Main theme of the study is a survey, was planned to investigate the health care behaviour of the representative sample rural population under Rajshahi Division. Health seeking behaviours of the sampled population have been documented through a Knowledge, Attitude and Practice (KAP) survey and their links or relations were investigated with different factors like knowledge, traditional beliefs (perceived etiologist), economic condition, education, gender and distance with the health facilities etc.
In the research study entitled "Psychosocial Factors related to Health Care Behaviour of the rural people under Rajshahi Division", the survey planned was qualitative and methodology was adopted for qualitative data collection in the survey.
Rationale for intensive study of the population in limited study areas for qualitative data:
An in-depth study of rural population with samples of statistically valid number in limited study areas of Rajshahi Division (in Uttam Union of Rangpur and Chhinai and Pandul Union in Kurigram) was "representative" for whole Rajshahi Division rural people for yielding result. Study of the rural population all over the Rajshahi Division was not required for the qualitative behavioural study "Psychosocial Factors related to Health Care Behaviour of the Rural people under Rajshahi Division".
The rationale is as follows:
For qualitative data of a population with homogenous culture, language, and ethnicity etc. in a very small but populous country, intensive study of the typical population in any place is enough and repeating the procedures in the other places within the same typical population groups allover the Division or country is not absolute as they have almost the similar traditional beliefs, socioeconomic conditions, cultures and practices etc. so, results will be almost similar. This is particularly true for Bangladesh. Mentioned factors are almost similar for whole Bangladesh (homogenous culture), or more truly for whole Rajshahi Division would be almost similar for the following reasons (reasons for cultural homogeneity population):
1. Unlike India, Russia or other very large counties (where number of population groups inhabit in different areas and have individual own cultures), Bangladesh is a small country with tiny area of 147.570 Sq. Km. (56977 Sq. miles) only. Bangladesh has almost homogenous population in respect to religion, linguistics, socioeconomic conditions and traditional beliefs etc. Typical population groups (98% Bengali) in this country are homogenous so as the Rajshahi Division. Rajshahi Division is one of the 6 administrative Divisions and has same characteristic population groups.
"Except for about 400,000 Bihari, the Muslims who immigrated from Bihār, India—and some small groups in the southeast, the Bangladeshis consider themselves homogeneous people. They have an Indo-European heritage, with some Arab, Persian, and Turkish influence. The people of West Bengal in India are of the same ethnic group as the Muslim Bangladeshis, but they are mostly Hindu. To emphasize this difference, most people refer to themselves as Bangladeshi rather than Bengali, the cultural-linguistic term for Bangla speakers. With a population density of 864 persons per square kilometer (1998) (more than 2,239 persons per square mile), Bangladesh is one of the most densely populated countries in the world. Most of the people live in thousands of small villages that blanket the country. Only about 19 percent (1997) live in cities."1
2. Unlike other countries depicted above, there is only one language (Bangla) among all the inhabitants (sometimes with negligible local variations in spoken forms i.e. in he Districts of Chittagong, Sylhet Noakhali etc. but the written script is same everywhere). For Rajshahi Division, the fact is more conspicuous, language is more strongly typical allover its areas regarding the common and only language, Bengali compared to other administrative Divisions of Bangladesh.
Unlike the described countries, Bengali is the only local newspaper language through out the country. Text and other books are published in the only local language (Bengali). Radio and Television media broadcast programs in the Bengali. So, information and knowledge disseminations and all communications are in the same language (Bengali). No ethnic community in this area has any functional written language other than Bengali and their spoken ethnic languages are mostly Bengali in variant forms. Regardless the religious identities, all of them have the same language both spoken as well as written.
"Bangla (also known as Bengali), the official language, is also spoken in India’s West Bengal. Spoken Bangla has several distinct dialects, the most guttural of which are spoken in the northeastern and southeastern districts of Bangladesh. Most Bangla dialects are soft and somewhat musical. People with a university education usually also speak English, but they often incorporate various colloquialisms derived from Bangla. The Bihari speak Urdu, an official language in Pakistan. Small groups along the southeastern border speak in their own languages"2.
3. Religious proportion of the typical population groups is almost same in all parts of Bangladesh and that is more evident in Rajshahi Division, i.e. Muslims, Hindus, Buddhist and Christians.
"Bangladesh has the second largest Muslim population in the world; more than four-fifths of the people are Muslim, mostly Sunni Muslim. Most of the rest of the population is Hindu, although there are also Buddhist and Christian minorities. Education system is same for whole country"3.
"Ethnic divisions - Bengali-98 percent, Other-2 percent
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Languages --
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Bangla (official), Urdu, English
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Religions: -
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Muslim-88 percent, Hindu-10 percent, Other-2 percent"4
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Literacy rates are almost similar in the regions. Similar political trends are observed. Almost all people have similar appearance, height, hue and other anthropological aspects.
As the behavioral aspects like health care behavior etc. depend mainly on the above determinants or factors, intensive study of a population in a single place would satisfactorily yield the expected qualitative data for the total population or the statistically defined "universe".
B. Rationale for the Sample size:
For qualitative data, intense and in-depth study (qualitative survey) of statistically defined "large" Sample size among the population fulfilled the demand of the study (qualitative survey) and give statistical validity. In the study, 348 in-depth interviews were conducted. The number is statistically valid for the followings:
1. When over more than 30 were taken as the samples and selected for in-depth study, it can be called statistically "large" sample5. So, total number of respondents >=300 proposed for the study can be defined as "large" statistical sample for investigation or in-depth study of a population.
2. "If you intend to analyze cross-tabulations of variables, you should keep two points in mind when determining sample size. First, each category of an independent variable included in a cross-tabulation should contain at least 50 cases, since percentages calculated on the basis of fewer than 50 cases tend to be unreliable. The minimum sample size required ensuring at least 50 cases in each category of the independent variables is obtained by dividing 50 by the proportion (Ps) of total cases you expect in the smallest category of variables" 6:
m = 50/ Ps
3. "Qualitative data can be collected through qualitative methods such as unstructured interviews, focus group discussions, direct observations, and content analysis etc.
The chief drawback of structured interviews is that the responses obtained tend to be superficial. An alternative approach to interviewing, which allows greater depth of exploration, is to seek detailed, open-ended responses to questions. Such interviews are usually known as in-depth interviews. In this procedure, instead of reading formal questions from a structured interview schedule, the interviewer has an outline of topics or a set of general questions to serve as a guide to the kind of information required. Details that are not brought out initially are sought through follow up questions, called probes.
The chief drawbacks of unstructured interviews are (1) the responses, being un-standardized, are difficult to quantify; (2) the interviews require highly skilled and experienced interviewers; (3) the analysis is extremely time-consuming. The shortage of qualified interviewers and analysis, and the high cost of conducting and processing such interviews usually mean a small sample size must be used (sometimes as few as 20-30 respondents).
In-depth interviews are generally most useful exploratory studies that seek to clarify important concepts or generate hypothesis prior to developing questionnaires for quantitative surveys. They also are useful for generating supplementary, explanatory data to augment the relatively superficial findings from larger surveys" 7.
References:
1, 2, 3, 4: © & (p) 1995-1999 Microsoft Corporation, sources:
United States Census Bureau, International Programs Center; International database, 1999; (www.census.gov). Population density data are from the individual country statistical bureaus, and the United States Census Bureau, International Programs Center; International database, 1999; (www.census.gov).Ethnic divisions and religion data are largely from the latest Central Intelligence Agency (CIA) World Fact book, as well as various country censuses and reports. Language data are largely from the Ethnologue, Languages of the World, Summer Institute of Linguistics; (www. sil.org).-
5. Dr. Md. Zainul Abedin. A Handbook of Research for the Fellows of M.Phill and Ph.D. Programmes (Dhaka, Chittagong: Book Syndicate, 1996). Pp. 66-67.
6. Andrew A. Fisher, John E. Laing, John E. Stoeckel, John W. Townsend. Handbook for Family Planning Operations Research Design (2nd ed.; New York: The Population Council, 1991), pp.43-44.
7. Andrew A. Fisher, John E. Laing, John E. Stoeckel, John W. Townsend. Handbook for Family Planning Operations Research Design (2nd ed.; New York: The Population Council, 1991), pp.50
C. Sampling technique
1. The study was designed to conduct in the typical villages of rural areas under Rajshahi Division of Bangladesh and all the respondents were selected from there for study as per the subject of the study. For the purpose, a two-fold methodology was adopted to select respondents for the study for in-depth interview: i) from a Union of Rangpur District, about 250 (covering about 5% of the total number of households in the Union) were taken as the respondents. ii) To minimize the possible gaps and variations in responses regarding the social, traditional and cultural beliefs for aboriginal, tribal or ethnic populations (of Rajshahi Division/Bangladesh, approximately 2% population of the total for Bangladesh), a number of in-depth studies (100) were conducted in two pockets in Kurigram District within the geographical area of Rajshahi Division (District of Kurigram, from Pandul and Chhinai Unions of Upazillas of Ulipur and Rajarhat) where significant number of ethnic population is present (Rajbanshi, Khen and Kuch etc.).
Thus in total about 350 (250+100) respondents were selected for interview and 348 of in-depth interviews were conducted with them.
Stratified Random, Systematic Random and Purposive sampling techniques were adopted for drawing the samples for the study as follows:
Among the Districts of Rajshahi Division, 2 Districts were taken (Rangpur and Kurigram)-Random Sampling technique
Among the Thanas of Rangpur District and Kurigram District, 1 Thana was taken from Rangpur District and 2 Thanas from Kurigram Districts (Rangpur Sadar from Rangpur and Ulipur and Rajarhat from Kurigram ) though Random Sampling technique
Among the Unions of Rangpur Sadar Thana, Ulipur Thana and Rjarhat Thana, 1 Union was taken from each Thana (Uttam Union from Rangpur, Pandul Union from Ulipur Thana and Chhinai from Rajarhat Thana) through Random Sampling technique
Among the Mouzas/villages/clusters of Uttam union, 2 Mouza/cluster/village is taken (Golau and Bahadursinha) for Rangpur through Random Sampling technique and for Kurigram from Pandul Union and Chhinai Union through Random Sampling technique among purposively identified ethnic/aborigine population.
In Goalu and Bahadursinha villages of Uttam Union of Rangpur Sadar Thana of Rangpur District, households have been chosen through Systematic Random Sampling technique. In places, Purposive sampling technique also has been used.
2. Effective and proper data management has been ensured throughout. Tabulation plan has been complied with the objectives of the study. Data and information from the in-depth interviews have been gathered and compiled in the reporting forms with proper importance to the salient and atypical findings in respect of the track of the study subject.
Strange and interesting issues, incidences, stories, findings etc. explored and elicited from the in-depth interviews in the process of the study have been noted, preserved, and analyzed for further clarifications in the compiled report. From the in-depth interviews, salient features of the quantitative data and the quantitative accounts of the qualitative data have been presented first in words followed by the corresponding tabular presentations. Interesting findings have been compiled and compared against the prevailing knowledge about the topics and emphases have been given to establish the causes and justifications of the exceptions of the common norms in subsequent chapter.
The information has been compiled in the report in relevance with the in-depth interview end products for the qualitative presentations.
Case studies gave an opportunity to track the study topics in the individual variations and made possible for the researcher to re-examine and re-observe the individual trends, variations and scopes in the topics.
D. Study period
The period of the study was planned for a time relevant to the time length for the M. Phil and Ph.D. course and was planned to conclude at least within August 2003, thus providing enough time for data management and writing the final report within June 2004. A period of three months was required for the preparatory works for the thesis; almost two years were taken for fieldworks which were not done at a time as time was required for different works like primary reporting for seminar for transfer to Ph.D. and suggestions from the supervisor to select valid sample size for the samples etc. Rest of the time was required for data compilation, analysis and report writing.
E. Study area
The study area was the Village of Golau in Mouza Goalu of Union of Uttam in Rangpur Sadar Thana of the District of Rangpur. The particulars of the study area are as follows:
| Locality Name | Population | ||||||||
| District | Thana | Union | Mouza | Village | All | Male | Female | ||
| Rangpur | Rangpur Sadar | Uttam | Golau* | Golau | 192 | 259+16%** | ( ) | 727+ 6% *** | 677+ 6% |
| Kurigram | 1.Ulipur 2.Rajarhat | 1.Pandul 2.Chhinai | Pockets of Ethnic population | - | - | - | 24,637 in Pandul 26,302 in Chhinai | ||
* Golau Mouza contains only one village.
(Census 1991, published by BBS)
**/*** as suggested for 2001 counts by the officials of the Rangpur Sadar Thana Statistical Officials
Goalu and Bahadur Sinha are the typical villages of rural Rajshahi Division of Bangladesh and inhabited by typical rural population. They are nearly within 8 kilometer radius from the Rangpur town. Like other typical Bangladeshi villages, the rural populations of the village enjoy the usual facilities and drawbacks with respect to their health care access. Literacy rate of the village for 7+ years is 23.2 for all, of which males and females accounted for 32.5 and 13.3 respectively.
As mentioned earlier, Chhinai and Pandul are 2 Unions under Rajarhat and Ulipur Upazillas (Thanas) respectively of the District of Kurigram and they are at about 10 and 14 km. from Kurigram District Headquarter respectively.
F. Data collection technique (quantities/qualitative)
Data collection technique was participatory and community based. Two eligible volunteers (Female) were deployed from the same community, trained by the researcher who himself took part in conducting the interviews. They charged only a pocket expense. As from the same community, they could penetrate maximum while interviewing and observing.
A) Surveys have been conducted with the sampled respondents determined through sampling techniques as mentioned in households among family members (adult females and males depending upon the opportunities) i) two villages in Uttam Union of Rangpur Distrcit’s Sadar Upazilla and ii) in the Unions of Pandul and Chhinai of Ulipur and Rajarhat Upazillas of Kurigram District through prior-visit by a team headed by the researcher to make a list of addresses and names all the households and family adults/heads
B) In order to collect data to meet the study objectives and queries, respondents were interviewed in-depth with a semi-structured questionnaire.
A total of 256 in-depth interviews have been conducted in the village of Goalu and Bhahadr Sinha in the Uttam Union of Rangpur Sadar Upazilla. A total of 106 in-depth interviews were conducted in the villages under Pandul and Chhinai Unions of Ulipur and Rajarhat Upazillas respectively of the District of Kurigram.
C) Direct observation by the data collection/investigation team whenever/wherever required.
G. Data collection instruments
Semi-structured in-depth questionnaire (each questionnaire with 397 fields and of both single and multiple responses))
Direct observation (whenever and wherever possible)
H. Data collection plan/ Work Plan (field work):
Data Collection
Data collection constituted a most important task of the proposed study. However, obtaining accurate and reliable data depends on, among others, realistic planning, data collection procedure and constant monitoring, therefore elaborate and proper arrangement was done for the purpose.
The whole operation was conceived to entail three steps: planning, procedures and monitoring (or quality control). These three steps had been planned in conjunction with each other so that the whole operation was carried out smoothly and timely.
Planning for Data Collection
The planning of field data collection is outlined below:
Our previous experience on field operations called for a well-thought, realistic and feasible work plan. It was essential for ensuring timely completion of fieldwork and to obtain high quality data. In this regard, therefore, the first priority had been to prepare a work plan before the actual fieldwork was started, and it was done accordingly.
Work Plan for Data Collection:
The researcher collected relevant reports and research findings for literature review with the help of the respected supervisor Professor in the Department of Psychology, Rajshahi University mostly using the latest Internet technology from the websites. He reviewed the collected literatures and prepared a synopsis of those reports. For the purpose of collection of data from the respondents, a team of 3 was deployed for conducting in-depth interviews. As the best data could be obtained through a participatory and community based data collection procedure, i.e to involve community members in data collection and as the in-depth interviews were lengthy and time consuming process; hence more manpower was required in excess to the researcher alone, able volunteers were collected from the indigenous community to collect conduct the interviews and for observations. They were duly trained by the researcher and field tests were conducted. As male investigators seemed to be less welcomed in the extremely rural households for interview, female data collectors were deployed by the researcher.
The team was formed as under:
| Designation | Number |
| Researcher | 1 |
| Field Assistants (female) | 2 |
| Total | 3 |
The researcher himself conducted interviews as well as supervised the Field Assistants’ interviews for ensuring the quality of the fieldwork.
A total of 248 sampled respondents from village of Goalu and Bahadur Sinha were interviewed for the Rangpur District study area. Again about 100 respondents were interviewed in Kurigram study areas of the Pandul and Chhinai Unions in the ethnic pockets. Special efforts were taken to maintain gender equity among the interviewed respondents by trying equal percentage from both the sexes (50% female and 50% male)
Systematic Random Sampling technique was applied to select respondents in the Rangpur District segment, whereas in Kurigram District segment, ethnic pockets were identified purposively and then Systematic Random Sampling technique was used to draw respondent samples.
I. Quality control of the data
Researcher’s past experiences as a investigators for a number of research works greatly helped him in the data collection procedures.
The questionnaires were printed (please see the appendix). Monitoring of listing/data collection work has been ensured in different ways. The researcher undertook some specific steps for monitoring the data collection and listing works of interviewers. The researcher reviewed daily activities of the team and discussing problems with the other team members at the end of each day and used to edit all the listing formats/schedules at the field camp as well as check for inconsistencies and incompleteness. For ensuring quality of data, the researcher checked the consistencies of the completed schedules, re-visited a few of the already interviewed cases to make sure whether they were properly interviewed and solved/clarified any new problem that arose in the field. Furthermore, the researcher took assistance from one of his friend experienced in quality control of the data who also contributed as quality controller for the interview.
Also the following mechanism was exercised for quality control of the data collected:
- 100% questionnaires were scrutiny checked in the field by the researcher
- 20% questionnaires were back checked by the researcher
- 20% Interview were cross accompany called by the team members
- 20% questionnaires were scrutiny checked in the field by the researcher
- 10% questionnaires were back checked in the field by the researcher
- 10% Interview were accompany called by the researcher
- 100% questions in a questionnaire were checked at the time of back check.
J. Confidentiality of the data
As the study design was an "ethical study design", the confidentiality was kept as followings:
- Data collected from the respondents were kept fully confidential
- Unless felt absolutely essential for the interest of the study, sensitive issue was avoided in the interview.
- For data management including the coding, editing, computerization and analysis, always code numbers were used instead of the names of the respondents.
- No other persons/parties have access to the information collected except the supervisor and the Rajshahi University authority.
- Interviews were always conducted with the willingness and informed consent of the respondents.
K. Data management (tabulation-coding/editing and analysis plan)
Data management
Data management consisted of registration of schedules, editing, coding, and computerization, preparation of dummy tables (tabulation plan), analysis and matching of data.
The researcher undertook the responsibilities of the technical matters of editing, coding and computerization.
Computerization
The process of computerization have been carried out through the following stages
i) Designing of databases and program in Statistical Package in Social Science (SPSS/PC 11.0)
ii) Data entry
iii) Data cleaning (by validity check, consistency check, etc.)
iv) Report/table/information generation and printing
v) Taking backup for further/future analysis.
Total data management including the compilation of computer program, data editing, data entry and analysis has been performed by the researcher himself.
Survey data were analyzed according to the purpose of the specific objectives and research questions. Simple tables were preferred. Frequency tables were made for all the relevant variables and cross-tabulations were also prepared for necessary highlighting of any existing correlation between two sets of variables, such as gender and knowledge etc.
Also attempt was taken to present key findings through bar, line or pie charts wherever comparative analysis was felt necessary.
Report has been prepared with frequency and cross-tables, followed by write up. In suitable cases, multi-variate analysis has been performed.
Statistical tests (t-test, chi-square) were used for assessing the significance of difference between two sets of data for drawing inference whenever felt necessary.
The report contained an abstract with a set of recommendations.
L. Dissemination of the research finding (Dissemination strategy and report writing)
Dissemination strategy:
- Emphases were given to the objective related issues for making the information useful to the potential users (i.e. policy makers etc.) so that they could use those for the betterment of the health facilities of target population (the rural people).
- Emphases were given to highlight the most significant but achievable problems unveiled by the research.
- Both printed hard copy and soft copy in the CD were submitted for the convenience of the supervisor Professor, the Department and for the University of Rajshahi.
- Except the University of Rajshahi, Department of Psychology, the report or any part of the data was not disseminated to anybody.
- Researcher hopes that the report and the data will be disseminated through multiple approaches using a variety of channels to maximum number of audience/ readers after its final acceptance by the University of Rajshahi authority for the betterment of human beings and for the improvement of the knowledge of the mankind.
M. Writing of report
As per the general rule, primarily, the whereabouts of the study including findings was presented through a report as per the given outline by the supervisor professor of the study that suits with the requirement of the Department of Psychology, University of Rajshahi protocol. As the present report is an academic one, special thrust were put on the methodology and other academic issues as prescribed by the Department of Psychology, University of Rajshahi.
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