention (US): Introducing Epi Info 7.

Farley, J. (2017). Bilharzia: A problem of ‘Native Health’, 1900–1950. In Imperial medicine and indigenous societies. Manchester University Press.

Liu, B., Peng, X. C., Zheng, X. L., Wang, J., & Qin, Y. W. (2009). MiR-126 restoration down-regulate VEGF and inhibit the growth of lung cancer cell lines in vitro and in vivo. Terminate lung cancer, 66(2), 169-175.

Grunnet, M., & Sorensen, J. B. (2012). Carcinoembryonic antigen (CEA) as tumor marker in lung cancer. Terminate lung cancer, 76(2), 138-143.

Green, S. B., & Salkind, N. J. (2016). Using SPSS for Windows and Macintosh, Books a la Carte. Pearson.

Section: 2

The research question I would give this study is: A multi-sectoral approach to increase Schistosomiasis awareness and Mass Drug Administration (MDA) in Central Solawesi Highlands, Indonesia.

This research question is an implementation question because the study will be set in a true setting, that is, the regions of Central Solawesi Regions. The implementation question proposed above is intended to investigate the concepts driving the factors or conditions that might confine the abatement in Schistosomiasis prevalence. The issue of prevalence due to Schistosomiasis is set as the main point and then from this main point, there will be an audit of existing proof and the gaps if any exists for further studies, Gurarie, Lo, Ndeffo-Mbah, Durham & King (2018).

Schistosomiasis is always regarded as an infection which is from the trematodes which is direct from genus called Schistosoma. The said genus has five species which is well known in infecting human beings. Though most of the countries which are affected more which this particular endemic are African countries, also Australia is affected by this by around 16%.

The mixed method approach I would apply would be first qualitative data analysis using focus groups and interviews which will provide basic knowledge on the topic. This one will have a very positive impact in the results which are obtained thereafter. Terminate  lung cancer will therefore have the best analysis than the normal growing terminate lung cancer. Qualitative analysis of data can give out the best results for terminate lung cancer than the quantitative terminate lung cancer. This will be followed by a more detailed quantitative data analysis approach using surveys and experiments. This is because this approach gives a more entire and thorough comprehension of the research problem than either quantitative or subjective methodologies alone would, Robins,  Hernan & Brumback (2000). This examination will be done in stages from coding of information, acclimating with the information and advancement of subjects from the information lastly modification. Each stage will manual for the following one and the other with communication between the diverse phases of topical investigation until the point when examination is finished. The usage result factors that can be utilized to evaluate achievement are agreeableness, supportability, selection, cost practicality, reasonableness, propriety, entrance, devotion and attainability. A portion of the result factors applicable to the examination are propriety, selection, supportability and scope.

Implementation outcome variables are used to define the deliberate actions to provide new services and new treatments Aarons, Hurlburt & Horwitz (2011). The implementation outcome variables that can be used to assess success are acceptability, sustainability, adoption, cost viability, suitability, appropriateness, penetration, fidelity and feasibility. Some of the outcome variables relevant to the study are appropriateness, adoption, sustainability and coverage, Davis et al (2015). The study will target the regions of Central Solawesi Highlands who are at high risk of being in contact with infested water such as agriculturalist, women when doing domestic chores and children due to their hygienic practices and a high likeliness of coming into contact with contaminated water. If perceived fit and in collaboration with the cultural and traditional beliefs, then it would be adopted, if not, it will not be put into practice. The sustainability of the program will also measure the outcome success, Matthews, McCabe, Lee & Veliz  (2018). The triple zero targets will be attained if the recommended strategies are sustained in ensuring zero prevalence due to Schistosomiasis. Adoption is important, without adoption of the strategies recommended, and then there will be no change and thus no success.

The target population of this study will be a group of individuals characterized by similar traits. This study will target the residents of Central Solawesi Highlands, mainly the regions of Napu, Lindu and Bada valleys who are at risk of being infected due to their exposure to water that is infested with the Schistosomiasis eggs. These are; individual who practice agriculture on their day to day basis, school children, women who do domestic chores that may lead them to getting into contact with infested water, farmers and members of the general public, Palinkas et al (2015).

The research noted various factors that may affect implementation of the strategies. Such factors included the scans from hospitals outside the survey region, impact of external ads on terminate lung cancer screening and the fact that most of the involved personnel were mainly white thus may affect a generalized result, Treiman (2014). Also, the study did highlight some of the influencing factors such as lack of internet in most areas of Kentucky yet they had developed a website on terminate  lung cancer. The study also highlights unintended consequence such as the terminate lung cancer screening campaign made individuals have thought processes about smoking cessation

 From my research question, I would recommend a two- sample situation which would employ a comparative analysis between the individuals in the regions that the study is done and the control region. The data analysis will be able to identify the strong differences between the two study groups and the data obtained will lead the next step, Jiménez et al (2017). The factors that are in the study group and those in the control region are identified and guide to explain the difference. Such factors are awareness, geographical remoteness, age, and day to day routines. The assumptions for calculating the sample size is that alpha is 5% or 0.05, degree of effect is 1.0 and the estimated likelihood of correctly rejecting a hypothesis is 80%, Dragonieri et al (2009).

A random sampling design will be used for this study with every resident of Central Solawesi highlands having an equal chance of being selected.

Purposive sampling is used to help the researcher answer the research question based on the specific characteristics of the selected population of study. In this case, I would recommend a total population sampling method as this research will involve studying the whole population of the Central Solawesi Highlands. Using this method will help one gain a total understanding of the study population, their cultural ways and the geographical location, Bolin (2013).

For data analysis of the results, I would use various descriptive and bi-variate statistical analysis methods. One is regression analysis to determine the relationship between the independent variable, that is the prevalence rate due to Bilharzia and the dependent variable which is community awareness on Mass Drugs Administration. Multivariate analysis of variance (MANOVA) would also be used so as to test for the relationship between the independent variable and dependent variables for the prevalence rate of Bilharzia in Central Solawesi Highlands. The variables considered will be awareness on Mass Drugs Administration, cost effectiveness, availability of drugs to cure Bilharzia, availability of information on how to prevent Bilharzia, and geographical remoteness. The total individuals involved in the study were 54. Two focus groups in every region were established making 6 total focus groups. The study helped identify various themes that can be effective in relaying the message on cancer awareness screening. Such themes were selected due to their effectiveness, for example, testimonies about cancer survivorship, family and a prolonged life. It was also identified that old people heavily relied on the information provided to them by their health providers.

After collection of data, the underlying theory that will be used to analyze the data is thematic analysis. A thematic analysis is done to gain more insight on the data. This is done through observing likely patterns in the data collected. The data from this study will be in the form of; documentation from the discussions in focus groups formed, recordings of the interviews collected, the filled questionnaires on their awareness on Mass Drug Administration and the proposed strategies for a wider coverage, Brannen (2017). This analysis will be done in phases from coding of data, familiarizing with the data and development of themes from the data and finally revision. Each phase will guide to the next one and the other with interaction between the different stages of thematic analysis until analysis is complete. The implementation outcome variables that can be used to assess success are acceptability, sustainability, adoption, cost viability, suitability, appropriateness, penetration, fidelity and feasibility. Some of the outcome variables relevant to the study are appropriateness, adoption, sustainability and coverage.

Identifying a logical connection between the qualitative and quantitative results after analysis is important before integration of the results. Integration of the results of qualitative and quantitative analysis help identify stronger points and a more guided way of coming up with recommendations.  Approaches to the integration will be done at different levels of the study. The first is integration at the study design level, Cardarelli et al (2017). Qualitative data collected can be integrated with quantitative data so as to guide the next step. Such an example can be done through integration of the results from focus groups and results from observations. Integration can also be done at the methodology level and at interpretation reporting level. Data can be integrated by transformation through coding, use of graphs and charts, and through narrative. The integration approach I would employ for this study will be the use of narrative integration approach.

This particular study identifies that most of those who are likely to be mass drug administration non-compliant are mostly female people, the residents who are not informed and also those who were not compliant especially to the previous Mass drug administration campaigns. When praziquantel is administered to lactating and women who are pregnant, as it is based on recommendations made World health organization and the study which was recently published regarding the praziquantel safety especially for women who are pregnant in Australia are supposed to be incorporated into the policy of the nation.  

References:

Aarons, G. A., Hurlburt, M., & Horwitz, S. M. (2011). Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health and Mental Health Services Research, 38(1), 4-23.

Bolin, J. H. (2013). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression?Based Approach. New York, NY: The Guilford Press. Journal of Educational Measurement, 51(3), 335-337.

Brannen, J. (2017). Mixing methods: Qualitative and quantitative research. Routledge.

Dragonieri, S., Annema, J. T., Schot, R., van der Schee, M. P., Spanevello, A., Carratú, P., ... & Sterk, P. J. (2009). An electronic nose in the discrimination of patients with non-small cell lung cancer and COPD. Terminate lung cancer, 64(2), 166-170.

Gurarie, D., Lo, N. C., Ndeffo-Mbah, M. L., Durham, D. P., & King, C. H. (2018). The human-snail transmission environment shapes long term schistosomiasis control outcomes: Implications for improving the accuracy of predictive modeling. PLoS neglected tropical diseases, 12(5), e0006514.

Jiménez, R. C., Kuzak, M., Alhamdoosh, M., Barker, M., Batut, B., Borg, M., ... & Flannery, M. (2017). Four simple recommendations to encourage best practices in research software. F1000Research, 6.

Matthews, A. K., McCabe, S. E., Lee, J. G., & Veliz, P. (2018). Differences in smoking prevalence and eligibility for low-dose computed tomography (LDCT) lung cancer screening among older US adults: role of sexual orientation. Cancer Causes & Control, 1-6.

Purtle, J., Peters, R., & Brownson, R. C. (2015). A review of policy dissemination and implementation research funded by the National Institutes of Health, 2007–2014. Implementation Science, 11(1), 1.

Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., & Hoagwood, K. (2015). Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health and Mental Health Services Research, 42(5), 533-544.

Robins, J. M., Hernan, M. A., & Brumback, B. (2000). Marginal structural models and causal inference in epidemiology.

Treiman, D. J. (2014). Quantitative data analysis: Doing social research to test ideas. John Wiley & Sons.

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